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Tort reform doesn't alleviate doctors' fear
Physicians' fears of being sued for malpractice are out of proportion to their actual risk of being sued, according to a recent study by a University of Iowa researcher and colleagues.
The study also suggests that tort reform legislation aimed at controlling malpractice costs has not lessened physician concerns about malpractice lawsuits, and it may not be effective in altering defensive medicine practices like ordering unnecessary lab tests that can drive up the cost of health care, says senior study author David Katz, MD, associate professor of medicine with University of Iowa Health Care.
"We found that both generalist and specialist physicians fear being sued for malpractice, even in states where their risk of being sued is relatively low," Katz says. "One likely explanation is that physicians' concerns about malpractice are driven more by their perception that the malpractice tort process is unfair and arbitrary and less by their actual risk of getting sued."
Katz, who also is a research investigator in the Center for Research in the Implementation of Innovative Strategies in Practice at the Iowa City Veterans Affairs Medical Center, conducted the study with colleagues from the Center for Studying Health System Change in Washington, DC, and the Harvard School of Public Health. The findings were published in the September issue of the journal Health Affairs.1
The research team surveyed a nationally representative sample of physicians and found high levels of concern about being sued for malpractice among all physicians regardless of specialty or geographic location.
Physicians in the highest-risk states, however, expressed only modestly higher levels of concern than physicians in low-risk states (4.3 points on a 100-point scale). This small difference was particularly surprising given that physicians in the least risky states have less than one-third of the malpractice risk as those in the most risky states, Katz says. The researchers used objective measures of risk, such as malpractice premium rates and risk of incurring a paid malpractice claim, to calculate physicians' actual malpractice risk.
"The high levels of malpractice concern, even among physicians in relatively low-risk environments, is striking," Katz says. "One possible explanation is that most physicians do not have the information to accurately access their actual risk of being sued."
Many tort reform efforts are driven by the idea that fear of being sued leads physicians to practice defensive medicine, which raises health care costs, he says.
The study showed that several types of state tort reforms, such as caps on total damages, are individually associated with significantly reduced malpractice concerns, but the results were mixed.
Overall, Katz says the study suggests that current tort reform efforts aimed at reducing malpractice risk would be relatively ineffective in alleviating physicians' concern about lawsuits and therefore may not alter defensive medicine practices.
1. Carrier ER, Reschovsky JD, Mello MM, et al. Physicians' fears of malpractice lawsuits are not assuaged by tort reforms. Health Affairs 2010;29:1585-1592.