Wednesday, May 10, 2006

Closed Claims Analyais from NEJM

The NEJM has a fascinating piece [full text costs money] out this week by David Studdert et al. analyzing closed malpractice claims.  The abstract:

Background
In the current debate over tort reform, critics of the medical malpractice system charge that frivolous litigation — claims that lack evidence of injury, substandard  care, or both — is common and costly.

Methods
Trained physicians reviewed a random sample of 1452 closed malpractice claims  from five liability insurers to determine whether a medical injury had occurred and,  if so, whether it was due to medical error. We analyzed the prevalence, characteristics, litigation outcomes, and costs of claims that lacked evidence of error.

Results
For 3 percent of the claims, there were no verifiable medical injuries, and 37 percent  did not involve errors. Most of the claims that were not associated with errors (370  of 515 [72 percent]) or injuries (31 of 37 [84 percent]) did not result in compensation; most that involved injuries due to error did (653 of 889 [73 percent]). Payment  of claims not involving errors occurred less frequently than did the converse form of inaccuracy — nonpayment of claims associated with errors. When claims not  involving errors were compensated, payments were significantly lower on average  than were payments for claims involving errors ($313,205 vs. $521,560, P = 0.004).  Overall, claims not involving errors accounted for 13 to 16 percent of the system’s  total monetary costs. For every dollar spent on compensation, 54 cents went to administrative expenses (including those involving lawyers, experts, and courts). Claims  involving errors accounted for 78 percent of total administrative costs.

Conclusions
Claims that lack evidence of error are not uncommon, but most are denied compensation. The vast majority of expenditures go toward litigation over errors and payment of them. The overhead costs of malpractice litigation are exorbitant.

The issue also contains an interesting piece [again, full text costs money] by George Annas arguing that the tort system represents, rather than a barrier to hospital safety, in fact the best hope for improving hospital safety.

(Thanks to Seth Oldmixon in the comments on the prior entry for pointing both articles out.)

http://lawprofessors.typepad.com/tortsprof/2006/05/closed_claims_a.html

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