Medical Malpractice Insurance Research Articles

Social inflation and health care risk management.

This paper examines the concept of social inflation as it affects medical malpractice insurance claims, a phenomenon that warrants monitoring by risk managers in health care. The authors define social inflation as the growth in the cost of insurance claims that exceeds general inflation. The authors use data aggregated from insurance company Annual Statements and from a national database of malpractice reports to estimate that social inflation added $2.4 billion to $3.5 billion to booked losses over the 10 years ending in 2021, which is between 8% and 11% of total losses. The authors' approach is to show growth in loss development factors, a metric that property/casualty actuaries use to estimate claim costs. This approach is explained in detail. The paper concludes with commentary on how risk managers can incorporate consideration of social inflation in their overall assessment of risk.

Assessing the Impact of State Legislation on Medical Malpractice Insurance in Nepal

Assessing the Impact of State Legislation on Medical Malpractice Insurance in Nepal

Awareness of Health Professional Regulations, Associated Factors, and Malpractice Consequences among Dentists

Introduction: The rising number of complaints against dentists in Saudi Arabia was the main motivator to conduct this study, which aimed to assess the level of knowledge regarding health professional regulations among dentists, identify the associated factors, and explore the consequences of malpractice experience. Methods: This was a cross-sectional study conducted between February and July 2022 among dentists working at public or private dental clinics in Saudi Arabia and who had medical malpractice insurance coverage. To conduct the research, a predestined questionnaire comprised three sections: section 1 included 13 questions aimed to assess the knowledge related to the health professional regulations in Saudi Arabia; section 2 evaluated the most significant changes in providing dental care as a result of complaint experience; and section 3 assessed the impact of the complaint on dentists’ professional practice and physical and psychological conditions. Results: The study included 148 dentists who responded to the questionnaire. The dentists’ median score of their knowledge concerning legal health regulations in Saudi Arabia was 7 (range: 6–9) out of 13. The median score was higher among dentists who had been sued compared with those who had never been sued (8 [IQR: 7–9.75] vs. 7 [IQR: 5.25–9], respectively), although no significant difference was detected (p > 0.05). A significantly higher median score (p = 0.029) was recorded among male dentists (median = 7 [IQR: 6–10]) compared to female dentists (median = 7 [IQR: 5–8]). Conclusion: The overall level of knowledge of dental care legal regulations among the included dentists was good to some extent. Several dentists with a history of malpractice changed their behavior toward patients. This change in behavior was more common among dentists who had been previously sued.

The current state of regulatory and legal support for the rights of healthcare professionals in Ukraine

The article provides a comprehensive analysis of the regulatory and legal support for the rights of healthcare professionals in modern conditions. The author establishes that today medical professionals need legal protection, which consists in the introduction of medical malpractice insurance at the expense of the owner of a healthcare facility; establishment of decent remuneration for medical professionals; provision of healthcare facilities with medical devices, medicines, medical equipment, etc. to improve working conditions and effective performance of professional activities by medical professionals; introduction of effective mechanisms of social protection of medical professionals; establishment of interaction with the public authorities and other relevant bodies.
 The author concludes that today the priority area of the State's activity is to guarantee the rights of healthcare workers. However, ensuring the rights of healthcare workers remains one of the most problematic issues that needs to be addressed immediately by adopting appropriate decisions.
 One of the effective measures should be state and public control over the observance of the rights of healthcare workers. State control should be exercised by the specially authorised central executive body on healthcare and its territorial bodies, as well as other central and local executive bodies, local self-government bodies and their executive committees within their competence in accordance with the legislation of Ukraine. Public control over the observance of the rights of healthcare workers may be exercised by public associations of healthcare workers, associations of healthcare workers and/or members of their families, and other public associations within the limits established by the legislation of Ukraine. An effective mechanism may also be the creation of permanent medical and legal commissions in public associations of healthcare professionals, associations of healthcare professionals and other public associations within the limits established by the legislation of Ukraine for the development and improvement of legislative acts in the medical field.

