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Junkie
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Mojo please see the following news articles on insurance premiums and lawsuits:
http://www.slate.com/id/2145400/
Quote:
The Medical Malpractice MythForget tort reform. The Democrats have a better diagnosis.
By Ezra Klein
Posted Tuesday, July 11, 2006, at 6:20 AM ET
The Republican answer to runaway health-care spending is to cap jury awards in medical malpractice suits. For the fifth time in four years, Senate Majority Leader Bill Frist tried and failed to cap awards at $250,000 during his self-proclaimed "Health Care Week" in May. But this time, the Democrats put a better idea on the table.
Sens. Hillary Clinton and Barack Obama also want to save on health care. But rather than capping jury awards, they hope to cut the number of medical malpractice cases by reducing medical errors, as they explain in an article in the New England Journal of Medicine. In other words, to the Republicans, suits and payouts are the ill. To the Democrats, the problem is a slew of medical injuries of which the suits are a symptom. The latest evidence shows the Democrats' diagnosis to be right.
The best attempt to synthesize the academic literature on medical malpractice is Tom Baker's The Medical Malpractice Myth, published last November. Baker, a law professor at the University of Connecticut who studies insurance, argues that the hype about medical malpractice suits is "urban legend mixed with the occasional true story, supported by selective references to academic studies." After all, including legal fees, insurance costs, and payouts, the cost of the suits comes to less than one-half of 1 percent of health-care spending. If anything, there are fewer lawsuits than would be expected, and far more injuries than we usually imagine.
As proof, Baker marshals an overwhelming array of research. The most impressive and comprehensive study is by the Harvard Medical Practice released in 1990. The Harvard researchers took a huge sample of 31,000 medical records, dating from the mid-1980s, and had them evaluated by practicing doctors and nurses, the professionals most likely to be sympathetic to the demands of the doctor's office and operating room. The records went through multiple rounds of evaluation, and a finding of negligence was made only if two doctors, working independently, separately reached that conclusion. Even with this conservative methodology, the study found that doctors were injuring one out of every 25 patients—and that only 4 percent of these injured patients sued.
The Harvard study stands for a large body of literature. On their own, however, the results don't disprove the Republicans' thesis that many medical malpractice suits are frivolous. Maybe badly injured patients don't sue, while the reflexively litigious clog up the legal system, making tort reform a viable solution. But a new study, released in May, demolishes that possibility. Dr. David Studdert led a team of eight researchers from Harvard School of Public Health, Brigham and Women's Hospital, and the Harvard Risk Management Foundation* who examined 1,452 medical malpractice lawsuits. They found that more than 90 percent of the claims showed evidence of medical injury, which means they weren't frivolous. In 60 percent of these cases, the injury resulted from physician wrongdoing. In a quarter of the claims, the patient died.
When baseless medical malpractice suits were brought, the study further found, the courts efficiently threw them out. Only six of the cases in which the researchers couldn't detect injury received even token compensation. Of those in which an injury resulted from treatment, but evidence of error was uncertain, 145 out of 515 received compensation. Indeed, a bigger problem was that 236* cases were thrown out of court despite evidence of injury and error to patients by physicians. The other approximately 1,050 cases, in the research team's opinion, were decided correctly, with damage awards going to the injured and dismissal foiling the frivolous suits.*
Nor is there evidence to show that the level of jury awards has shot up. A recent RAND study looked at the growth in malpractice awards between 1960 and 1999. "Our results are striking," the research team concluded. "Not only do we show that real average awards have grown by less than real income over the 40 years in our sample, we also find that essentially all of this growth can be explained by changes in observable case characteristics and claimed economic losses."
Which brings us back to the Republicans' and Democrats' divergent approaches. The Obama-Clinton legislation fits well with Studdert's and RAND's findings. It also builds on successful efforts by the nation's anesthesiologists and a few hospitals to reduce their medical malpractice payouts.
Anesthesiologists used to get hit with the most malpractice lawsuits and some of the highest insurance premiums. Then in the late 1980s, the American Society of Anesthesiologists launched a project to analyze every claim ever brought against its members and develop new ways to reduce medical error. By 2002, the specialty had one of the highest safety ratings in the profession, and its average insurance premium plummeted to its 1985 level, bucking nationwide trends. Similarly, feeling embattled by a high rate of malpractice claims, the University of Michigan Medical System in 2002 analyzed all adverse claims and used the data to restructure procedures to guard against error. Since instituting the program, the number of suits has dropped by half, and the university's annual spending on malpractice litigation is down two-thirds. And at the Lexington, Ky., Veterans Affairs Medical Center, a program of early disclosure and settlement of malpractice claims lowered average settlement costs to $15,000, compared with $83,000 for other VA hospitals.
Clinton and Obama would offer federal grants and support to unroll such programs nationwide. And they want to create a national database to track incidents of malpractice and fund research into standards, procedures, and technologies that would prevent future injuries. So, what say you, Bill Frist? Is it time for another Health Care Week?
