How The Nation’s Poor Safety Net Infrastructure Contributes To Higher Malpractice Costs

Michelle Mello, the author of two studies which found that malpractice costs make up a small percentage of national health care expenditures and that malpractice reform does not significantly decrease physicians’ malpractice anxiety, appeared on C-SPAN’s Washington Journal this morning to discuss her findings and answer viewer questions. Mello argued that even though tort reform is not the silver bullet for lowering health spending, it may help increase the number of physicians and improve the quality of health care.

Importantly, Mello also said that the nation’s poor unemployment and disability systems may be pushing a growing number of individuals to look “toward tort litigation to get those expenses covered”:

MELLO: There is more of a culture of accountability here in U.S. than in other countries, and there is certainly higher level of litigation across all sectors, not just the medical malpractice arena. What makes it, I think, even more complicated with respect to medical malpractice is that we historically have done a lousy job of providing other kinds of social insurance that might meet patients’ needs in the aftermath of a medical injury. Most of the other countries that litigation is low, have made other provisions for taking care of these folks. Whether it’s through a disability insurance scheme, a comprehensive health insurance system that covers everybody without them having to pay. Or an accident injury compensation fund that’s administered by the government or private entities to which people can apply for compensation. So I think there are two factors going on here. One is cultural and the other is, do we drive people to the liability system by failing to provide fo their needs in other ways?

Watch a compilation of her appearance:

The liability system is also sometimes used to weed out poor physicians, Mello explained. “We’re not particularly aggressive using our state medical boards and other disciplinary problems to go over these quality problems. We tend to rely on lawsuits as a means of highlighting those practicing substandard care,” she said, explaining that since only a small number of patients ever file a claim, substandard physicians are often left intact.

Indeed, even though just 2% of malpractice events are ever brought as claims, malpractice litigation is much more common in the United States than in other countries. According to a Health Affairs study from 2005, “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.” U.S. malpractice payments, however, were on average lower “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.”