Risk Management: Gaining Control of Medical Malpractice Litigation

The purpose of risk management is to anticipate a crisis and prepare an actionable strategy, which accurately predicts the most successful outcome for the crisis. For doctors, a malpractice lawsuit is a crisis. It is always foreshadowed by a complication from a medical intervention. The complication can result from a medical error. However, it, also, can result from an error-of-nature. CCC+C is a risk management tool that is data driven and uses the scientific method to define, measure, analyze, improve, and control processes so that a medical error can be distinguished from an error-of-nature with 95% confidence. An error-of-nature is not preventable but a resulting frivolous lawsuit can be dismissed. Likewise, a medical error is preventable and a resulting meritorious lawsuit can be settled. Both outcomes depend on damage control. CCC+C is the damage control tool. When used by doctors as soon as a complication occurs, it manages all other obstacles presenting upstream from actuaries in medical malpractice insurance companies, plaintiff attorneys, defense attorneys and medical experts. In court, CCC+C is a forensic science designed to work in the same way as ACE+V, which is a forensic science that identifies fingerprints. Lastly, because CCC+C is transparent, it exposes unscrupulous tactics by any party on either side of litigation. It accurately predicts outcomes and controls litigation because it effectively protects from, defends against and prevents unscrupulous tactics. Therefore, CCC+C is a game changer in the arena of medical malpractice litigation.

Liability оf the Medical Institution for Medical Malpractice and Liability Insurance

Medical errors are frequent in medical profession, especially having in mind the nature of this profession. In addition to the doctor himself or another medical worker (civil and criminal liability), the health institution where he is employed can also be held liable (exclusively civil liability) for medical error. In this case medical institution is responsible for the mistakes of its employees. Bearing in mind that compensation claims could be huge, liability insurance appears as a form of protection of the medical institution, as well as the patients. In the first part of the paper, the authors analyse the concept of medical error as a basic condition for the liability of a medical institution. In the second part, they analyse main issues of the medical institution liability, as well as liability insurance.

A coevolution model of defensive medicine, litigation and medical malpractice insurance

We model the interactions between physicians and patients, subject to clinical and legal risks, by means of an evolutionary game. In each instant of time, there is a large number of random pairwise encounters between members of the two populations. In each encounter, a physician heals a patient. The outcome of the healing process is uncertain and may result in patient harm; if that happens, the patient may sue the physician for medical malpractice. Physicians have to choose between two alternative treatments, D and ND, with different levels of benefits and risks. The treatment D is less risky than the alternative treatment ND, but has the disadvantage of providing a lower expected benefit to the patient. Therefore its provision corresponds to practicing “negative” defensive medicine.Physicians prevent, at least partially, negligence charges by buying medical malpractice insurance. This transfers the risk of litigation from the physician to the insurer.The dynamics we analyze are determined by a three-dimensional discrete-time dynamic system, where the variables x and y are, respectively, the shares of defensive physicians and litigious patients, while the variable a represents the insurance premium.In such a context we show that, depending on the policy’s price calculation principle as well as on model’s parameters related to the accuracy of the judicial system and legal reforms, the game’s final outcome could be an appealing equilibrium point in which the defensive strategy of physicians and litigious behavior of patients vanish, an interior (Nash) equilibrium in which all strategies coexist, or even an oscillatory behavior arisen via a Neimart–Sacker bifurcation in which strategies coexist in a recurrent manner. Furthermore, we state a “no chaos” conjecture, supported by analytical, numerical and empirical arguments.

Does Public Health Insurance Expansion Influence Medical Liability Insurance Prices? The Case of the ACA’s Optional Medicaid Expansion

Medical liability insurance covers physicians’ liability, and its price could affect physicians’ practice. In this article, we use a unique county-level dataset to study how medical liability insurance prices of three specialties, internal medicine, general surgery, and obstetrics–gynecology (OB-GYN), changed after the Affordable Care Act (ACA) elective Medicaid expansion provision. The Medicaid expansion has largely increased the demand for health care services and potentially exposed physicians to higher medical liability risks. With higher expected losses, insurers could react by increasing medical malpractice insurance prices. We first study all counties in states that elected to expand Medicaid and compare them to counties in nonexpansion states. Then we narrow our analysis to consider differential effects in bordering counties with different Medicaid expansion statuses over the period 2010–2018. In both samples, we find significantly higher medical liability insurance prices 2 years after the expansion (on average) in expansion states in comparison to nonexpansion states, and the difference is larger for physicians practicing internal medicine (6–8% at 2 years after expansion) and general surgery (12–16% at 2 years after expansion) but less so for OB-GYN. Our OB-GYN results are likely because significant numbers of births were already covered under Medicaid and were not affected by the expansion. Our finding suggests that the expansion of health insurance increases liability costs to medical practitioners.

