Editore"s Note
Tilting at Windmills

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September 2, 2003
By: Kevin Drum

MALPRACTICE AGAIN....Ah, another study of the malpractice crisis gripping America's insurance companies doctors. This one, done by the General Accounting Office, actually checked up on all the anecdotal stories of malpractice doom to see if they were true, a brilliant technique known to the blogosphere as "fact checking their asses." Let's see what they found out.

First, are doctors leaving their practices or moving out of state because of skyrocketing premiums? Why yes, there were a few! But not many, and it doesn't appear to have actually had any broad effect on service:

In the five states with reported problems, however, we also determined that many of the reported provider actions taken in response to malpractice pressures were not substantiated or did not widely affect access to health care. For example, some reports of physicians relocating to other states, retiring, or closing practices were not accurate or involved relatively few physicians. In these same states, our review of Medicare claims data did not identify any major reductions in the utilization of certain services some physicians reported reducing because they consider the services to be high risk, such as certain orthopedic surgeries and mammograms.

(Italics mine.)

In a table later in the report, they show about 300 claims of physicians moving or retiring due to rising malpractice premiums. It turns out that a considerable number of these claims turned out to be wrong, and in any case that number is for three states with a combined total of about 43,000 doctors. Even if the number were verified, 300 out of 43,000 is not exactly crisis material.

The rest of the report is more of the same. Do doctors practice defensive medicine due to fear of lawsuits? Maybe, but the survey data is unreliable and followup studies indicate that tort reform has at best only a small impact on the practice of defensive medicine. Are premiums higher in states without tort reform? Again, maybe, but the data is pretty uncertain and other factors may be equally important.

In fact, the most remarkable thing about this report was just how little reliable data the GAO was able to find. Malpractice reform has been a hot topic for several decades now, and yet time after time when I read reports on the subject I discover that complete data is nearly impossible to get and there are only a handful of studies available studies that turn out on inspection to be rather limited in scope and doubtful in methodology.

Given the supposedly critical nature of the problem and the broad solutions being proposed, it's inexplicable that Congress hasn't (a) started requiring recordkeeping that would provide researchers with reliable raw data and (b) ponied up some serious cash for a detailed study of malpractice and tort reform. "Serious" in this case probably means only a few million dollars, a pittance compared to the alleged seriousness of the problem.

How is it possible that such a large problem has been on the radar screen for 30 years without once being the subject of a well-funded and genuinely large scale study? It almost makes one think that perhaps the major players in this drama don't really want one.

Now why would that be?

Kevin Drum 11:43 AM Permalink | Trackbacks

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