Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Medical malpractice reform won’t save money

Peter Ubel, MD
Policy
February 25, 2015
Share
Tweet
Share

Two problems loom large over the American medical care system. First, we spend outrageous amounts of money on health care, with too many patients receiving too many services at too high a price. Second, our malpractice system is an international embarrassment, with too many health care providers sued by too many patients for too little reason.

Many experts have pointed out that these problems are two sides of the same coin. On the cost side: the high price of medical care makes doctors and hospitals into lucrative litigatory targets. On the malpractice side, litigation drives up health care costs by forcing physicians to charge higher fees so they can pay costly malpractice insurance, and by incentivizing these same physicians to order unnecessary tests and procedures to avoid getting sued by patients who expect such interventions.

Because of the close connection between health care costs and our malpractice system, many experts contend that if we fix the latter — if we reduce the chance that health care providers will face frivolous lawsuits — we will lower costs, by reducing the need for doctors to practice defensive medicine. In effect, we’ll, um, kill two sides of the coin with one flip. (I know: Time to abandon this metaphor.)

An October study in the New England Journal of Medicine showed no reduction in health care spending in states that reformed their malpractice systems. The study focused on three states — Texas, Georgia, and South Carolina — which between 2003 and 2005 had reformed their malpractice systems so that emergency care providers could only be sued for offering care that was “grossly negligent,” a high legal bar that strongly dissuades lawyers from filing frivolous lawsuits.

If you are a physician in, say, Oklahoma, and a patient comes to your emergency room with uncomplicated low back pain, you might know medically speaking that the patient does not need a CT or MRI of his spine. But if you are worried about a malpractice suit, you might order such a test just to be safe. By contrast, in neighboring Texas you would have no reason to think this way, because you would recognize that no lawyer could make the case that forgoing an imaging test would be grossly negligent.

If you’re a doctor in North Carolina caring for a person with moderate pneumonia, you might know that her symptoms can be treated with oral antibiotics and a follow-up appointment in the primary care clinic. But you might admit her to the hospital anyway, out of concern that if her symptoms progress and she starts experiencing any kind of adverse effects, she will “lawyer up.” In South Carolina, on the other hand, you will have no lawyerly incentive to admit her to the hospital.

To test whether malpractice reform reduced health care costs, a research team led by Daniel Waxman from RAND matched each of the three reform states to five neighboring states that had no such reform. They mapped out changes in health care spending and utilization, both before and after the reforms took place. The idea here is to look for an inflection point, a change in the trajectory of health care spending in the reform states that is not seen in the states which stuck with the status quo.

Instead of inflection points, however, the researchers uncovered a series of largely parallel lines, with the exception of Texas where health care costs actually increased rather than decreased relative to its neighbors after the malpractice reform law was passed:

Effect-of-Malpractice-Reform

Average costs of emergency care? No reduction. Percent of patients sent to the hospital after emergency room evaluations? No lower. Proportion of patients receiving CTs or MRIs? Not. A. Smidgen. Of. Restraint.

There are a slew of problems with the American malpractice system. Careful studies have shown that lawsuits do not effectively target poor medical care. Many a physicians’ career has been unjustly ruined by frivolous lawsuits. But we can no longer claim with confidence that our malpractice system directly leads to increased health care expenditures.

Malpractice reform isn’t likely to save us money. But we should reform the system anyway.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.

Prev

What do bridges and public health have in common?

February 25, 2015 Kevin 0
…
Next

The frustrated and marginalized American doctor

February 25, 2015 Kevin 5
…

ADVERTISEMENT

Tagged as: Malpractice

Post navigation

< Previous Post
What do bridges and public health have in common?
Next Post >
The frustrated and marginalized American doctor

ADVERTISEMENT

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD

More in Policy

  • Unused IV catheters cost U.S. hospitals billions

    Piyush Pillarisetti
  • Why your health care dashboard isn’t working and how to fix it

    Dave Cummings, RN
  • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

    Robert E. White, Jr. & The Doctors Company
  • How new loan caps could destroy diversity in medical education

    Caleb Andrus-Gazyeva
  • Why transplant equity requires more than access

    Zamra Amjid, DHSc, MHA
  • Ideology, not evidence, fuels the anti-trans agenda

    Andie Riffer, PhD and Shawn E. Parra, LCSW, MSW
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 15 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Medical malpractice reform won’t save money
15 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...