Do noneconomic damage caps reduce medical malpractice insurance premiums? Evidence from North Carolina

AbstractThe impact of medical malpractice reforms, especially caps on noneconomic damages, is of special interest to policymakers and physicians. Adopting such caps has become rare during the past decade, and most existing analyses study state reforms occurring during periods of dramatic rises in malpractice insurance rates. This study contributes to the literature by examining how caps implemented in noncrisis periods affect malpractice premiums. It examines the effect of the 2011 North Carolina's adoption of a noneconomic damages cap by comparing county‐level malpractice premiums for three specialties between North Carolina and states without caps both before and after the reform. It finds little evidence of pre‐existing trends, followed by a lagged but significant reduction in premiums for each of the studied specialties in North Carolina. The timing and size of the effects are comparable to findings from the literature studying malpractice reforms passed during times of more dramatic liability trends.

Study on Medical Malpractice Insurance in Romania

Study on Medical Malpractice Insurance in Romania

A Coevolution Model of Defensive Medicine, Litigation and Medical Malpractice Insurance

A Coevolution Model of Defensive Medicine, Litigation and Medical Malpractice Insurance

How Do Insurers Price Medical Malpractice Insurance?

How Do Insurers Price Medical Malpractice Insurance?

The Evolution of the Anesthesia Patient Safety Movement in America: Lessons Learned and Considerations to Promote Further Improvement in Patient Safety.

Ellison C. Pierce, Jr., M.D., and a small number of specialty leaders and scientists formed a remarkable, diverse team in the mid-1980s to address a dual crisis: a safety crisis for anesthetized patients and a medical malpractice insurance crisis for anesthesiologists. This cohesive team's efforts led to the formation of the Anesthesia Patient Safety Foundation, the American Society of Anesthesiologists's Committees on Standards of Care and on Patient Safety and Risk Management, and the society's Closed Claims Project. The commonality of leaders and members of the Anesthesia Patient Safety Foundation and American Society of Anesthesiologists initiatives provided the strong coordination needed for their efforts to effect change, introduce standards of care and practice parameters, obtain financial support needed to grow patient safety-oriented new knowledge, integrate industry and other relevant leaders outside of anesthesiology, and involve all anesthesia professions. By implementing successful patient safety initiatives, they promoted the recognition that anesthesiology and patient safety are inextricably linked.

Establishment of disaster medical assistance team standards and evaluation of the teams’ disaster preparedness: An experience from Taiwan

Taiwan set up disaster medical assistance teams (DMATs) after the Chi-Chi earthquake, but these teams lack unified standards. This study was divided into two phases. Phase I was a Delphi study conducted in 2019 with 26 experts who were invited to establish Taiwan's DMAT standards by modifying the World Health Organization Emergency Medical Team (WHO EMT) type I fixed standards. Phase II was a cross-sectional study conducted in 2020. A questionnaire was used to evaluate the disaster preparedness of DMATs by standards set in phase I. In phase I, Taiwan's DMAT standards were established after three rounds of Delphi consensus, with a response rate of 88.5%. The major departures from the WHO EMT standards were the exclusion of obstetric care, mental health, rehabilitation, and laboratory and blood transfusion standards and the addition of an ultrasound standard. During phase II, a total of 32 teams were invited, and the response rate was 96.9%. The overall standard achievement rate was 56.9%, and the three lowest achievement rates corresponded to sanitation (22.6%), medical malpractice insurance (25.8%), and pharmacy and drug supply (25.8%). The national DMATs, official DMATs, DMATs funded by government, and DMATs with ≥10 years of experience had significantly higher achievement rates for partial or overall standards. Using localized standards to evaluate the disaster preparedness of each team, DMATs were found to have many shortcomings mainly due to the lack of unified government announcement standards, legal protection, and adequate financial support.

Medical malpractice system in the Republic of Moldova

In this paper is discussed medical malpractice management system from the Republic of Moldova. In the Republic of Moldova is adopted the “fault system” which represents a tort litigation system. The Moldovan medical malpractice management system is analyzed from legal and normative framework, institutional framework, administrative issues, deterrence, fi nancing, compensation, costs occur to parties involved in malpractice cases, error reporting, etc. The Moldovan tort liability system is a “social insurance of a market society” where patients are compensated when the negligence of the healthcare providers is proved to be the cause of the injury. The results of the medical malpractice management system assessment demonstrated deficiencies in system organization and functioning, namely: lack of specifi c legislation to defi ne and regulate medical malpractice and medical civil liability, the concept of medical malpractice does not meet the requirements and standards of international doctrine, the approach of medical civil liability is incoherent from theoretical point of view and in consequence from the practical one, compulsoriness to follow the judicial track in order to establish medical malpractice and obtain compensation, existence of enormous fi nancial risks for the health care providers in the conditions of absence of medical malpractice insurance, lack of monitoring and evaluation system of medical errors.

