NCPA - National Center for Policy Analysis


February 6, 2006

The heated debate surrounding potential reforms of the medical malpractice system might have a chance to cool down since new studies show that some the rhetoric behind the debate may be misleading, says Katherine Baicker and Amitabh Chandra (Regulation).

According to researchers:

  • Increases in malpractice payments do not seem to be the driving force behind increases in premiums, nor do they seem to affect the overall size of the physician workforce, although they may affect some subsets of the physician population more severely.
  • No research has linked the decline in physician supply to worse health outcomes or reduced patient satisfaction.
  • Evidence shows that the strongest effect of greater malpractice pressure is in increased use of imaging services, with somewhat smaller effects on the uses of other discretionary, generally low-risk services such as physician visits and consultations, use of diagnostic tests and minor procedures.
  • There is also little evidence of increased utilization of major surgical procedures.

Moreover, these studies have provided insight into the mechanisms through which reforms are likely (and unlikely) to operate, says Baicker and Chandra:

  • State-level tort reform is unlikely to affect the practice of medicine by averting local physician shortages.
  • There is no relationship between the level of malpractice premiums and the presence of traditional tort reform measures such as damage caps.
  • However, the evidence does not imply that traditional tort reform measures are ineffective, but it does call into question the view that states with traditional tort reforms have lower levels of premiums or defensive medicine than states that have not implemented such reforms.

Furthermore, there is little evidence to suggest that malpractice payments are driving the dramatic increase in overall health care expenditures, says Baicker and Chandra.

Source: Katherine Baicker and Amitabh Chandra, "Defensive Medicine and Disappearing Doctors?" Regulation, Fall 2005.

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