True Cost of Malpractice Insurance in the Health Services Industry Term Paper

Excerpt from Term Paper :

Rising Cost of Medical Malpractice: The Impact of Medical Insurance on Patients and Physicians

The purpose of this study is to examine the extent to which rising medical malpractice premiums have affected the quality care provided by physicians. Research suggests that a majority of specialty practitioners are pulling out of practice because of rapidly rising medical insurance premiums. A majority of physicians are unable to pay premiums that are rising upwards of 43% on average per year. Research has suggested that the recent crisis is due to a number of factors, including a recessive economy and excessive jury awards in recent claims. The solution lies not solely in legislative measures that entail caps on punitive damages, but rather more intensive examination of the cause of such premium increases and examination of more alternative solutions. This study aims at examining the causes and consequences of rising premiums, and examination of proposed solutions to the potential crisis of American health care. If a solution is not found, research suggests that with more frequency, the quality of health care provided will decline and more and more practitioners drop out of practice as a result of an inability to afford ever increasing premiums.

Chapter One: Introduction and Problem Statement

Medical malpractice premiums have increased exponentially during the last decade, resulting in a decreased pool of qualified physicians available to consumers seeking quality care. As a consequence, consumers are left with fewer and fewer options when seeking out quality medical care. In some circumstances, consumers are left with no convenient available options. In addition, physicians are faced with the ever looming prospect of discontinuing many services formerly offered patients. Physicians are dropping many practices as a result of an inability to cover the premiums associated with insuring such services. Many physicians have been forced out of practice as a result of rising medical malpractice premiums. Patients have found themselves faced with the crisis of finding qualified professionals in an ever shrinking market. A majority of smaller physician practices find themselves at a crossroads; desiring to provide patients with the utmost in quality care, but unable to do so because of exorbitant premiums.

Health care costs and insurance premiums are both a social and economic problem (Gilfillan, 1993). Rising insurance premium costs affects consumers and physicians equally; physicians are plagued by rapidly rising premiums causing them to reduce either the quality or volume of care offered to patients. Patients are forced to select from a narrowing pool of physicians due to the changes resulting from physicians dropping out of critical care practice. Yet premiums continue to rise, and adequate solutions have yet to be developed and implemented across the board.

Due to many factors, in recent years health insurance premiums and medical malpractice insurance premiums have risen to remarkable rates (Gilfillan, 1993). Part of the rapid increase in health insurance premiums has been attributed to the decline in the economy. Additionally, rapidly rising premiums have been associated with increased jury awards in cases of medical malpractice. Regardless of the causes, physicians are crying out for reform, as are patients seeking quality care under limited circumstances.

Medical malpractice rewards were originally intended to punish violations of trust (Bloche, 2002). Originally, a majority of medical malpractice claims arose from serious medical deficiencies. In recent years however, juries seem to have imposed idealized expectations upon doctors and health plans (Bloche, 2002). An increasing number of medical malpractice claims have in part resulted. Some may be legitimate, others may be considered extraneous in nature. Regardless of the legitimacy of such claims, a crisis is resulting, one that must be addressed from numerous perspectives.

Some opponents of increasing claims have suggested that the current medical malpractice liability system in fact encourages a potentially "increasing risk of error and patient injury" by causing doctors to focus on protective measures rather than quality medicine (Liang, 2001). Indeed, a number of physicians have indicated a reduction of services as a result of increased premiums. Many physicians as well, rather than focus on "quality" care, have adjusted their outlook to reflect preventive and defensive practice. It seems that a majority of physicians are implementing practices more akin to protecting themselves rather than ensuring the safety and well being of patients.

For a plaintiff to prevail in a medical negligence lawsuit, they must first prove that he/she sustained damages that were caused by the "failure of the physician to take due care, defined as customary practice of physicians in good standing with the profession" (Danzon, 1991). However, experience shows that medical malpractice claims arise for many reasons above and beyond those that might be defined by true liability.

The purpose of this study is to examine how rising medical malpractice premiums are affecting physicians and patients. Additionally, this study will aspire to examine what solutions may be possible to prevent continuance of the crises facing practicing physicians. To that extent the following have been developed:

Null Hypothesis: Rising medical malpractice insurance premiums directly impacts a physician's ability to practice quality medicine and patients' subsequent access to quality care in a negative manner.

Alternative Hypothesis: Rising medical malpractice insurance premiums do not directly affect a physician's ability to practice and patients' subsequent access to quality care in a negative manner.

This research study will document the impact of rising premiums on physician's ability to provide care and patients subsequent access to quality health care programs.

Significance of Study

The significance of this study is based on the researcher's commitment to quality care and particularly to consumers within the United States in desperate need of continuing quality care. The author believes that the abundance of unnecessary claims has resulted in a deficiency of qualified physicians, as more and more find themselves unequipped to deal with the rising expense of providing care.

As a current and future patient the author has a special interest in ensuring the best outcome for both physicians and patients in the future, and is thus obligated to explore the crisis in much greater detail, in the hope of developing alternative solutions for the future. This thesis will allow the researcher to investigate the decline in availability of qualified professionals perhaps resulting from increasing medical malpractice insurance premiums, and expose the potential crisis related to unsubstantiated medical malpractice claims that may be facing American citizens.


AMA - American Medical Association

Medical Malpractice: Generally medical malpractice has been defined as the "failure to take due care, defined as efficient care" when providing medical services (Danzon, 1991).

Tort Law - Common law, in which the law provides a remedy for injustices delivered to a person or persons

Likert Scale- A tool utilized to measure survey responses, typically utilizing a scale with a ranking system of 1-5, whereby survey participants rank responses according to their level of acceptance or agreement with statements.

Chapter Two: Review of the Literature

The purpose of this study is to examine the effects and consequences of rising medical malpractice premiums on patients and healthcare providers. A trend has surfaced in recent years indicating that more medical malpractice premiums are rising. Supplemental to this, medical malpractice claims seem to be on the rise. This is due perhaps, to an increased evidence of awards to patties suing physicians for claims of medical malpractice. The aim of this study is not to deny patients the right to pursue legitimate compensation for medical negligence claims; rather it is intended that this study will uncover the mechanisms which have led to rapidly rising and uncontrollable premiums. This study also intends to examine the impact of such rises in premiums, and assess how these changes have affected both patients and physicians. This study also intends to identify and assess potential solutions for the currently healthcare crisis that has resulted from rapidly rising premiums.

According to Fielding and Waitzkin (1999), the problem of medical malpractice claims "is like an iceberg; the bulk is hidden beneath the surface, and the visible portion is the few sensational cases covered in the media."

Indeed, the media tends to focus on the few extreme cases of medical malpractice that have occurred in order to sensationalize victims of negligence. Unfortunately, such practices do not assist the plight of physicians attempting to protest against the recent surge of exorbitant medical insurance premiums. In fact, such sensationalism only serves to fuel the fire of such practices.

The practice of medicine in contemporary society has increasingly become more technology based. Physicians are utilizing ever increasingly sophisticated procedures that often add new risks, which consequently set the stage for an increased rate of claims (Fielding & Waitzkin, 1999). As a result of increasingly new technology, physics take on more and more risks when treating patients. At the same time, physicians present patients with better outlooks and the potential for greater healing by utilizing newer technologies. However, new technology is not without risk.

Medical malpractice claims are rising exponentially in contemporary society. A great majority of these cases are civil rather than criminal complaints (Fielding & Waitkin, 1999). Regardless,…

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