Health Affairs, 23, no. 4 (2004): 9 doi: 10.1377/hlthaff.23.4.9 © 2004 by Project HOPE	New Online   How Would Obama, McCain Cover The Uninsured?   Debating Cost Of Uninsured   Try Medicare-For-All   HA Blog Top 10

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Malpractice Crisis

PROLOGUE

The Medical Malpractice Crisis

William Sage, from Columbia Law School, argues for overhauling the structure and financing of malpractice liability insurance. Sage attributes much of the current crisis to a widening gap between first-party health insurance and third-party malpractice insurance and urges Medicare and Medicaid to play a major role in the medical liability system of the future. Carol Liebman and Chris Hyman, also from Columbia, describe a program of medical error communication and mediation-based dispute resolution that can improve patient care as well as reduce malpractice litigation. The measures they support can be adopted voluntarily by hospitals and physicians even if political consensus is lacking. Catherine Struve, from the University of Pennsylvania Law School, focuses on the litigation process. She criticizes recent proposals for "medical courts" and "expert screening panels" and suggests simpler, more effective ways to help judges and juries make better-informed rulings with respect to both liability and damages.

The final two papers offer new empirical evidence of the current malpractice system’s adverse impact on physicians and patients. Harvard’s Michelle Mello and colleagues report results from a survey of physicians in high-liability specialties that reveal widespread provider discontent that could compromise quality of care. In a study not part of the Pew research, Harvard’s David Studdert and colleagues review a sample of high-end jury verdicts that were subject to California’s cap on noneconomic damages; they conclude that the cap is unfair to patients who suffer grave injuries involving pain and disfigurement. The picture of the malpractice crisis that emerges from this work is familiar to health care policymakers: a complicated problem deserving attention, challenging but not unsolvable.

Health Affairs gratefully acknowledges the Project on Medical Liability in Pennsylvania, funded by the Pew Charitable Trusts, which provided partial support for this section of papers.

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