Academic Appointments

2023-24 Courses

All Publications

  • Effects of the medical liability system in Australia, the UK, and the USA LANCET Kessler, D. P., Summerton, N., Graham, J. R. 2006; 368 (9531): 240-246


    Although the direct costs of the medical liability system account for a small fraction of total health spending, the system's indirect effects on cost and quality of care can be much more important. Here, we summarise findings of existing research on the effects of the medical liability systems of Australia, the UK, and the USA. We find systematic evidence of defensive medicine--medical practice based on fear of legal liability rather than on patients' best interests. We conclude with discussion of four avenues for reform of traditional tort compensation for medical injury and several suggestions for future research.

    View details for Web of Science ID 000239095000036

    View details for PubMedID 16844494

  • Making markets work: Five steps to a better health care system HEALTH AFFAIRS Cogan, J. F., Hubbard, R. G., Kessler, D. P. 2005; 24 (6): 1447-1457


    Although the U.S. health care system has made remarkable advancements, it is costly and wasteful, and it leaves many people without appropriate care. The challenge for public policy is to enable consumers and taxpayers to obtain good value for their health care dollars. Achieving this objective stands the greatest chance of success if health care markets function well. To make markets work, we recommend changes in five areas of public policy: tax reform, insurance reform, improved provision of information, enhanced competition, and malpractice reform. Our policy reforms will improve the productivity of the health care system, make insurance more affordable, reduce rates of uninsurance, and increase tax fairness and progressivity.

    View details for DOI 10.1377/hlthaff.24.6.1447

    View details for Web of Science ID 000235033500008

    View details for PubMedID 16284016

  • Impact of malpractice reforms on the supply of physician services JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Kessler, D. P., Sage, W. M., Becker, D. J. 2005; 293 (21): 2618-2625


    Proponents of restrictions on malpractice lawsuits claim that tort reform will improve access to medical care.To estimate the effects of changes in state malpractice law on the supply of physicians.Differences-in-differences regression analysis that matched data on the number of physicians in each state between 1985 and 2001 from the American Medical Association's Physician Masterfile with data on state tort laws and state demographic, political, population, and health care market characteristics.Effect on physician supply of "direct" malpractice reforms that reduce the size of awards (eg, caps on damages).The adoption of "direct" malpractice reforms led to greater growth in the overall supply of physicians. Three years after adoption, direct reforms increased physician supply by 3.3%, controlling for fixed differences across states, population, states' health care market and political characteristics, and other differences in malpractice law. Direct reforms had a larger effect on the supply of nongroup vs group physicians, on the supply of most (but not all) specialties with high malpractice insurance premiums, on states with high levels of managed care, and on supply through retirements and entries than through the propensity of physicians to move between states. Direct reforms had similar effects on less experienced and more experienced physicians.Tort reform increased physician supply. Further research is needed to determine whether reform-induced increases in physician supply benefited patients.

    View details for Web of Science ID 000229443400020

    View details for PubMedID 15928283

  • Advance directives and medical treatment at the end of life JOURNAL OF HEALTH ECONOMICS Kessler, D. P., McClellan, M. B. 2004; 23 (1): 111-127


    To assess the consequences of advance medical directives--which explicitly specify a patient's preferences for one or more specific types of medical treatment in the event of a loss of competence--we analyze the medical care of elderly Medicare beneficiaries who died between 1985 and 1995. We compare the care of patients from states that adopted laws enhancing incentives for compliance with advance directives and laws requiring the appointment of a health care surrogate in the absence of an advance directive to the care of patients from states that did not. We report three key findings. First, laws enhancing incentives for compliance significantly reduce the probability of dying in an acute care hospital. Second, laws requiring the appointment of a surrogate significantly increase the probability of receiving acute care in the last month of life, but decrease the probability of receiving nonacute care. Third, neither type of law leads to any savings in medical expenditures.

    View details for DOI 10.1016/j.jhealeco.2003.08.006

    View details for Web of Science ID 000189210600005

    View details for PubMedID 15154690

  • How liability law affects medical productivity JOURNAL OF HEALTH ECONOMICS Kessler, D. P., McClellan, M. B. 2002; 21 (6): 931-955


    Previous research suggests that "direct" reforms to the liability system-reforms designed to reduce the level of compensation to potential claimants-reduce medical expenditures without important consequences for patient health outcomes. We extend this research by identifying the mechanisms through which reforms affect the behavior of health care providers. Although we find that direct reforms improve medical productivity primarily by reducing malpractice claims rates and compensation conditional on a claim, our results suggest that other policies that reduce the time spent and the amount of conflict involved in defending against a claim can also reduce defensive practices substantially. In addition, we find that "malpractice pressure" has a more significant impact on diagnostic rather than therapeutic treatment decisions. Our results provide an empirical foundation for simulating the effects of untried malpractice reforms on health care expenditures and outcomes, based on their predicted effects on the malpractice pressure facing medical providers.

    View details for Web of Science ID 000179293500001

    View details for PubMedID 12475119

  • The effects of hospital ownership on medical productivity Conference on the Industrial-Organization-of-Medical-Care Kessler, D. P., McClellan, M. B. BLACKWELL PUBLISHING. 2002: 488–506


    To develop new evidence on how hospital ownership and other aspects of hospital market composition affect health care productivity, we analyze longitudinal data on the medical expenditures and health outcomes of the vast majority of nonrural elderly Medicare beneficiaries hospitalized for new heart attacks over the period 1985-1996. We find that the effects of ownership status are quantitatively important. Areas with a presence of for-profit hospitals have approximately 2.4% lower levels of hospital expenditures, but virtually the same patient health outcomes. We conclude that for-profit hospitals have important spillover benefits for medical productivity.

    View details for Web of Science ID 000179256800008

    View details for PubMedID 12585304