Physicians' Fears Of Malpractice Lawsuits Are Not Assuaged By Tort Reforms

Center for Studying Health System Change, Washington, DC, USA.
Health Affairs (Impact Factor: 4.97). 09/2010; 29(9):1585-92. DOI: 10.1377/hlthaff.2010.0135
Source: PubMed


Physicians contend that the threat of malpractice lawsuits forces them to practice defensive medicine, which in turn raises the cost of health care. This argument underlies efforts to change malpractice laws through legislative tort reform. We evaluated physicians' perceptions about malpractice claims in states where more objective indicators of malpractice risk, such as malpractice premiums, varied considerably. We found high levels of malpractice concern among both generalists and specialists in states where objective measures of malpractice risk were low. We also found relatively modest differences in physicians' concerns across states with and without common tort reforms. These results suggest that many policies aimed at controlling malpractice costs may have a limited effect on physicians' malpractice concerns.

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Available from: Emily R Carrier, Feb 25, 2014
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    • "If fear of malpractice is a driver of defensive practices, then such fear should be assessed. Prior studies have shown that tort reform fails to decrease fear of malpractice among providers [6]. In addition, providers in South Carolina, Texas, and Georgia may not have felt that they were protected by the new law. "

    Full-text · Article · Apr 2015 · The American journal of emergency medicine
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    • "According to several studies, the risk of malpractice litigation leads to the practice of defensive medicine [3,4,10-12]. Worries about the financial burden and high cost of liability insurance premiums also seem to be positively linked to practicing defensive medicine [3]. "
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    ABSTRACT: Practicing safe behavior regarding patients is an intrinsic part of a physician's ethical and professional standards. Despite this, physicians practice behaviors that run counter to patient safety, including practicing defensive medicine, failing to report incidents, and hesitating to disclose incidents to patients. Physicians' risk of malpractice litigation seems to be a relevant factor affecting these behaviors. The objective of this study was to identify conditions that influence the relationship between malpractice litigation risk and physicians' behaviors. We carried out an exploratory field study, consisting of 22 in-depth interviews with stakeholders in the malpractice litigation process: five physicians, two hospital board members, five patient safety staff members from hospitals, three representatives from governmental healthcare bodies, three healthcare law specialists, two managing directors from insurance companies, one representative from a patient organization, and one representative from a physician organization. We analyzed the comments of the participants to find conditions that influence the relationship by developing codes and themes using a grounded approach. We identified four factors that could affect the relationship between malpractice litigation risk and physicians' behaviors that run counter to patient safety: complexity of care, discussing incidents with colleagues, personalized responsibility, and hospitals' response to physicians following incidents. In complex care settings procedures should be put in place for how incidents will be discussed, reported and disclosed. The lack of such procedures can lead to the shift and off-loading of responsibilities, and the failure to report and disclose incidents. Hospital managers and healthcare professionals should take these implications of complexity into account, to create a supportive and blame-free environment. Physicians need to know that they can rely on the hospital management after reporting an incident. To create realistic care expectations, patients and the general public also need to be better informed about the complexity and risks of providing health care.
    Full-text · Article · Jan 2014 · BMC Health Services Research
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    • "Some have speculated that this pervasive fear may stem from physicians lacking access to accurate and objective data about their risk of being sued, and how this risk differs from peers in other specialties [12]. Another speculation is that physicians are subject to the well-documented human tendency to overestimate the risk of rare events [12]. Do physicians in high-liability risk specialties really have that vastly different of experience with the MPL system than their low-liability risk peers? "
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    ABSTRACT: "High-liability risk specialties" tend to be the focus of medical malpractice system research and debate, but concerns and fears are not limited to this group. The objective of this study was to examine whether "high-liability risk" medical specialties have a different experience with the malpractice system than "low-liability risk" specialties. We reviewed claims data from the Physician Insurers Association of America's Data Sharing Project between January 1985 and December 2008. We used linear regression, controlling for year, to determine how liability risk affected outcomes of interest. In high-liability risk specialties, 33% of claims result in indemnity payments compared to 28% for low-liability risk specialties (p < 0.001). The average indemnity payment for high-liability risk specialties was $315,314 compared to $267,146 for low-liability risk specialties (p = 0.25). Although only a small percentage of claims go to trial, low-liability risk specialties have significantly more claims that are ultimately dropped, withdrawn or dismissed, while high-liability risk specialties have significantly more claims that result in plaintiff settlement (p < 0.001). Malpractice risk exists for all specialties. Variability in indemnity costs are found in both high- and low-liability risk specialties. Differences in the reasons for which claims are initiated for high- and low-liability risk specialties likely necessitate different risk management solutions.
    Full-text · Article · Nov 2013 · BMC Health Services Research
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