For Doc Liability
From Obama’s big med speech:
Many .., particularly on the Republican side … have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. … I don’t believe malpractice reform is a silver bullet, but I’ve talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I’m proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine.
But only a small percentage of actual malpractice ever leads to a suit, and a new NBER analysis says:
Growth in malpractice payments over the last decade and a half contributed at most 5.0% to the total real growth in medical expenditures, which topped 33% over this period. On the other side of the ledger, malpractice liability leads to modest reductions in patient mortality; the value of these more than likely exceeds the cost impacts of malpractice liability.
A Vladimir Shklovsky emailed a few weeks ago saying that under current US liability law the fact that some practice is standard in an industry is a defense against a liability suit, but it is not an absolute defense. Except in medicine; you simply can’t be legally liable for anything you did if most other docs do it too.
I recall reading in Paul Starr’s classic The Social Transformation of American Medicine that what first gave US docs power was that at the time, local med practice was an absolute defense. So if you didn’t play ball with the local docs, they’d refuse to defend you in such suits, leaving you open to devastating liability.
Amazingly, we are so terrified of the idea that our docs might not do everything possible to save us that we simply will not allow anyone else to question their judgment. Not insurance companies, not academics, not legal judges or juries. And so it seems, not even other docs.
It's actually a good signaling subject.
Malpractice insurance itself is not a large expense for most doctors (OB/GYN and neurosurgeons being the most serious exceptions).
In my conversations with doctors, they have admitted to me that defensive medicine is primarily practiced not to avoid money costs, but because doctors don't like being sued. It's a reputational and personal embarrassment.
As a practical matter, if true, that suggests that tort reform which handles suits quietly and discreetly, with a minimum of aspersions cast upon the doctor and a minimum amount of time required from the doctor to defend himself, would be far more effective at reducing the cost of defensive medicine than tort reform that reduces malpractice awards, even if they reduce them very substantially.
@ Bill: "There may be differences in outcomes, but not on a risk adjusted basis. You see, if it is really risky, and where you have a systemic risk, the docs do it in the hospital."
Not in our community. The figures *are* risk adjusted. Our docs purposely take the risky cases to our hospital because it has the best post-op care and the best chance of patient survival. In reality, the results have caused one of the local non-profits to shut down their heart program, and to buy a percentage of our facility. It is *the hospital*.
True enough about the Medicare compensation when we started, but there have been *huge* cutbacks, and our margin in quite small. It's nor nearly as good an investment as say my wife's Merle Norman cosmetic franchise.