Medical Malpractice and the U.S. Health Care System

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 9
Introduction......Page 15
Part two: the health policy impact of medical malpractice......Page 16
Part three: malpractice reforms that solve the right problems......Page 17
Part four: in search of a "new paradigm"......Page 18
After the malpractice crisis......Page 20
Acknowledgments......Page 21
Part one: framing medical malpractice as a health policy issue......Page 23
The Litigation Process......Page 25
Insurance Arrangements......Page 27
Compensation......Page 29
Deterrence......Page 31
Corrective Justice......Page 35
Efficiency......Page 36
Defensive Medicine......Page 37
Bristling Behaviors......Page 39
Cloaking Behaviors......Page 41
Conclusions......Page 43
Barriers to policy integration......Page 44
The limitations of conventional tort reform......Page 45
Malpractice reform and health system change......Page 47
Medical Progress......Page 48
Industrialized Health Care......Page 49
Expanding the reform domain......Page 50
Legal Process......Page 51
Liability Insurance......Page 52
Getting to a better system......Page 53
System Accountability......Page 54
Testing Innovative Reforms......Page 55
3 Medical Malpractice and the New Politics of Health Care......Page 57
Historical context: a brief history of malpractice politics......Page 58
1960s-1970s......Page 59
1980s......Page 60
2002-Present......Page 62
Political context: malpractice and the new politics of health care......Page 63
Private Concern? No, Public Crisis!......Page 66
This Frame Is My Frame.........Page 68
Implementation......Page 73
The road ahead......Page 80
Part two: the health policy impact of medical malpractice......Page 83
4 Who Pays When Malpractice Premiums Rise?......Page 85
Thinking about incidence......Page 86
NaIota Diaeresisve stories and nonintuitive behavior......Page 89
Empirical evidence on the incidence of malpractice premiums......Page 90
Policy implications......Page 95
Conclusion......Page 97
5 The Effects of the U.S. Malpractice System on the Cost and Quality of Care......Page 98
Why are the liability system's effects on medical care important?......Page 99
Empirical assessment of the liability system's effects on medical care......Page 100
Protection from Liability for Quality Improvement Systems......Page 103
Guidelines-Based Systems......Page 104
Conclusion......Page 105
6 Liability, Patient Safety, and Defensive Medicine: What Does the Future Hold?......Page 107
The Causes of Malpractice Crises: Rival Theories......Page 108
Tort Reform......Page 109
Disclosure......Page 111
Medical Injury Policy at the Crossroads......Page 113
Surveying the "Leading Edge" of Defensive Medicine: Strengths and Weaknesses......Page 115
The Concepts of Assurance and Avoidance Behaviors......Page 116
Respondents......Page 117
Frequency of Assurance and Avoidance Behaviors......Page 119
The physicians’ view......Page 123
Policy implications......Page 126
Summary......Page 127
7 Medical Liability and the Culture of Technology......Page 129
Technology and health law......Page 130
The General Liability Propensity......Page 131
Specific Technologies......Page 133
Cultural Explanations......Page 140
The Demand for Technology......Page 142
The Supply of Technology......Page 143
Policy Controls......Page 144
The Culture of Technology......Page 145
Legal and Policy Changes......Page 147
Conclusion......Page 148
Part Three: MALPRACTICE REFORMS THAT SOLVE THE RIGHT PROBLEMS......Page 149
8 Promoting Fairness in the Medical Malpractice System......Page 151
What fairness means......Page 152
How fair is the original malpractice system?......Page 154
How fair are the reforms?......Page 156
The fairness of the reform process itself......Page 162
Testing the theory: the iom proposal......Page 164
Conclusion: is fairness attainable?......Page 167
Background: disaggregating medical malpractice damages......Page 168
Insurance Industry......Page 170
Health Care Industry......Page 171
Variations on a Theme: Damages Caps Around the Country......Page 172
Report Card: Evaluating the Effectiveness of Caps......Page 174
Problems That Caps Inadvertently Exacerbate......Page 182
looking ahead: new directions for reforms......Page 184
Plaintiffs' lawyers and the decision to sue......Page 187
Judges, pretrial case management, and motions for summary judgment......Page 189
Jury performance and trial reforms......Page 191
Preliminary Instructions on Substantive Law......Page 192
Note-Taking by Jurors......Page 196
Juror Questions for Witnesses......Page 198
Permitting Jury Discussions Prior to Deliberations......Page 199
Improving Expert Testimony......Page 201
Making Jury Instructions More Comprehensible......Page 202