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http://www.consumeraffairs.com/news0...ce_pubcit.html
Quote:
Report Finds No Link Between Doctors' Premiums and Malpractice Suits
April 21, 2005
Malpractice Insurance
• Malpractice Insurers Inflated Losses, Study Finds
• Report Suggests Malpractice Insurance Price-Gouging
• Report Finds No Link Between Doctors' Premiums and Malpractice Suits
• GE: Malpractice Caps Don't Work
A new report finds no link between doctors' rising insurance premiums and medical malpractice lawsuits filed by injured patients.
At the same time that insurance rates in some areas have been climbing, the number and total value of malpractice payouts to patients have been flat since 1991 and, in fact, show a significant decline since 2001, when the spike in insurance rates began, the Public Citizen study found.
"The hard, factual evidence cannot be any clearer: We have no medical malpractice lawsuit crisis in America," said Joan Claybrook, president of Public Citizen.
"Insurance companies may be padding their bottom lines by jacking up rates on doctors, but it is not because of patients seeking relief for bad medical care through our courts. The true crisis continues to be in inadequate measures for patient safety and incompetent medical care by a small number of physicians," she said.
The data show that from 1990 to 2004, only 5.5 percent of doctors account for 57.3 percent of all malpractice payments. In addition, only 11.4 percent of doctors who have made three or more malpractice payouts have ever been disciplined.
The medical malpractice payment trends report analyzes the most current information from the federal government's National Practitioner Data Bank (NPDB). The NPDB reports on malpractice payments made on behalf of doctors by malpractice payers, such as insurance companies, state-run insurance funds and self-insured health care providers. Those making malpractice payments are required by federal law to report them to the NPDB.
The NPDB also contains information about disciplinary actions taken against doctors and provides a repository of data that those employing doctors can query for background checks.
In analyzing records from the NPDB, Public Citizen found that:
• The annual number of malpractice payments is down. Despite alarms by doctors and insurers about a "crisis," the number of malpractice payments paid on behalf of doctors - chiefly by their insurance companies - has fallen over the past three years, from 16,682 in 2001 to 14,441 in 2004, a drop of 13.6 percent. The 2004 number is only 5.5 percent higher than the 13,687 payments recorded for 1991. Adjusting for population growth, the number of payments per 100,000 people has fallen from 5.85 to 4.91 from 2001 to 2004, a decline of 16.1 percent. Since 1991, the number of payments per 100,000 people has dropped by 9.2 percent, from 5.41.
• The total value of malpractice payments has been flat since 1991. Total malpractice payments increased from $2.1 billion in 1991 to $4.2 billion in 2004. However, from 1991 to 2004, the inflation-adjusted amount has changed little, rising from $2.1 billion to $2.3 billion - an average annual increase of only 0.8 percent.
• Jury verdicts are not out of control. The median size of payments from judgments appears to have soared, from $125,000 in 1991 to $265,000 in 2004. But adjusted for inflation, the median payment grew from $125,000 in 1991 to $146,100 in 2004 - an average annual increase of only 1.2 percent.
• There has been a 56 percent decline in million-dollar payouts. The incidence of payments of $1 million or more, adjusted for inflation, is down 56 percent from 1991 to 2004, from 2.25 percent of all payments to just 1 percent of all payments. Even during the so-called "crisis" years between 2001 and 2004 when insurance rates were spiking, the incidence of large payments declined 31 percent, from 1.44 percent of payments to 1 percent.
• The incidence of surgical and obstetrics payouts has not increased. Although surgeons and obstetricians complain the loudest about malpractice insurance rate hikes, the incidence of surgical and obstetrics payouts is virtually unchanged from 1991 to 2004. In 1991, 9.5 percent of all payouts were for obstetrics cases; in 2004, the figure was the same. Surgical cases accounted for 25.6 percent of payments in 1991, and 26.1 percent of payouts last year.
• Cases of serious injury to patients continue. Three-quarters of payments for 2004 involved major or significant injuries, or death, and these most severe cases account for 89 percent of the value of payouts made. "Failure to diagnose" cases have grown from 16 percent of payouts in 1991 to 20 percent in 2004, while "improper performance" cases have grown from 10 percent to 15 percent of payouts.
"The evidence shows that the system is working as it should, with minor injuries receiving little compensation and the great bulk of malpractice awards going to cases of major, debilitating injuries - or death," said Frank Clemente, director of Public Citizen's Congress Watch.
"Rather than complain about medical malpractice lawsuits, the medical community should address its own failings and strive aggressively to improve the performance and competency of its doctors and better protect patients. That is the surest way to keep both doctors and patients out of the courtroom."
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These are some pretty telling statistics that seem to discount the notion that it is frivolous lawsuits that are causing the premiums to go up and point toward greed being the cause. |