The past several years have seen significant increases in the costs of medical malpractice litigation. The result has been higher malpractice insurance premiums for physicians and health care facilities, which in turn has led to higher costs for the health care system.In 2001, premiums for medical malpractice insurance topped $21 billion, double the amount 10 years earlier.1 The increases continued in 2003 and 2004.2 At a time when other costs for providing medical services are increasing and reimbursement from third-party payers is decreasing, physicians are being forced to make some difficult decisions about their careers and the care they provide. It should not be a surprise that this trend in increased liability insurance costs is beginning to take a toll on access to pediatric services.From 1992 to 2001, premiums for medical malpractice insurance more than doubled, increasing an average of 8.1% per year. That is 3 times faster than the overall rate of inflation over the same period and double the rate of inflation for medical care. Relative to the size of the economy, measured as share of gross domestic product, malpractice insurance has increased every year since 1989 and stands at 3 times the level of 1975.Why is medical malpractice insurance so expensive? According to the American Academy of Actuaries, a key reason why medical malpractice insurance is so costly is the escalating size of malpractice claims.As Table 1 shows, the median damage award in medical malpractice cases jumped 176% from 1994 to 2001.3 The median damage award for medical malpractice cases in 2002 was $1,010,858, a slight increase after hovering at the $1,000,000 mark since 2000. The 2002 median awards for medical negligence in childbirth cases were the highest for all types of medical malpractice cases, $2,252,645, with median awards at $1,000,000 for medication cases, $975,000 for diagnosis cases, $687,500 for patient relations issues, $648,000 for nonsurgical treatment cases, and $500,000 for surgical cases.4In some areas of the country, the crisis has shifted from one of medical liability insurance affordability to availability, as fewer companies can afford to stay in the market and those that do become more selective about whom they will cover. How can this problem be solved? The American Academy of Pediatrics (AAP) believes the solution can be found in comprehensive medical liability reform—a solution that couldTo learn more about the AAP position on medical liabili-ty reform, visit the “Medical Liability Crisis” area of the Members Only Channel of the AAP Web site (http://www.aap.org/moc). Once there, scroll down to “Reports” and click on Liability for Medical Malpractice: Issues and Evidence, a joint May 2003 economic committee study for the US Congress, to read more about the benefits of medical liability reform. You may want to get involved with efforts by your AAP chapter to address medical liability reform.