the judge's role after the verdict......Page 203
conclusion......Page 204
11 Disclosure and Fair Resolution of Adverse Events......Page 205
Recommendations......Page 207
What patients and families want after an error......Page 208
Establish a communications process consult service......Page 209
Planning Disclosure Conversations......Page 212
Conducting Disclosure Conversations......Page 213
Debriefing After Disclosure Conversations......Page 215
Apologize when appropriate......Page 216
Participants Make the Decisions......Page 219
Participants Can Discuss All Issues Which Are Important to Them......Page 220
Mediation Styles Differ......Page 221
Mediation Helps the Parties Overcome Barriers That Prevent Negotiated Agreements......Page 222
Mediation Used Soon After an Injury Can Help Parties to Resolve Claims Promptly......Page 223
Repairing the Physician-Patient Relationship and Improving Patient Safety......Page 226
Barriers to Use of Mediation......Page 227
Conclusion......Page 228
Part Four: IN SEARCH OF A "NEW PARADIGM"......Page 231
Today's policy context......Page 233
The rise of institutions – and of their legal responsibilities......Page 235
Hospital enterprise liability as a medical liability reform......Page 238
An early 1990s proposal for mandatory, exclusive hospital liability......Page 240
The health security act and enterprise liability for health plans......Page 242
Managed care's rise and retrenchment......Page 246
The receding of provider integration......Page 248
The Patient Safety Movement......Page 250
Patient Safety and Liability......Page 251
The Law as the Instrument of Systems Change?......Page 253
Unintended side effects of enterprise liability......Page 255
Conclusion......Page 257
13 Private Contractual Alternatives to Malpractice Liability......Page 259
The Potential Benefits of Liability......Page 262
Existing Problems......Page 265
Economic arguments for contractual liability......Page 266
Physician Contracting Out of Liability......Page 267
Entity-Level Contractual Liability......Page 269
Potential cost to patients of contractual liability......Page 270
Lower Benefits of Contractual Liability......Page 271
Information Problems......Page 277
Contracting and Commitment......Page 278
Conclusion......Page 280
14 Medical Malpractice Insurance Reform: “Enterprise Insurance” and Some Alternatives......Page 281
The medical liability insurance underwriting cycle......Page 283
Reducing medical liability insurance premiums: an unworthy goal......Page 288
Reducing volatility in insurance premiums: another unworthy goal?......Page 291
Ensuring access to medical liability insurance......Page 293
Enhancing the injury prevention role of medical liability insurance......Page 295
Injury Prevention Rewards......Page 299
Reallocating the burden of medical liability insurance......Page 300
Conclusion: responding to potential objections to enterprise insurance......Page 301
Reduction in Physician Autonomy......Page 302
Administrative Complications......Page 303
15 Governments as Insurers in Professional and Hospital Liability Insurance Markets......Page 305
Large Claims and the Insurance Cycle......Page 306
Dealing Directly with Adjustment Costs......Page 310
Forms That Deal with the Causes of Volatility in Premiums and Availability of Coverage......Page 311
Forms That Deal with the Consequences of Volatility in Premiums and Availability......Page 315
Overview......Page 316
Patient Compensation Funds......Page 317
Joint Underwriting Associations......Page 321
Guaranty Funds......Page 322
Medical No-Fault Programs......Page 323
Public provision and tort reform: can government play a constructive role in liability coverage without changing the tort liability system?......Page 326
What Are Public Insurers Doing Currently?......Page 327
Is New Legislation Needed?......Page 329
bottom line: is public provision of medical malpractice insurance part of the problem or part of the solution To recurring medical malpractice insurance crises?......Page 330
Why medicare-led malpractice reform?......Page 332
Medicare Can Reconnect Malpractice Policy to Health Policy......Page 333
Common Law Tort Serves the Medicare Population Poorly......Page 334
Malpractice Adjudication Fits Well Within Medicare......Page 335
Medicare's Relationship with Physicians, Hospitals, and Other Providers......Page 337
Medicare Claims Management and Medical Review Capacity......Page 339
Medicare's Beneficiary Appeals Process......Page 341
Medicare's Beneficiary Ombudsman Program......Page 343
Legal Authority......Page 344
Substantive Components of Medicare-Led Reform......Page 348
Procedural Components......Page 358
Conclusion......Page 363
Bibliography......Page 365
Index......Page 403