THE INFLUENCE OF OBSTETRIC NO-FAULT COMPENSATION ON OBSTETRICIANS PRACTICE PATTERNS

OBJECTIVES: The objectives were to determine level of satisfaction amo ng obstetricians with the no-fault insurance programs in Florida and V irginia and to study any reported practice patterns attributable to im plementation of no-fault compensation. STUDY DESIGN: Structured survey s were conducted with 119 obstetricians in Florida and Virginia. RESUL TS: More than 90% of obstetricians were enrolled in no-fault insurance programs, but only 13% reported having had a patient compensated by a no-fault program. Only 14% knew of a colleague with a patient who had been compensated. Despite no-fault compensation, threat of lawsuits w as a factor in 39% of cases of physicians who quit practicing obstetri cs. The no-fault programs did not cause obstetricians to report increa ses in their obstetric caseloads or in their fraction of patients at h igh risk. Overall, obstetricians were far more satisfied with the no-f ault system than with the tort system. Still, more than half of the re spondents expressed dissatisfaction with premiums assessed by no-fault insurance. CONCLUSION: Obstetricians who knew about the no-fault prog rams were generally satisfied with their performance. However, the no- fault programs have not built a constituency with physicians, and the programs are relatively small in their scope of coverage. No-fault com pensation thus has had minor impact on reported obstetric practice. To be effective in improving patient access, no-fault compensation must be broader in scope.