Medical Malpractice and Insurance

Medical Malpractice Myth Review

A summary of the book

The Medical Malpractice Myth authored by Tom Baker, tackles the complex subject of medical malpractices in an insightful and concise manner. Mr. Baker is an accomplished professor of law who specializes in Insurance and Tort Law. In the first few pages of the book, Mr. Baker, lays out the myth; i.e. that an unprecedented number of people are filing medical malpractice lawsuits and that lawyers and their clients are reaping hundreds of thousands if not millions of dollars in unjustified awards, while medical doctors are struggling to pay huge insurance premiums which have already forced some to close their practices (Noah, 2005).

The book is written in eight chapters. In the first chapter, Baker lays out the myth and provides plenty of evidence to its contrary. He then points his readers to the real problem that is facing the health care industry; i.e. not too many lawsuits against physicians but too many instances of medical malpractices. He then explains that the real cost of medical malpractices is not the financial burden on doctors but the number of lost lives, pain, suffering lost wages and productivity and additional medical fees that those who are suing have to bear.

From the second chapter to the seventh one, Baker investigates and elaborates on a number of different aspects about the myth in detail. In the second chapter, he points to the fact that healthcare professionals and the public in general should be more worried with the rising cases of medical malpractice and not the number of lawsuits. In the third chapter, he persuasively contends that the real culprit for high medical malpractices insurance premiums is the insurance sector's management of reserves, profits and losses during different seasons of the underwriting cycle and not the litigations against doctors and hospitals (Baker, 2007). In the fourth chapter, Baker provides evidence against the notion that more and more patients are filing frivolous suits and that an increasing number of judges and juries are awarding them huge amounts of money in damages even in cases where physicians have observed their duty of care. Baker then covers the value of litigation in helping in compensating injured patients and in improving the safety of patents; the misconception that defensive medicine is one of the top reasons for increased costs of health care; and the myth that fear of facing malpractice lawsuits is decreasing the supply of physicians and making it difficult for people to access health care in the fifth, sixth and seventh chapters respectively. Lastly, in the final chapter Baker proposes a number of reforms to deal with some of the identified problems in the medical malpractice system of litigation (Noah, 2005).

All the reforms proposed by Baker are evidence-based and are meant to achieve the following goals:

1. Significantly reduce the incidences of medical malpractice

2. Increase awareness in the general public to enable patients to evaluate whether their negative medical outcomes constitute medical malpractices before they file lawsuits.

3. To improve compensation for medical injuries

4. To reform the medical malpractice insurance industry so that the underwriting cycle doesn't exert unnecessary financial pressure on doctors (Baker, 2007).

Baker acknowledges the fact that these reforms are not easy to achieve and that the individuals pushing for them will have to surmount significant challenges to achieve them (Noah, 2005).

The Motive for Writing the Medical Malpractice Myth

Baker (2007), describes his motive for writing the book as an effort to reframe the public discourse on medical malpractice lawsuits. And that by doing so the concerned parties can see the truth and start acting accordingly. According to Coombs, this shows that the targeted readers are politicians and other policymakers who might have accepted the myths and misconceptions that Baker is challenging in his book.

Illumination of One Or More of The Biomedical Ethical Concerns, Explicit or Implied, To Which the Book Gives Useful Insight.

Professor Baker highlights the thinking that there are many cases in which plaintiffs obtain large damages even though the defendants were not negligent; and that such lawsuits have led to: physicians wasting considerable resources on defensive medicine; significant increases in insurance premiums; and excellent physicians losing their jobs or closing their private practices (Coombs). However, according to him this is not true. Baker first highlights the fact that in a report to the congress, the Office of Technology Assessment, said there were no good or bad effects to medical malpractice litigations (Baker, 2007). He also points out that only two studies have somewhat indicated that such lawsuits did not result in improved healthcare outcomes for patients. More multi-ethnic research did not find any proof that that the malpractice litigation system provokes defensive medicine (maybe since the change to managed care from fee-for-service offers a solid counter-force through constraining payment for the practices which cannot be substantiated by the health needs of the patient. Baker observes that there is an issue with the utilization of procedures and tests that have minute or absolutely no benefit at all. According to him, the appropriate solution is medical management that is evidence-based, and not restriction of the rights of patients to seek out reparation for iatrogenic occurrences (Coombs).

Professor Baker presents a nuanced and careful analysis of the malpractice insurance market. Baker mentions that the episodic appearance of "hard markets," whereby insurance rates quickly rise, is a relic of the innate volatility of such markets. Regulations of insurance necessitate companies to annually alter their reserves to show their evaluation of foreseen losses. The "long tail" (the extended duration from an act of supposed malpractice to final resolve), the somewhat huge amounts at stake in numerous claims, as well as the inflation in healthcare costs which could increase the likelihood of damages moving forward make it challenging for insurance companies to precisely foresee their eventual exposure. These ambiguities, joined with the requirement for actuarial conservatism, occasionally result to sharp increments in needed reserves and an ensuing spike in the premiums (Coombs).

Generally, the supply of doctors responds a lot more to focused incentives like fiscal aid for medical school education, than to the indirect impacts of the litigation system. There is an issue of few doctors in the rural areas since the probable earnings for such doctors are a lot less than anywhere else. There might be a similar marginal effect for those whose promise to carrying on in practice is less strong (for instance older doctors), or even younger doctors who chose a practice specialty and location. Baker acknowledges that the single area whereby malpractice appears to considerably affect the practice decisions of any physician is obstetrics. A number of doctors leave obstetrics, focusing the practice in the hands of a smaller number of physicians. This might, however, enhance the quality of care given that the remaining doctors will likely be more experienced. Baker notes that there is a subjective but little hard proof of any substantial drop in access to care as an outcome of malpractice litigation (Baker, 2007). Just like defensive medicine and malpractice insurance premiums, a real problem exists, though less serious than portrayed by the myths' proponents. Altering the rules for medical malpractice litigation is a greatly inept way of reacting to these issues (Coombs).

Finally, provide a personal response and recommendation that might be useful to other students.