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The US Medical Liability System: Evidence for Legislative Reform

¹ Tacoma Family Medicine Residency Program, Department of Family Medicine, University of Washington, Seattle, Wash
² Department of Pediatrics, New York University School of Medicine, NYU Center for Child Health Research, New York, NY
³ Robert Graham Center, Washington, DC
⁴ American Society of Anesthesiologists, Washington, DC

CORRESPONDING AUTHOR: Janelle Guirguis-Blake, MD, Tacoma Family Medicine Residency Program, 521 Martin Luther King Jr Way, Tacoma, WA 98405, jguirgui{at}u.washington.edu

BACKGROUND Despite state and federal efforts to implement medical malpractice reform, there is limited evidence on which to base policy decisions. The National Practitioner Data Bank (NPDB) offers an opportunity to evaluate the effects of previous malpractice tort reforms on malpractice payments and premiums.

METHODS For every state and the District of Columbia, we calculated the number of malpractice payments, total amount paid, and average payment from NPDB data reported from 1999 through 2001. We analyzed 44,913 claims using logistic regression to study associations between payments, physician premiums, and 10 state statutory tort reforms.

RESULTS Wide variations exist in malpractice payments among states. The reforms most associated with lower payments and premiums were total and noneconomic damage caps. Mean payments were 26% lower in states with total damage caps ($196,495.34 vs $265,554.50, P = .001). Mean payments were 22% less in states with noneconomic damage caps ($219,225.98 vs $279,849.86, P = .010). Total damage caps were associated with lower mean annual premiums, especially for obstetricians ($22,371.57 vs $42,728.68, P <.001). Hard noneconomic damage caps were associated with premium reductions for obstetricians (30,283.75 vs 45,740.88; P = .039).

CONCLUSIONS Significant reductions in malpractice payments could be realized if total or noneconomic damage caps were operating nationally. Hard noneconomic damage and total damage caps could yield lower premiums. If tied to a comprehensive plan for reform, the money saved could be diverted to implement alternative approaches to patient compensation or be used to achieve other systems reform benefiting patients, employers, physicians, and hospitals.

Key Words: Liability, legal • malpractice • legal liability, premiums • cost control • insurance, liability

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