Malpractice Claims Rates Research Articles

Do health care managers know the comparative quality of their care?

Compared with other industries, health care is a high-risk industry. In this study, two national data sets on patient claims and a survey of improvement efforts in Swedish health care were used to investigate the linkage between how health care managers perceive their performance regarding adverse medical events and their performance as reflected in patient malpractice claims rates. The departments' focus on patient safety issues in their improvement efforts was also evaluated. Our results show that Swedish health care department managers underestimate their departments' frequency of adverse medical events relative to that of similar units. Also, there is no correlation between the managers' perception of adverse medical events and their actual frequency of patient malpractice claims. More research is needed on the use of patient-generated malpractice claims and claims rates to promote a higher awareness of the magnitude of the safety problems in health care.

Do women simply complain more? National patient injury claims data show gender and age differences.

The Swedish Counties Mutual Insurance (LOF) owns and operates the Swedish Patient Insurance Company, (PSR) a no-blame insurance system that compensates patients for injuries that result from errors in medical practice. We combined malpractice claims data (from PSR) with national hospital discharge registry data (National Board of Health and Welfare-Socialstyrelsen) and determined Swedish inpatient malpractice claims rates for the years 1996-2000. Women have higher claims rates than men, but their claims are adjudicated as valid more often than men's claims. The data are consistent with other lines of evidence suggesting poorer quality of care for women, e.g., heart disease, kidney disease, and cancer. Middle-aged (40- to 59-year-old) patients file malpractice claims at almost twice the national rate, whereas patients younger than 19 years and older than 80 years of age file at significantly below the average rate. Differences in claims rates have major financial and quality of care implications. Further studies are needed.

Malpractice Risk Prevention for Primary Care Physicians

The recent medical malpractice "crisis" has seen skyrocketing liability premiums and increasing fear of liability. Primary care physicians, especially family medicine and internal medicine physicians, have historically experienced low rates of malpractice claims, both in number and amount of payment. This can be attributed to several factors: the esteem held by internal medicine and family medicine physicians in their communities, relatively low numbers of invasive procedures, reluctance of patients to include "their" primary care physician in any potential litigation, and, probably most importantly, the atmosphere of mutual trust and communication between the internist or family physician and the patient. Recent years have seen this trend erased, as insurance industry data suggest primary care physicians presently face significant potential exposure for medical malpractice claims. It is imperative that primary care physicians take steps to insure they are adequately covered in case of a malpractice claim and that they practice aggressive but appropriate risk management to lessen the likelihood of a claim.

How liability law affects medical productivity

Previous research suggests that “direct” reforms to the liability system—reforms designed to reduce the level of compensation to potential claimants—reduce medical expenditures without important consequences for patient health outcomes. We extend this research by identifying the mechanisms through which reforms affect the behavior of health care providers. Although we find that direct reforms improve medical productivity primarily by reducing malpractice claims rates and compensation conditional on a claim, our results suggest that other policies that reduce the time spent and the amount of conflict involved in defending against a claim can also reduce defensive practices substantially. In addition, we find that “malpractice pressure” has a more significant impact on diagnostic rather than therapeutic treatment decisions. Our results provide an empirical foundation for simulating the effects of untried malpractice reforms on health care expenditures and outcomes, based on their predicted effects on the malpractice pressure facing medical providers.

Physicians' feelings: toward a balance in medical education.

Physicians' feelings: toward a balance in medical education.

The Effects of Malpractice Pressure and Liability Reforms on Physicians' Perceptions of Medical Care

Understanding how and why liability laws and liability reforms alter the medical treatment decision-making process is central to reforming the current U.S. malpractice liability system. Survey methods serve a valuable role in this process because they measure how malpractice pressure affects physician perceptions of appropriate practices, and thereby capture an important determinant of treatment decisions. Based on analysis of the American Medical Association Socioeconomic Monitoring System survey, we present four findings. First, physicians from states enacting liability reforms that directly reduce malpractice pressure experience lower growth over time in malpractice claims rates and in real malpractice insurance premiums. Second, physicians from reforming states report significant relative declines in the perceived impact of malpractice pressure on practice patterns. Third, individual physicians' personal experiences with the malpractice system are a key determinant of the perceived importance of defensive medicine. Fourth, the impact of individual physicians' claims experience on perceptions is smaller in reforming than in nonreforming states. Taken together, these results suggest that reforms in law affect physicians' attitudes, both by reducing the probability of an encounter with the liability system and by changing the nature of the experience of being sued, for those physicians who defend against malpractice claims.

Distribution of orthopaedic surgeons, lawyers, and malpractice claims in New York.

