At the Intersection of Health, Health Care and Policy Cite this article as: Emily Carrier Malpractice And Liability Reform: The Author Replies Health Affairs, 32, no.11 (2013):2059 doi: 10.1377/hlthaff.2013.1098
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2013 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
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doi:
10.1377/hlthaff.2013.1098
Malpractice And Liability Reform: The Author Replies Mike Stinson and Katie Orrico argue in favor of adopting traditional tort reforms such as damages caps at the federal level, based on evidence from well-designed studies 1 showing an association between a bundle of such reforms and lower hospital spending for Medicare beneficiaries. My colleagues and I (Aug 2013) agree that both these studies and our own prior work 2 found a significant effect of damages caps on the practice of and attitudes about defensive medicine. What is striking, however, is how modest the effect’s size is. Health care provider organizations have lobbied for damages caps and other tort reforms with a vehemence that suggests their adoption will end our nation’s struggle with overuse of health care services. However, the evidence shows these reforms are no panacea. A recent Congressional Budget Office analysis 3 predicts that a comprehensive set of national tort reforms would reduce national health spending by just 0.5 percent. More than half of the states already have damages caps, and our work shows that even in the presence of such reforms, physicians still experience the liability environment in their state as deeply worrisome. The considerable energy that has been poured
into lobbying for damages caps might be better directed toward adopting measures that have a real chance of assuaging the anxiety described by Edward Volpintesta: not just limiting providers’ liability, but providing alternative ways of resolving disputes over medical injuries. Marina Cuttini and colleagues describe findings similar to ours in a very different geographical and clinical setting. We note that our regression model was specified according to previous research2 that showed no strong independent relationship between physicians’ concern level and factors such as practice type. However, we agree with Cuttini and colleagues that further research can help clarify the way physicians’ concerns affect their clinical decision making. Emily Carrier Center for Studying Health System Change WASHINGTON , D . C . NOTES 1 Kessler DP, McClellan M. Do doctors practice defensive medicine? Q J Econ. 1996;111(2): 353–90. 2 Carrier ER, Reschovsky JD, Mello MM, Mayrell RC, Katz DA. Physicians’ fears of malpractice lawsuits are not assuaged by tort reforms. Health Aff (Millwood). 2010;29:1585–92. 3 Congressional Budget Office. Letter to the Hon. Bruce L. Braley [Internet]. Washington (DC): CBO: 2009 Dec 29 [cited 2013 Aug 20]. Available from: http://www.cbo.gov/sites/default/files/ cbofiles/ftpdocs/108xx/doc10872/12-29-tort_ reform-braley.pdf
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The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/32/11/2059.1.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2013 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on May 29, 2015 by guest
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
doi:
10.1377/hlthaff.2013.1098
Malpractice And Liability Reform: The Author Replies Mike Stinson and Katie Orrico argue in favor of adopting traditional tort reforms such as damages caps at the federal level, based on evidence from well-designed studies 1 showing an association between a bundle of such reforms and lower hospital spending for Medicare beneficiaries. My colleagues and I (Aug 2013) agree that both these studies and our own prior work 2 found a significant effect of damages caps on the practice of and attitudes about defensive medicine. What is striking, however, is how modest the effect’s size is. Health care provider organizations have lobbied for damages caps and other tort reforms with a vehemence that suggests their adoption will end our nation’s struggle with overuse of health care services. However, the evidence shows these reforms are no panacea. A recent Congressional Budget Office analysis 3 predicts that a comprehensive set of national tort reforms would reduce national health spending by just 0.5 percent. More than half of the states already have damages caps, and our work shows that even in the presence of such reforms, physicians still experience the liability environment in their state as deeply worrisome. The considerable energy that has been poured
into lobbying for damages caps might be better directed toward adopting measures that have a real chance of assuaging the anxiety described by Edward Volpintesta: not just limiting providers’ liability, but providing alternative ways of resolving disputes over medical injuries. Marina Cuttini and colleagues describe findings similar to ours in a very different geographical and clinical setting. We note that our regression model was specified according to previous research2 that showed no strong independent relationship between physicians’ concern level and factors such as practice type. However, we agree with Cuttini and colleagues that further research can help clarify the way physicians’ concerns affect their clinical decision making. Emily Carrier Center for Studying Health System Change WASHINGTON , D . C . NOTES 1 Kessler DP, McClellan M. Do doctors practice defensive medicine? Q J Econ. 1996;111(2): 353–90. 2 Carrier ER, Reschovsky JD, Mello MM, Mayrell RC, Katz DA. Physicians’ fears of malpractice lawsuits are not assuaged by tort reforms. Health Aff (Millwood). 2010;29:1585–92. 3 Congressional Budget Office. Letter to the Hon. Bruce L. Braley [Internet]. Washington (DC): CBO: 2009 Dec 29 [cited 2013 Aug 20]. Available from: http://www.cbo.gov/sites/default/files/ cbofiles/ftpdocs/108xx/doc10872/12-29-tort_ reform-braley.pdf
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