The Article in Brief

The US Medical Liability System: Evidence for Legislative Reform

Janelle M. Guirguis-Blake, MD, and colleagues

Background It is widely believed that increases in malpractice insurance premiums, high awards in malpractice cases, and doctors' fear of lawsuits have contributed to rising US health care costs. This study analyzes all payments made to settle malpractice claims or satisfy malpractice judgments on behalf of doctors in the United States from 1999 through 2001.

What This Study Found There are wide variations among states in malpractice payments. Total payments for the 3-year period ranged from $15.4 million in Wyoming to more than $1.8 billion in New York. Caps on total payments and on payments for noneconomic damages are associated with lower payments. Total caps on payments are also associated with lower insurance premiums.

Implications

• The wide state-to-state variations in malpractice payments suggest that compensation for injured patients is unequal.
• Significant reductions in malpractice payments could be achieved if caps on total malpractice payments or caps on noneconomic damages are in effect nationally in the United States. Hard caps on noneconomic damages and total damages might contribute to lower insurance premiums. If tied to a comprehensive plan for reform, these reductions could be used to benefit patients, employers, physicians, and hospitals.
• The authors suggest that a broader solution to the inequities in the current liability system requires strategies aimed at improving the quality and safety of the health care system.