Robert Wood Johnson Foundation report on malpractice issues

Recently I wrote a post about malpractice issues. I didn't know much about the subject, and got some useful corrections from helpful commenters. I know this is how the whole Web 2.0 "social media" thing is supposed to work, but it's wonderful and humbling (and FUN!) when it happens.

One visitor is Claudia Williams, director of Health Policy and Public Affairs at the Markle Foundation. She said

Clearly the malpractice system needs to be fixed (it's inefficient, confrontational, and does nothing to improve quality) but not because of the hyped cost figures cited by some.

and steered us to some 2006 work she commissioned at the Robert Wood Johnson Foundation (RWJF) which seems to be a good education about the whole malpractice subject. An excerpt from that web page (emphasis added):

"Improving insurer financial ratios suggest that the malpractice crisis is now abating in some states, [yet] malpractice crises are a recurring problem. Over the last 30 years there have been three periods of rapidly rising premiums, each sparking policy-maker concerns about affordability and accessibility of coverage and the effectiveness of policy solutions. States have enacted a variety of reforms to prevent or temper malpractice crises, but there is a paucity of reliable information available to policy-makers about the effects of these reforms and the impact of the malpractice crisis on health care delivery.

Some Key Questions Addressed in This Issue:

* How does a volatile malpractice environment affect health care delivery?
* What has been the impact of state tort reforms on premiums, claims frequency, claims payouts and physician supply?"

That page links to some documents. I particularly like the medical malpractice primer. (It's now three years old, and I sure would like to see it updated.)

A key item (page 6) is that the author found no reliable estimate of the national cost of "defensive medicine," which is (for instance) the CT scans that commenter "doc3osh" cited in the earlier post. (Doctors prescribe many CT scans, to defensively avoid being sued for not doing so.) (The paper doesn't assert that those costs don't exist; it says there's no good calculation of their cost.)

Some of the report's findings (page 9):

• The system does a poor job compensating patients injured by medical malpractice.
  
  
• The system has high transaction costs. For every dollar paid in malpractice insurance premiums, only about 40 cents goes to injured patients.
  
  
• Awards in malpractice cases are inequitable. Many plaintiffs with meritorious claims receive nothing, while others receive awards that seem disproportionate to the severity of their injury. Moreover, plaintiffs with similar injuries receive quite different awards, even in the same jurisdiction.
  
  
• The system focuses on the misdeeds of individual healthcare providers, but medical errors are often due to breakdowns in whole systems of care.
  
  
• It is difficult to hold a hospital or other healthcare system liable for a medical error so malpractice awards are usually levied against individual physicians.
  
  
• There is no real evidence that the medical liability system deters negligent care.
  
  
• The system has perverse effects on patient safety initiatives.

Also: "Rising claims costs – driven by an increase in average payouts not claims frequency – have contributed to rising premiums, but do not explain the sudden spike in premiums around 1999–2000." (Those costs largely did account for the crises of 20 and 30 years ago, but they're a small part of the surge that happened 10 years ago.)

The 4-page policy brief seems like a terrific introduction to the whole subject, too.

I gotta say, this process of learning about the healthcare morass is a bit scary. The more I learn, the more I see it's a complex mess, and the more I might fear looking like a fool if I dare to open my mouth about something.

But what the heck, folks. The complexity is a result of too little visibility into what's actually going on, and we might as well dare to speak up. On his blog, Paul Levy likes to quote the old line about "Sunlight is the best disinfectant." Huzzah.

Thanks to everyone who contributes to our learning process, here and elsewhere.