I recently picked up The Medical Malpractice Myth by Tom Baker, thinking I'd enlighten myself about the whole tort-reform/medical error debate. Baker is one of few scholars to take a substantive look at the research surrounding medical malpractice in the United States. The book is his attempt to explode the idea that frivolous lawsuits are paralyzing our system and increasing health care costs:
Adding together all the premiums of all the different kinds of liability insurance together results in a big number -- about $215 billion in 2003 -- but that number is hardly exploding, and the medical malpractice share -- $11 billion --- looks pretty small by comparison. It looks even smaller next to the $1.5 trillion plus we spent on health care that year. Something that amounts to less than 1 percent of health care costs simply cannot have the impact that the medical malpractice myth would have us believe.The stat missing from this paragraph is that more people are killed (cw is 100,000 people a year) due to medical error every year than auto and workplace accidents combined. There are much fewer lawsuits than we would actually expect given the number of patients injured every year. A look at the above numbers -- only $11 billion out of $215 billion in the insurance liability industry is for medical malpractice -- shows that the rate of death and injury isn't being reflected in premium costs.
Further, Baker actually overstates the amount of health care spending dedicated to malpractice costs -- it's not less than one percent, it's less than one half of one percent. So it's not just that we're seeing significantly fewer law suits than experts would predict, it's that the current malpractice spending in light of all health-care spending is laughably small.
That's why fixes like tort-reform won't make a difference except to make it even more difficult for injured patients to sue. Given the already infinitesimal spending on malpractice (and that stat includes premiums, legal costs, and awards), limiting lawsuits won't make a dent in health care spending, nor will it be powerful enough to rope in costs.
And while you're here reading, head over to the Medical Blog Awards to vote for me for Best Policies/Ethics Blog. Thanks!
I would like to remind you that these figures do not include the larger figures of 'defensive medicine'. Try this report from the HHS. Interesting to say the least.
aspe.hhs.gov/daltcp/reports/litrefm.pdf
Posted by: Fred Jones | January 09, 2006 at 02:39 PM
Fred, that's a position paper from the administration, not research done by HHS, and completely full of lies.
There is no outbreak of clinics closing because of malpractice costs. And with all the medical errors out there, it seems we could use a bit of defensive medicine.
But the bottom line is that defensive medicine is made up. Tomorrow I'll be posting extensively on it, so come back for your full take-down.
Posted by: Kate | January 09, 2006 at 02:46 PM
I wish people would stop quoting the 100,000 figure from the IOM study. I wonk on patient safety in our hospital, and I am an advocate for patient safety, and in a perverse way I am a little happy that the publicity from the IOM study has focused attention on patient safety.
But the study was crap. It contains so many methodological errors that the results cannot be taken at face value. It has been thoroughly discredited on an academic level, but it got so much play in the media and the political world that it has become the conventional wisdom.
Sigh.
Posted by: shadowfax | January 10, 2006 at 05:54 PM