Factors associated with medical malpractice: results from a pilot study (original) (raw)
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The Medical Malpractice Crisis: A Comparative Empirical Perspective
Law and Contemporary Problems, 1991
INTRODUCTION The 1980's have seen a crisis in medical malpractice liability in the United States, in Canada, and in the United Kingdom.' This paper presents the results of a detailed empirical study of the Canadian malpractice experience. Our analysis has two important comparative reference points: First, it compares malpractice trends in Canada with trends in the United States, the United Kingdom, and Australia. Second, the paper compares the malpractice liability experience in Canada of physicians with the malpractice experience of dentists, engineers, lawyers, and chartered accountants, and with trends in personal injury claims for automobile accidents. This comparative approach allows us to suggest factors that have contributed to growth in claims frequency and severity in all three countries, and to reject some popular conceptions about the origins of the crisis. We analyze three sets of factors that are often associated with rising trends in frequency and severity of malpractice claims: changes in the professional environment, changes in the social environment, and changes in the legal environment. On the basis of our results, we believe that the first two sets of factors have attracted insufficient attention relative to the third in current research and policy analysis.
Medical malpractice: a time for more talk and less rhetoric
Specialty law digest. Health care, 1987
The author would like to thank Professor Laurel S. Terry for her valuable assistance in editing this Article, and E. Karen Hanson, his research assistant, for her research and comments. 1. AMERCAN MEiCAL ASSOC[ATION SpEcuL TASK FORCE ON PROFmESIONAL LuABmr AND INSURANCE, PROFESSIONAL LIABILrry IN THE '80s, REPORTS 1, 2 AND 3 (1984) [hereinafter cited as AMA RaEor]. 2. AMA REPORT 1, supra note 1, at 3. 3. Id. at 8-11. 4. Id. at 11. 5. ASSOCIATION Op TRIAL LAwYERs OF AMERicA, THE AMERcAN MEDICAL ASSOCIATION IS WRONG-THERE iS No MEDICAL MALPRACTICE INSURANCE CRsSIS 1, 8 (1985) [hereinafter cited as ATLA REPORT). 6. Id. at 11. 7. The terminology these two groups employ demonstrates the gap between them. The AMA prefers 'professional liability' to ATLA's 'medical malpractice.' See generally AMA REPowr, supra note 1. 8. The words are those of Prof. Richard A. Epstein, writing in 1976. They are every bit
Medical Malpractice: Theory, Evidence, and Public Policy
Harvard Law Review, 1986
Every few years, a new round of malpractice insurance premium increases occurs, and there are renewed pressures on public officials to "do something about the malpractice insurance problem." Although there is no consensus about the causes of the problem, views about the causes are strongly held. The views often depend on where the observer stands, and there is a regrettable tendency to identify a single culprit-"greedy lawyers" paid on a contingent fee, "careless doctors," "litigious patients," or "greedy insurers." Unfortunately, little is really known about the causes of the malpractice insurance crises and about the efficacy of alternative policy options. In part, lack of knowledge is the result of inadequate data-but there are also few serious theoretical studies on malpractice issues. Research by Patricia Danzon, sometimes with coauthors, is an exception to this generalization about lack of useful studies. Her theoretical, empirical, and policy analysis in the malpractice area is imaginative and careful, making good use of best-practice economic techniques. Much of her work has been technical and is inaccessible to many noneconomists. Although Danzon's most recent book does not break much new ground, it is a welcome summary of much of her past research on malpractice, written and organized in a form that will be accessible to readers outside her field. Danzon's theoretical analysis, both positive and normative, is based on the economist's neoclassical model. Each party in the transaction maximizes his or her well-being subject to constraints. Information is often difficult for patients to obtain. Because of asymmetric information, the doctor may be well positioned to take advantage of the patient; making the doctor liable for compensation in cases of injury due to negligence is one mechanism, albeit an imperfect one, for protecting the patient against abuse. It is also possible for doctors to be too cautious, that is, to provide too much preventive care. The same neoclassical paradigm states that an efficient outcome is one that results in the sum of four types of costs being minimized-insured losses, uninsured losses, prevention cost, and overhead (cost of litigation, insurance overhead). Thus, a dollar of prevention is only
Medical malpractice : the extent, consequences and causes of the problem
2015
In recent years South Africa has seen a sharp increase in medical malpractice litigation. A number of factors have contributed to this increase and doctors as well as other healthcare providers have been profoundly affected thereby. It seems as though the proliferation of claims for the adverse consequences of medical intervention, which has been a rising global trend, has eventually reached our shores. Not only has there been an increase in the frequency of claims, but the amounts that have been awarded have also risen significantly.
