Health Affairs, 26, no. 3 (2007): 903 doi: 10.1377/hlthaff.26.3.903 © 2007 by Project HOPE	New Online   House Health Reform Bill   Paying for Reform   Vetting AHIP's Report   HIV/AIDS Costs   Brief: Insurance Reform   HA Blog Top 10

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Letters

Bad Modeling?

The model, however, is based on a large group of anonymous "experts" making judgments on the basis of their own disclosure experiences. Whether they have any and how much is undisclosed. Then a Monte Carlo procedure is used to attempt to correct for uncertainty. This is problematic at best. What’s more, although the authors acknowledge that our 1999 paper is the only study to examine the disclosure-claim relationship, they still draw their conclusions entirely from their questionably expert-based model.¹

Our report of seven years’ experience using a full disclosure and voluntary compensation system (which is now in its twentieth year) supported a conclusion of more claims but no more direct cost. This was the case despite disclosure (without exception) and compensation for all sizes of errors and injuries, not only the ones large enough to attract an attorney. Studdert and colleagues state that "disclosure is the right thing to do; so is compensating patients who sustain injury as a result of substandard care." Yet they seem sanguine in publishing a flawed study that is apt to encourage risk managers to stay the deny-and-defend course because of the (unfounded) fear of doubling or tripling their liability exposure. We see this as both irresponsible and bad science.

Steve S. Kraman and Ginny Hamm
University of Kentucky, College of Medicine, Lexington, Kentucky Veterans Affairs Medical Center, Lexington, Kentucky

NOTES

 

1. S.S. Kraman and G. Hamm, "Risk Management: Extreme Honesty May Be the Best Policy," Annals of Internal Medicine 131, no. 12 (1999): 963–967.[Abstract/Free Full Text]

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