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This Health Policy Report describes the malpractice system in the United States, examines its shortcomings, and analyzes the forces that have led to past and current malpractice crises. The authors review options for reform of the U.S. malpractice system. Conventional tort reforms include caps on damages, limits on attorneys' fees, and shortening of the statute of limitations. Experts have also proposed major system reforms, such as enterprise liability or administrative compensation. Options for reform of the American malpractice system. Few issues in health care spark as much ire and angst as medical-malpractice litigation. Physicians revile malpractice claims as random events that visit unwarranted expense and emotional pain on competent, hardworking practitioners. Commentators lament the “lawsuit lottery,” which provides windfalls for some patients, but no compensation for the vast majority of patients injured by medical care. 1 , 2 Within the health care industry, there is a nearly universal belief that malpractice litigation has long since surpassed sensible levels and that major tort reform is overdue. Yet the drive to litigate continues. Plaintiffs' attorneys and some consumer groups interpret providers' grievances as . . .

Although the direct costs of the medical liability system account for a small fraction of total health spending, the system's indirect effects on cost and quality of care can be much more important. Here, we summarise findings of existing research on the effects of the medical liability systems of Australia, the UK, and the USA. We find systematic evidence of defensive medicine—medical practice based on fear of legal liability rather than on patients' best interests. We conclude with discussion of four avenues for reform of traditional tort compensation for medical injury and several suggestions for future research.

A major medical malpractice crisis is unfolding in the United States today. The American Medical Association has identified 18 states in which physicians and institutional health care providers are having grave difficulties obtaining affordable professional liability insurance. In the past two years, insurance premiums in these states have increased dramatically for physicians in high-risk specialties such as obstetrics, emergency medicine, general surgery, surgical subspecialties, and radiology (see Figure). Another 26 states are on “orange alert,” with indicators suggesting a serious and worsening situation. Physicians in West Virginia, New Jersey, Florida, Pennsylvania, Mississippi, Illinois, Texas, and Missouri have held or threatened . . .

\"In 2014, we entered into a deficit position, and are now working to get back to full funding over a five-year period,\" [Hartley Stern] said. The province's pecuniary position, he noted, is the result of two factors: rising protection costs and a previous Ontario government decision to divert more than$250 million earmarked for CMPA to offset another funding obligation. The Quebec region has experienced relatively stable costs and as a result no fee increase is slated for 2016. The aggregate fee requirement is $ 81 million, roughly the same as it has been for the last two years. \"The trend shows a fairly modest increase and we have chosen to maintain the cost per member,\" Stern said. Stern reassured members that under the existing system there has been an equal paying field. \"No region has been disadvantaged,\" he stressed. \"There has been no subsidization of one region for another.\"

Using nationally representative data from the United States, this paper analyzed the effect of a state's medical malpractice environment on referral visits received by specialist physicians. The analytic sample included 12,839 ambulatory visits to specialist care doctors in office-based settings in the United States during 2003–2007. Whether the patient was referred for the visit was examined for its association with the state's malpractice environment, assessed by the frequency and severity of paid medical malpractice claims, medical malpractice insurance premiums and an indicator for whether the state had a cap on non-economic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on non-economic damages of $250,000 were significantly associated with lower likelihood of a specialist receiving referrals, suggesting a potential impact of a state's medical malpractice environment on physicians’ referral behavior.

Massachusetts has the fourth-highest median malpractice settlement payments for all states. The American Medical Association (AMA) declares it a crisis state. As a test case, we analyzed its premiums from 1975 to 2005. In 2005 mean premiums were $17,810 for the coverage level and policy type most frequently purchased. Most physicians paid lower inflation-adjusted premiums in 2005 than in 1990. Mean premiums increased in only three specialties comprising 4 percent of physicians: obstetrics, neurology, and orthopedists-spinal surgery. However, because of discounts and surcharges, in 2005 premiums within the three highest-risk specialties varied nearly threefold, and nearly one-third paid less than in 1990.Massachusetts has the fourth-highest median malpractice settlement payments for all states. The American Medical Association (AMA) declares it a crisis state. As a test case, we analyzed its premiums from 1975 to 2005. In 2005 mean premiums were $17,810 for the coverage level and policy type most frequently purchased. Most physicians paid lower inflation-adjusted premiums in 2005 than in 1990. Mean premiums increased in only three specialties comprising 4 percent of physicians: obstetrics, neurology, and orthopedists-spinal surgery. However, because of discounts and surcharges, in 2005 premiums within the three highest-risk specialties varied nearly threefold, and nearly one-third paid less than in 1990.

Pennsylvania, like many states around the country, is in the throes of a \"tort crisis.\" The cost of professional liability insurance for physicians and hospitals is escalating rapidly, as its availability shrinks. Many hospitals are poorly situated to bear these rising costs, especially in an environment of flat reimbursement rates and poor investment returns. Hospitals' distress has become a matter of general concern because of the potential public health implications of hospital closures and service restrictions. This paper examines the impact of the liability crisis on Pennsylvania hospitals and the strategies being used to weather the storm, including alternative risk financing and closer ties between hospitals and affiliated physicians. It concludes by connecting these trends to larger medical malpractice policy issues.

The conventional wisdom is that malpractice premiums have steadily risen and now constitute a crisis for medical practice. The best available data suggest otherwise. American Medical Association (AMA) surveys of self-employed physicians from 1970 to 2000 indicate that premiums rose until 1986, then declined until 1996, rose thereafter, but were lower in 2000 than in 1986. Other items represented a much greater share of total practice expenses in 1970 yet increased rapidly until 1996 and moderately thereafter, while spending on premiums fell during 1986-2000. National trends were reflected with variations in obstetrics/gynecology, surgery, and anesthesiology and in nine regions surveyed. [PUBLICATION ABSTRACT]

During a January 2004 speech at an Arkansas medical center, President Bush remarked, \"[W]e've got too many darn lawsuits, too many frivolous and junk lawsuits that are affecting people... [W]e need medical liability reform to make sure that medicine is affordable and available... Lawsuits don't heal patients. That's a fact.\" Despite the fact that medical malpractice reform has been the subject of political speeches and legislation for nearly three decades, it continues to attract a great deal of attention from both state and federal politicians who aim to solve the perceived medical malpractice crisis. With health care costs continuing to soar, frustrated consumers and voters have proven to be receptive audiences for politicians with legislative reform proposals. Many of the proposed reforms, however, have also drawn sharp criticism from groups like consumer watchdogs and trial lawyer associations.