THE INCENTIVE EFFECTS OF MALPRACTICE LIABILITY RULES ON DENTAL PRACTICE BEHAVIOR

OBJECTIVES. The impact of malpractice liability rules on dental practi ce behavior was estimated using data from a 1992 nationwide survey of US general dentists. The study examined the premise that malpractice l iability rules can affect quality of care and related resource allocat ion decisions by dentists, but that market features, such as relativel y complete and ''non-experience rated'' malpractice insurance, are lik ely to weaken the incentive effects of malpractice liability. METHODS. General practice dentists in the United States were selected randomly , and 3,048 dentists were studied by mail survey. Secondary data on co unty-level characteristics were used to measure market area factors. Q uality-of-care measures were derived from the survey about self-report ed practice policies and behavior and participation in continuing educ ation. Legal measures were assembled from state statutes and appellate court decisions. Ordinary least squares was used to assess the relati on between legal variables and dependent variables of quality of care, continuing education, and the rate of dental output. RESULTS. Hypothe ses about the effects of malpractice law on practice quality and parti cipation in continuing education were not supported. The relation betw een pro-dentist law and output was supported. A number of legal provis ions related to differences in practice behavior, but often in ways op posite to the expected direction. CONCLUSIONS. The direct effects of s pecific malpractice liability rules on dentist practice behavior often failed to point in the direction predicted by theory and were economi cally insignificant. It is possible that relatively complete malpracti ce liability insurance, coupled with ''noisy'' liability rules, substa ntially dulls the deterrent effect of malpractice liability. Other for ces, such as the dentist's past malpractice claims experience, were mo re significant in shaping dentist behavior.