The New York State Department of Health Medical Malpractice Insurance Database was used to determine the number and location of malpractice claims filed by residents of New York State against board certified orthopaedic surgeons between 1979 and 1993. The numbers of board certified orthopaedic surgeons, lawyers, law firms doing medical malpractice work, and malpractice claims per capita for each county were calculated. Stepwise linear regression analysis was used to determine whether the per capita rate of malpractice claims was predicted by the population density of board certified orthopaedic surgeons, law firms filing malpractice claims, or total population of lawyers. Three thousand one hundred eighty-two malpractice claims were filed during the period of interest. The per capita rate of malpractice claims did not correlate with the population density of board certified orthopaedic surgeons. The per capita malpractice claim rate, however, was significantly correlated with the population density of law firms filing malpractice claims and with the overall population density of lawyers. Orthopaedic practices located in areas with high concentrations of lawyers involved in medical malpractice litigation appear to have a higher risk of having malpractice claims filed against them than practices located in other areas.

The Effects of Malpractice Pressure and Liability Reforms on Physicians' Perceptions of Medical Care

Understanding how and why liability laws and liability reforms alter the medical treatment decision-making process is central to reforming the current U.S. malpractice liability system. Survey methods serve a valuable role in this process because they measure how malpractice pressure affects physician perceptions of appropriate practices, and thereby capture an important determinant of treatment decisions. Based on analysis of the American Medical Association Socioeconomic Monitoring System survey, we present four findings. First, physicians from states enacting liability reforms that directly reduce malpractice pressure experience lower growth over time in malpractice claims rates and in real malpractice insurance premiums. Second, physicians from reforming states report significant relative declines in the perceived impact of malpractice pressure on practice patterns. Third, individual physicians' personal experiences with the malpractice system are a key determinants of the perceived importance of defensive medicine. Fourth, the impact of individual physicians' claims experience on perceptions is smaller in reforming than in nonreforming states. Taken together, these results suggest that reforms in law affect physicians' attitudes, both by reducing the probability of an encounter with the liability system and by changing the nature of the experience of being sued, for those physicians who defend against malpractice claims.

Medical Board Regulation of Physician Licensure: Is Excessive Malpractice Sanctioned?

This paper considers the deterrent effect that self-regulation has on a patient‘s propensity to sue under malpractice law. A model of tort-driven self regulation is developed and its implications are examined using data on the disciplinary actions of the Florida Medical Board and data on closed malpractice claims. Doctors who in 1987-1991 generated abnormal rates of malpractice claims had a higher rate of disciplinary actions in the following period 1992-1995. Significantly, the evidence suggests that the Board may also be more likely to discipline older physicians and non-certified practitioners, perhaps in response to special interests of industry members.

Physician malpractice: does the past predict the future?

To assess whether there is a population of physicians who have consistently poor malpractice claims experiences over time. Retrospective cohort study. 12,730 physicians insured in New Jersey from 1977 to 1991. After adjusting for specialty, the physicians were grouped according to who had the highest, very high, and high rates of malpractice claims, approximating 1%, 5%, and 10% respectively, of the insured population. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated comparing the physicians in these high-risk categories with the other physicians. Of the 55 physicians who had the highest malpractice claims rates during the first four years, two (3.6%) were in the highest group during the subsequent three years (OR 2.8; 95% CI 0.7 to 10.8), five (9.1%) were in the very high group (OR 2.0; 95% CI 0.7 to 5.3), and 11 (20%) were in the high group (OR 2.3; 95% CI 1.1 to 4.6). Of the 260 physicians in the very high group during the first four years, 11 (4.2%) were in the highest group during the subsequent three years (OR 3.6; 95% CI 1.8 to 6.4), 26 (10.0%) were in the very high group (OR 2.3; 95% CI 1.5 to 3.6), and 46 (17.7%) were in the high group (OR 2.0; 95% CI 1.4 to 2.8). Of the 947 physicians in the high group during the first four years, 24 (2.5%) were in the highest group during the subsequent three years (OR 2.3; 95% CI 1.4 to 3.7), 62 (6.6%) were in the very high group (OR 1.5; 95% CI 1.1 to 1.9), and 118 (12.5%) were in the high group (OR 1.3; 95% CI 1.1 to 1.6). Similar results were found when using awards as the outcome. Most physicians who have high malpractice rates during their first four years improve over time. Physicians who have high rates of malpractice during one period should not be subjected to disciplinary action. However, carefully evaluating physicians who consistently have high rates of malpractice during two periods may represent an effective strategy for identifying problem physicians.

