The 1980's have witnessed a dramatic increase in cesarean section rates and medical malpractice premiums for obstetricians and family practitioners. Although some commentators attribute part of the higher cesarean rates to defensive medicine, no study has attempted to test the purported association using large data sets and controlling for risk factors. The Medical Practice Study Group has collected computerized hospital discharge data for one-quarter of the hospitalizations in New York State in 1984 and virtually complete malpractice claims data on actions against hospitals and physicians. In addition, it has reviewed a probability sample of 31,000 records from 51 hospitals to obtain information on the incidence of adverse events discovered in New York State hospitals in 1984. Using these data, the Group proposes to test the hypothesis that a higher risk of litigation faced by providers of obstetrical care is associated with higher cesarean rates. The proposed analysis will control for known clinical risk factors and adjust for other possible explanations for variations in cesarean rates.