Applying Human Factors Methods to Improve Healthcare Risk Management Tools

The Healthcare Insurance Reciprocal of Canada (HIROC) is a not-for-profit medical malpractice insurance reciprocal that has a vision of partnering to create the safest healthcare system. Each year, patients die from preventable patient safety incidents in Canada. A proactive focus on risk management and embedding safety into healthcare systems is key to improving patient safety. HIROC conducted semi-structured interviews to help identify usability areas of interest for two primary risk management tools: The Risk Assessment Checklist and the Risk Register. A total of 16 participants from HIROC Subscribers, all with experience in risk management, quality improvement or patient safety, volunteered to partake in the semi-structured interviews. A thematic analysis of the data collected informed usability improvements. For the Risk Assessment Checklist, participants indicated that the tool is informative as it helps create risk management awareness across their organizations. Participants found the Risk Assessment Checklist interface easy to use and are pleased that submitting their self-assessments is a streamlined process. For the Risk Register, participants reported that the tool is simple and easy to use. Specifically, they find value in having an electronic system that keeps them organized and provides a way for them to track and trend their progress. Participants identified some usability concerns that the research team addressed with proposed design reflections informed by Jakob’s Ten Usability Heuristics (Nielsen, 1994).

Patient Decision Aids Improve Patient Safety and Reduce Medical Liability Risk

Tort-based doctrines of informed consent have utterly failed to assure that patients understand the risks, benefits, and alternatives to the healthcare they receive. Fifty years of experience with the doctrine of informed consent have shown it to be an abject catastrophe. Most patients lack an even minimal understanding of their treatment options. But there is hope. Substantial evidence shows that patient decision aids (PDAs) and shared decision making can bridge the gap between the theory and practice of informed consent. These evidence-based educational tools empower patients to make decisions with significantly more knowledge and less decisional conflict than clinician-patient discussions alone. Unfortunately, despite robust evidence of effectiveness, few U.S. clinicians use PDAs when they deliver healthcare services. This must change. It is time to move PDAs from research to practice, from the lab to the clinic. This Article describes a key tool that can nudge clinicians to use PDAs with their patients: the monetary incentive of a professional liability insurance premium reduction. Medical malpractice insurance companies should offer premium discounts to clinicians who use PDAs. This incentive will spur PDA use. And PDA use will improve patient safety. That benefits both patients and malpractice insurers. TABLE OF CONTENTS I. Introduction II. Unrealized Promise of Patient Decision Aids A. What Are Patient Decision Aids? B. PDAs Are Effective at Empowering Patients C. Too Few Clinicians Use PDAs III. Medical Liability Insurers Should Incentivize Clinicians to Use PDAs by Offering Premium Discounts A. Medical Malpractice Insurers Already Use Premium Discounts to Incentivize Other Risk-Reducing Conduct B. Offering Premium Discounts Will Spur Wider PDA Uptake IV. PDAs Reduce Liability Risk from Negligent Nondisclosure Claims. A. Medical Liability Insurers Face Significant Risk Exposure from Negligent Nondisclosure Claims 1. Negligent Nondisclosure Claims Are Common 2. Negligent Nondisclosure Claims Are Expensive to Handle B. Carrots and Shields: Using PDAs Enhances Liability Protection. 1. De Jure Safe Harbor Legal Immunity 2. De Facto Safe Harbor Legal Immunity C. Sticks and Swords: Failing to Use PDAs Increases Liability Risk for Negligent Nondisclosure 1. Disclosure Mandates and Presumptions of Negligence 2. Growing Liability Risk under the Reasonable Patient Disclosure Standard D. Using PDAs Reduces Risk by Improving Documentation V. PDAs Reduce Liability Risk from Other Medical Malpractice Claims A. Medical Liability Insurers Face Significant Risk Exposure from Medical Malpractice Claims B. PDAs Result in Better Outcomes and Fewer Claims C. PDAs Result in More Satisfied Patients Who Bring Fewer Claims VI. Conclusion

