Development of a composite measure of state-level malpractice environment

Jeanette W. Chung, Min Woong Sohn, Ryan P. Merkow, Elissa H. Oh, Christina Minami, Bernard S. Black, Karl Y. Bilimoria*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective To develop a composite measure of state-level malpractice environment. Data Sources Public use data from the National Practitioner Data Bank, Medical Liability Monitor, the National Conference of State Legislatures, and the American Bar Association. Study Design Principal component analysis of state-level indicators (paid claims rate, malpractice premiums, lawyers per capita, average award size, and malpractice laws), with indirect validation of the composite using receiver-operating characteristic curves to determine how accurately the composite could identify states with high-tort activity and costs. Principal Findings A single composite accounted for over 73 percent of total variance in the seven indicators and demonstrated reasonable criterion validity. Conclusion An empirical composite measure of state-level malpractice risk may offer advantages over single indicators in measuring overall risk and may facilitate cross-state comparisons of malpractice environments.

Original languageEnglish (US)
Pages (from-to)751-766
Number of pages16
JournalHealth Services Research
Issue number2
StatePublished - Apr 2014


  • State health policies
  • health policy
  • observational data

ASJC Scopus subject areas

  • Health Policy


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