Toward a Theory of Medical Malpractice
This Article introduces a novel methodology for understanding medical malpractice law and guiding its reform. I divide the legal rules that apply in medical malpractice cases into four basic categories: "entry rules," "exit rules," "treatment rules," and "setup rules." The first two of these categories of rules intersect with the other two categories. Our medical malpractice system thus consists of treatment-related and setup-related entry and exit rules.
The Medical Malpractice Explosion: An Empirical Assessment of Trends, Determinants, and Impacts
Britain and Australia. In all cases, frequency and severity rates appear to have risen quite dramatically over the past decade and a half. The article proceeds to explore various hypotheses that might explain these trends. While empirical analysis does not yield firm conclusions, the fact that so many jurisdictions have experienced a somewhat similar phenomenon makes it doubtful that the primary cause ofthe increase is likely to be idiosyncratic features of one particular country's tort system. Instead, the authors conjecture that various changes in medical technology may well be a more important explanatory factor. The article goes on to examine the empirical evidence on the impact ofexpanding liability on physician behaviour and in turn whether observed changes in physician behaviour have caused reductions in the medical injury rate. While it seems clear from the evidence that the liability system has 'induced various changes in physician behaviour, it is much less clear whether these changes have reduced the medical injury rate or are otherwise socially desirable.]
JAMA: The Journal of the American Medical Association, 1979
In line with the overall tort system, the purpose of medical malpractice liability is to compensate patients who suffer an injury as a result of medical negligence. However, an effective tort system must balance appropriate compensation of victims with the need to prevent an unintended disincentive toward reasonable behavior which can have the effect of reducing the availability of quality care. BACKGROUND Patients are entitled to compensation from providers who fail to provide a reasonable standard of care, and as a result, cause a patient to suffer an injury. This is a basic tenant of tort law, which is a cornerstone of the American legal system. The purpose of the American legal system, however, is to appropriately compensate victims while protecting and encouraging desirable acts that produce goods and services demanded by others. Data suggest the medical malpractice system falls short of capturing legitimate cases and delivering compensation to victims. A seminal study conducted in 1990 found that fewer than two percent of patients identified as victims of medical malpractice filed claims. Six percent of injured patients who had not been victims of negligence also filed claims. In the end, only one percent of victims of medical malpractice receive compensation. 1 Medical malpractice litigation is also expensive. Since 1950, tort cost growth has exceeded that of gross domestic product by an average of roughly two percentage points and the escalation of medical malpractice litigation costs has outpaced the increase in overall U.S. tort costs. 2 Research shows the medical malpractice system induces undesirable practice patterns that results in increased cost and reduced access to care. Liability concerns have, and will continue to have, negative impact on access to care. For example, in Florida 83 percent of radiologists do not read mammograms and the top reason (24.6 percent) for not doing so was liability. Of the respondents who provide obstetric care, only 40 percent indicated that they deliver babies. Of the same population, 13 percent plan to discontinue obstetric care in the next two years, more than 90 percent of whom are under 65. Overall, the Florida Department of Health reports that 13 percent of physicians in the state planned to retire or reduce the scope of their practice in the next five years and the primary reason given (by 27.4 percent of the respondents) was liability. 3 To protect themselves against potential liability, physicians commonly practice defensive medicineordering more tests and procedures than necessary to protect themselves from