Tort Reform and Moral Hazard

States have been enacting tort reforms to reduce the liability of physicians conducting malpractice. However, tort reform may create a moral hazard because physicians may take less care due to reduced liability. This paper investigates whether physician moral hazard presents after tort reform. I study this problem through the lens of medical malpractice insurers who, as the primary payer of medical malpractice claims, have the data and ability to predict the behavioral changes of physicians as well as patients. I look at insurers’ post-reform revisions on loss reserves, which were the overall changes in future expected malpractice losses and can be affected by three factors – physician moral hazard, patients filing fewer claims, and caps on loss payments. Physician moral hazard causes an increase in the expected malpractice losses, whereas the other two factors both lead to reduced loss payments. The loss reserve revision is estimated through the full information reserve revision, which is the reported incurred losses minus an actuarial prediction based on a regression method and previous year’s reserve data. The main identification strategy is a difference-in-difference model. I find that after controlling for state and firm characteristics, insurers adjust loss reserves upward after the enactment of the reform to punitive damages and the reform to joint and several liability rules, indicating the prevalence of physician moral hazard. Punitive damages may unpredictably lead to a catastrophic jury verdict against physicians, and the joint and several liability rules can make physicians liable for losses of others who are jointly liable but bankrupt. The empirical results imply that tort reform that significantly lowers physicians’ financial liabilities can reduce the deterrence effect of law and cause a moral hazard issue.

The Origins, Evolution, and Spread of Anesthesia Monitoring Standards: From Boston to Across the World.

In the mid-1980s, the anesthesia departments at hospitals affiliated with Harvard Medical School were faced with a challenge: mounting medical malpractice costs. Malpractice insurance was provided by the Controlled Risk Insurance Company (CRICO), a patient safety and medical malpractice insurance company owned by and providing service to the Harvard medical community. CRICO spearheaded an effort to reduce these costs and ultimately found a way to decrease the risks associated with anesthesia. Here, we chronicle events that led to the dramatic changes in medical practice that resulted from the activities of a small group of concerned anesthesiologists at Harvard-affiliated hospitals. We place these events in a historical perspective and explore how other specialties followed this example, and end with current strategies that minimize the risk associated with anesthesia. We conducted interviews with principals who formulated original standards of patient monitoring. In addition, we consulted documents in the public domain and primary source material. Efforts of these pioneers resulted in the establishment of the seminal Harvard-based anesthesia monitoring standards for minimal monitoring. What followed was an unprecedented transformation of the entire field. After the implementation of these standards at Harvard-affiliated hospitals, the American Society of Anesthesiologists (ASA) adopted "Standards for Basic Anesthetic Monitoring" for use during the administration of all anesthetics in the United States. Other nations have since adopted similar guidelines and these practices have resulted in significant improvements in patient safety. Currently, we estimate mortality due to anesthesia in healthy patients to be 1:400,000-perhaps as much as 10 times lower since the early 1980s. What began as an attempt to lower medical malpractice costs in a group of university hospitals became a worldwide effort that resulted in improvements in patient safety. Other specialties have adopted similar measures. Currently, an attitude and appreciation of safety are exemplified by several practices that include among others-the adherence to these patient safety guidelines, simulator training, the promulgation of standards and guidelines by ASA, and the use of a safety checklist before induction of anesthesia.

Using Big Data Analytics to Identify Dentists with Frequent Future Malpractice Claims.

Healthcare spending has been growing at an increasing rate in the US, due in part to medical malpractice costs. Dental malpractice is an area that has not been studied in depth. Using National Practitioner Data Bank (NPDB), we explored the extent of dental malpractice claims and sought to construct a predictive model that can help us identify dental practitioners at risk of performing medical malpractice. Over 1,500 dental malpractice claims were reported annually, and over $1.7 billion being paid out by medical malpractice insurers over the past 15 years. Majority of claims resulted in minor injuries, and the number of major injury claims increased over years. In prediction, we randomly split the data into train (75%) and test (25%) datasets. We trained and tuned models using 5-fold cross validation on the training set. Then, we fitted the model on the test data for performance measures. We used Logistic Regression, Random Forest (RF) and XGBoost and tuned the hypermeters of models accordingly through grid search and cross validation. XGBoost was the best machine learning model to predict the risk of dentists having several malpractice reports. The best performing model had an accuracy of 72.8% with 30.6% F1 score. The NPDB database is a valuable dataset to study dental malpractice claims. Further analysis of information extracted from this dataset is warranted.