Wendesday Health Stuff

Hey everyone, I'm back! Thanks to all the well-wishers and commentors while I was gone. The appointment went well; I won't be having surgery for at least 2 and half weeks, possibly much longer. So rest assured I'll providing my usual commentary until then.

For now, I want to point you all to Graham, who wrote on Atul Gawande's recent New Yorker interview. The post originally caught my attention because someone highly recommended me Gawande's book, Complications: A Surgeon's Notes on an Imperfect Science.

In the magazine, Gawande comments on malpractice:

Are American doctors in a tougher position than those in, say, Great Britain or Canada?

The major difference between malpractice here and in Great Britain and Canada turns out not to be in the number of lawsuits. At this point, the U.K. and Canada seem to be catching up with our rate of lawsuits. The big difference is that the awards are far smaller. This is partly because of the traditions of their court systems, but it’s also because they have universal health coverage. Patients in those systems already have their medical expenses covered for their lifetime, as well as some disability benefits. So malpractice awards are restricted to other costs—lost wages, or compensation for suffering, for example—and these are much smaller costs on the whole.

Gawande's point seems pretty solid to me. Health care costs for a disabled child or chronically critical loved one can easily reach $1 million, and when heatlh care coverage isn't assured, that's a terrifying sum.

It makes sense, except that he's wrong. This Health Affairs article found that the average payment per judement in the UK was 36% higher than the average payment in the U.S.

Surprisingly, U.S. malpractice payments (including both cases that resulted in a judgment for the plaintiff and cases resulting in a settlement) were lower, on average, than those in Canada and the United Kingdom. In 2001 the average payment in the United States was $265,103, which was higher than in Australia but 14 percent below Canada and 36 percent below the United Kingdom. While U.S. media and public attention have focused on multimillion-dollar awards at the upper end of the range, the average was actually smaller than in Canada and the United Kingdom in 2001.

So, I'm not entirely sure where Gawande is getting his numbers from, but there's a serious disconnect here. If the UK payments had been 5% higher than U.S. payments, that'd be one thing. But the average UK payment here was $411,171 to the U.S.'s $265,103.

I'm hoping to see some good letters to the editor point this out. Anyone else have an idea if this could be a reasonable discrepancy? Or is Gawande just flat out wrong?

Comments

[Adrock]

Interesting. What about the percentage of suits v.s. the number of citizens? (The article is subscription only.) I'm curious to know if overall we have more suits.

[Kate]

Yeah, I'm sorry about Health Affairs the subscription stuff. I know it's a pain.

"In terms of the number of suits, Are more malpractice claims filed in the United States? The United States had 50 percent more malpractice claims filed per 1,000 population filed than the United Kingdom and Australia, and 350 percent more than Canada (Exhibit 3). Two-thirds of the U.S. claims were dropped, dismissed, or found in favor of the defendant; in one-third, plaintiffs received compensation after a settlement or judgment. The same distribution of claim results occurred in Canada. In the United Kingdom, fewer claims are dropped and dismissed and more are settled; during 1995–2002, 36 percent of claims were dropped, 60 percent were settled, 1 percent were found for the defendant, and 2 percent were found for the plaintiff."

So there you go -- we had a lot more suits, but many more were dropped. Looking at the numbers, I think we still have more claims overall, but considering how many are dropped, not a huge number more.

The problem is that bringing all those claims, even when they're dismissed, cost a lot of money.

[almostinfamous]

atul gawande is from around athens, ohio(where i currently live) and his dad's a pretty well known guy around this area and i've actually met atul gawande a couple of times. next time i see him, i'll try to remember and tell him about this :)

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