My post last week on Medical Malpractice generated a good bit of virtual commentary, some calling me to task for supporting one point of view and others saying I missed the central issues. Thanks to all for their considered and thoughtful comments. I’ll address them and do my best to be brief and factual.
Mad Hatter complained that the statistics in my post contradicted themselves – well, no, the stats don’t contradict themselves. They are available in the cited study at Health Affairs.(abstract only, article available to subscribers or for purchase) And other types of expenses, notably salaries and utilities, went up more than med mal over that period. One of the problems with med mal cost studies, as pointed out in the article, is that pricing data is somewhat suspect. The authors of the HA article provide a good perspective on that concern.
Others noted that the HA report is based on an analysis that concluded in 2000, and therefore did not apply to today’s med mal environment. To that, I would note that although costs did rise dramatically between 2000 and 2004, recent studies indicate med mal premium rates appear to be stabilizing and in some cases decreasing…
Several readers said Med Mal matters more than I think, and I’m understating the problem. Regular Managed Care Matters reader Erick Novack took me to task for not noting the recent NEJM article claiming 40% of med mal suits are groundless – good point Eric and thanks for the heads up (I do my best to keep up on these things, but sometimes miss important info).
At the risk of crossing into point-counterpoint, I would reiterate a point made in the original post, that many real malpractice problems never become suits. – My point is that the attention paid to med mal is way out of proportion to its significance as a driver of health care costs and access, on a national scale. I do not argue that it is a problem, but do take issue w the “sizing” of the issue. As Ralph noted, I have pointed out that the problem is due in large part to the vagaries and business practices of insurance companies, which are doing their best to create an artificial “crisis”. Ralph also highlighted WV’s attempt to address parts of the med mal issue, including award caps, but these efforts have apparently not resulted in meaningful change, due (at least in part) to another nuance of the law. I’ve also taken the insurance industry to task for their profiteering, raising prices despite no evidence of an increase in underlying claims.
Eric also thinks I’ve been unfair and biased, noting “I am very disappointed, that despite the opportunity to present the other very important medical liability study published in the past week, you only chose to highlight the one that supports the myths of the trial attorneys.”
I disagree with the characterization of my post. The post certainly does NOT support “the myths of the trial attorneys”; my point is med mal insurance costs are not a key driver of overall costs and access, and that “the inefficiencies in the insurance market are much greater contributors to the problem than are tort costs.”
Finally Eric says that physicians can’t pass on cost to patients; why not? Empirical evidence indicates health care costs are going up faster than the overall rate of inflation, due to increases in prices and utilization. And that’s true for physician costs as well as overall health care costs.
BC suggested I review the Century Foundation’s proposal on med mal – when searching for it I found a study that further supports my theses(?) that med mal claims are NOT driving up insurance costs; that the insurance industry is not doing a good job with med mal, and that limits on awards are NOT the answer. Heck, awards aren’t even a problem.
So here’s my net – med mal is not nearly as big an issue in reality as it is emotionally. The inefficiency of the insurance “market” is by far the largest contributor to the problem. Tort reform is a red herring. MCM readers are smart and insightful and well-read.
And please, please, search my entire blog for other posts on a topic before taking me to task for bias!
Now I have to get to work, but will try to track down the Century Foundation reform proposal (which I could not find on their website)…
And thanks to all.
Whatever you conclude about the red herring we seem to have permanently on our table the well documented fact is that at least 90% of the medical errors never result in any claim.
Now that is something worth correcting. I say make the claims mandatory for about 5 years and we would likely see the end of bad medicine. It would be managed out of existence.
“Erick Novack took me to task for not noting the recent NEJM article claiming 40% of med mal suits are groundless.”
There’s another, quite different, way to look at that study – specifically that 97% of Med Mal claims are based on fact. Not sure if you accept HTML, so I’ll just post the URL, and readers can see for themselves.
http://www.corpreform.com/2006/05/97_of_malpracti.html
Joe — For the Century Foundation reform proposal, go to http://www.tcf.org. About 2/3 of the way down the home page on the left, it’s called: A New Deal For Health Care: How To Cover Everyone and Get Medical Costs Under Control. If you click on the link, there is another link to download the pdf file containing the report.
Angus- nothing lies like statistics.
If, as you suggest by your promotion of the linked article, that everyone with an ‘injury’ should be compensated, you are arguing directly FOR a major overhaul of the medical liability system.
In fact, you are looking for a ‘workers’ compensation’ equivalent in medical liabiltiy. In most workers’ comp. systems (I shall speak directly about Arizona), all that matters is that an injury occurred- regardless of fault. As the AZ Supreme Court ruled last August, you can even show up to work on alcohol and drugs and, if you get hurt, the system will pay.
Importantly, if you wish to ‘opt out’ of the system and put yourself into the standard ‘tort’ system, you must make that known prior to any injury occurring.
So, do you actually support me in my recommendation for a ‘health court’ system?
Also, the workers’ comp system is paid for by all workers who might be affected through employer premiums… would you support funding the system in a similar way?
And to GTL- I presume you would support a ‘no fault’ health court system as well, to get more people compensated?
I’m with Joe. I think the New England Journal piece lacks context. If 40 percent of all med mal suits are groundless, how does that compare to other suits of all kinds? The answer to that question would tell us whether that 40 percent figure is a bad thing or not. Unfortunately, neither Eric, nor I, nor the NEJM have the figures to say one way or the other. So using that study to support one argument or another is disingenuous. It’s just a nice conversation piece.
Just as cops learned how to stop protecting bad cops, doctors need to learn how to stop protecting bad doctors. Stamp out medical errors by policing your own, and we won’t even be having this argument anymore.
Rick- I love the ‘police your own’ argument. While it is true that physicians need to do a better job of defining unacceptable practices (note that is far, far different from current p4p proposals), I fail to understand why medicine is different than every other industry.
Do contractors in one town control the quality of contracters in another? Perhaps one restaurant should be responsible for the sanitary conditions in other restaurants? And so on, and so on… How am I protecting a bad doctor in another state, let alone one in the next town?
The issue, as you say, is the rate of meritless lawsuits in other arenas. If the 40% number holds elsewhere, it merely lends more credence to the claim that the system is broken.