Doctors sued for uninterest, say researchers in US

Doctors who seem hurried and uninterested are at risk of being sued even if they practise good quality medicine, said researchers in the US last week. A team led by researchers from Vanderbilt University in Nashville, Tennessee, examined the malpractice records of obstetricians in Florida during 1987 and found that those who had higher levels of satisfaction among their patients also had lower rates of malpractice claims filed against them. The study, published in JAMA, the Journal of the American Medical Association (1994;272:1583-7), was done …

Physician Demographics and the Risk of Medical Malpractice

Abstract purpose: This study was undertaken to clarify which, if any, physician demographic characteristics are associated with an increased rate of medical malpractice claims. methods: We analyzed the malpractice experience of 9,250 physicians insured for at least 2 years from 1977 to 1987 in the state of New Jersey. After adjusting for years at risk, physician claims per year was categorized into low, medium, and high. results: Male physicians were three times as likely to be in the high-claims group as female physicians, even after adjusting for other demographic variables (relative risk, 3.1; 99% confidence interval, 2.2 to 4.4). Specialty was strongly associated with claims rate, with neurosurgery, orthopedics, and obstetrics/gynecology having 7 to 12 times the number of claims per year as psychiatry, the specialty with the fewest claims. The rate of claims varied with age (p conclusion: Male physicians are three times as likely to be in a high-claims category as female physicians. We suspect that the most likely explanation for this finding is that women interact more effectively with patients. Understanding the reasons for the variation in claim rates between physicians may lead to the development of methods to reduce the overall rate of malpractice claims.

Physician demographics and the risk of medical malpractice

purpose: This study was undertaken to clarify which, if any, physician demographic characteristics are associated with an increased rate of medical malpractice claims.methods: We analyzed the malpractice experience of 9,250 physicians insured for at least 2 years from 1977 to 1987 in the state of New Jersey. After adjusting for years at risk, physician claims per year was categorized into low, medium, and high.results: Male physicians were three times as likely to be in the high-claims group as female physicians, even after adjusting for other demographic variables (relative risk, 3.1; 99% confidence interval, 2.2 to 4.4). Specialty was strongly associated with claims rate, with neurosurgery, orthopedics, and obstetrics/gynecology having 7 to 12 times the number of claims per year as psychiatry, the specialty with the fewest claims. The rate of claims varied with age (p <0.001) and peaked at approximately age 40. No association was evident between claims rate and a physician's site of training or type of degree.conclusion: Male physicians are three times as likely to be in a high-claims category as female physicians. We suspect that the most likely explanation for this finding is that women interact more effectively with patients. Understanding the reasons for the variation in claim rates between physicians may lead to the development of methods to reduce the overall rate of malpractice claims.

Psychiatric malpractice claims in Maryland

Historically, professional liability issues have not been a major focus of concern among psychiatrists or psychiatric institutions. In 1975, the American Medical Association (AMA) reported that the malpractice claims rate against psychiatrists was the second lowest of all physician specialities (AMA, 1975). A major study by the National Association of Insurance Commissioners (NAIC) of all reported medical malpractice claims closed during 19751978 in the United States, found that claims against psychiatrists represented only 0.3% of the 71,788 malpractice claims included in the analysis (NAIC, 1980). Several reasons have been advanced for the low rate of psychiatric claims filed during the 1970s. Slawson and Guggenheim (1984) note that the NAIC data base contains no claims brought by patients of Veterans Administration or other public hospitals-a factor possibly leading to underreporting of claims and/or lower levels of claims filed against psychiatrists who are more likely than most other clinical specialists to be employed in such settings. In addition, it has been argued that psychiatric treatment, unlike obstetrical and other surgical procedures, for example, rarely leads to grave or permanent physical injuries -the type of unanticipated treatment outcomes most likely to result in large malpractice claims and substantial awards. Slawson and Guggenheim (1984) also speculate that most malpractice claims result from a breakdown in the doctor-patient relationship and reason that psychiatrists may have experienced few claims because they are the medical specialists most likely to focus on interpersonal relationships. An alternative (or additional) explanation has been offered by Stone (1984) in a discussion of legal and judicial concerns regarding the prescribing behavior of many mental health professionals with respect to neuroleptic drugs. Stone notes, “Were it not for the reformer’s zeal of mental health litigators and the readiness of federal courts to deal with these cases as a matter of constitutional rights applicable to all patients in similar circumstances, they might well be tried as cases of medical malpractice” (1984, p. 1385). Thus, it could be argued that one reason the rate of psychiatric claims has been relatively low is that a large number of concerns about the quality of care provided to psychiatric patients have been dealt with in the courts as constitutional issues regarding a