The opinion of the groups that are concerned with the patient rights and safety is that the policy measures undertaken to reform tort claims and revamping the malpractice insurance did not do much towards addressing the nucleus of the malpractice crisis i. e. , the ‘medical errors’. The medical errors are found to be highly prevalent in the market. The recent malpractice had differed from the earlier ones in that in recent times there is growing awareness among the public about the occurrence of medical errors.
“The Institute of Medicine’s 2000 report, To Err Is Human: Building a Safer Health System, brought wide attention to the issue, estimating that 44,000 to 98,000 hospital deaths per year are attributed to medical errors. ” (Mello, M, 2004) The focus on the medical errors has shifted the objectives of the policy measures about the malpractice. It has placed the providers in a disadvantageous position of disproving that the malpractice litigation is unreasonable.
(Mello et. al 2005) The demand for enhancing the patients’ safety aspects in the policy measures has also shown an increasing tendency as a result of the growing awareness of the effect of medical errors. (Schoenbaum and Bovbjerg, 2004) Another impact of the shifting focus towards medical errors is to make the state and federal regulators to provide for more detailed disclosure requirements of adverse events for the information of the patients.
This has also caused an increase in the crisis since detailed information on medical errors may lead to more number of patients making claims in respect of their similar sufferings which in turn will make the insurers shy away from the malpractice insurance. In a nutshell the patient safety movement has affected the malpractice insurance system as such and the kinds of policy responses which may get the support from the public. Impact of Medical Malpractice Insurance on Physicians and Patients
The health care quality, health care costs, and the access to the health care are some of the issues which are impacted by the rising costs of medical malpractice insurance. There are estimates that malpractice costs account for less than 2 percent of the national health spending. There is increasing concerns about the growing cost of defensive medicine which in turn increases the medical malpractice costs and also jeopardizes the quality of the treatment to the patients. (Kaiser Family)
Over the past decades increases in the medical malpractice insurance premiums have restricted affordability of the physicians and which in turn made the physicians to discontinue providing certain services to the patients. In addition lack of profitability on the malpractice insurance products has made some large insures stop selling their products with the result that the physicians will not be able to obtain the necessary coverage to protect their liability. (GAO) The following are some of the issues which the physicians face as a direct impact of the mounting malpractice insurance costs:
• The medical malpractice insurance premiums have been steeply increasing and it has reached a maximum increase of 14 percent which eats up to the earnings of the practitioners. This demoralizes the physicians to offer professional services with an open mind and this directly affects the welfare of the patients. Ridgely Ochs reports “Nassau and Suffolk, markedly litigious areas, have the highest combined medical malpractice insurance rates in the state — 22 percent higher than Manhattan and 72 percent higher than Syracuse.
And high-risk specialties such as obstetrics and neurosurgery have been suffering for a decade or so due to lower managed care reimbursements and rising costs, including malpractice coverage. ” • The physicians claim in most of the cases of malpractice claims the injury to the patients is caused by the medical system failures and the present malpractice system do not recognize this element and since the hospitals and other service providers may not be held liable the physicians have all been made to face the brunt of the malpractice claims.
Though this statement cannot be taken as true in its entirety there is an element of flaw in the medical malpractice system to make the physicians liable for even the medical errors that have resulted in the injury to the patients. However this claim by the physicians is countered by the Joseph Awad, the past president of the New York State Trial Lawyers’ Association in saying “There’s only one reason insurance premiums are going up and that’s because of damages by medical errors.
” According to Joseph Awad, the 1999 study by National Academy of Science’s Institute of Medicine reported that 98,000 people die every year for reasons arising out of medical errors. He further complains that the physicians do not even making the basic changes necessary for the profession like using the computers for prescription in that still they deliver handwritten prescriptions. • There is always a claim that there are inequalities in the jury awards in malpractice related judgments.
These inequalities in turn cause increases in the malpractice insurance premiums and the physicians cannot afford to protect them with the high cost involved in buying the insurance. But this argument is also criticized on the basis of the finding of the Center for Justice, & Democracy, a national consumer group that has a special objective o tracking the civil justice and insurance related issues.
According to this group the medial errors form the root cause for the inflation in medical malpractice insurance costs and not the jury’s awards. This finding is based on the data on the claims since mid 1980s considered by the group. • The biggest impact on the patients because of the increase costs of the medial malpractices insurance on the patients is the quality of medical care being provided to them.
This is seriously affected by the attitude of the physicians in asserting their position with respect to meeting the cost of malpractice insurance costs. At one end there is the high premium costs which takes a huge toll of the earnings of the physicians which make them rethink of covering the professional liability which in turn makes them reserve some of their professional capabilities being extended to the patients, simply because they are not able to cover their liabilities on those professional skills owing to the high cost of premiums.
Another factor that deters from extending the required services to the patients is the inherent fear in them of the possible claims that they may be asked to pay back to the patients due to some mistakes in diagnosis or errors in medical procedures for which he is directly responsible and also for any medical error which may result because of the medical system failures for which he is made indirectly responsible. In any case the ultimate sufferers are the patients.
Conclusion The issue of medical malpractice is challenged by the fact that the availability of data to make a precise assessment of the scope of the problem and the impact of the policies affecting the malpractice is often lacking or incomplete. For instance the malpractice cases that do not result in a jury award either because of an out of court settlement or dismissed for some reasons are not included in the data base that are being used in the research.
However in view of the seriousness of the issue of medial malpractice insurance and the mounting costs thereof, the American Insurance Association has suggested wide ranging reform measures which among others include the following: • Setting up limits on non-economic damages – Claim costs have been found to be lower in those states where the limits on non-economic damages are in place. An analysis of the claims shows that in states like California, Colorado, Indiana, and Maryland it is found that the average loss costs per physician lower than other states.
Large states without such caps like Florida, New Jersey, New York, and Pennsylvania have the highest medical malpractice loss costs. According to U. S. Office of Health and Human Services, (Addressing the New Health Care Crisis: Reforming the Medical Litigation System to Improve the Quality of Healthcare March 2003), there has been an increase of 18% in the premium costs, in the states with non-economic damage limits of $250,000 or $350,000. In those states where there are no such caps the increase has been found to be in the range of 45%. • Reimbursements from collateral sources are to be made to offset the claim amounts.
• Proposals for abolition of joint liability • With a view to reduce the time involved in the processing of the litigation relating to the malpractice claims a pre-trail screening of the claims is suggested as a proposal for reform • Limits on punitive damages, stricter rules on expert witness testimony and controls on attorney fees are some other proposals for reforms. (AIA).
References: AIA ‘Medial Liability Reforms’ American Insurance Association <http://www. aiadc. org/AIAdotNet/landing. aspx? docid=304378> Anderson GF, Hussey PS, Frogner BK, Waters HR.
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