I. THE VARIOUS COSTS OF THE
A. Costs Associated with Underuse
B. Costs Associated with Misuse
C. Costs Associated with Overuse
1. Defensive Medicine
2. Offensive Medicine
3. Cost-apathetic Medicine
4. Compassionate Medicine
II. IS CURRENT MEDICAL MALPRACTICE
LAW THE ANSWER?
A. Can Tort Law Tackle the Healthcare
B. Can Current CPGs Tackle the Costs
of the Healthcare System?
1. When the Government Writes
b. Evidence from States' Experience
c. Evidence from Federal Experience
2. Guidelines Written by Hospitals and
3. Guidelines Written by HMOs,
Health Insurers, or
4. Guidelines Written by Professional
C. The Treatment of CPGs in Practice
1. The Treatment of Guidelines Within
the Medical Profession
2. Courts' Treatment of Guidelines
III. THE DESIGN OF PRIVATE
A. The Legal Infrastructure
1. Liability from the Ex Ante
2. Contractually Standardized Care
and Reimbursement Levels
3. Private Regulatory-Compliance
4. Intellectual Property Protection for
5. Not Recognizing the State of the Art
6. Guaranteeing Private Regulators'
7. The Value of Constrained Pluralism
IV. EVALUATION IN LIGHT OF OBJECTIONS
A. The PRR Compared to
1. What is the Difference Between PRR
and Liability for Gatekeepers?
2. What is the Difference Between PRR
3. Why Not Strict Liability or No-Fault
4. Why Do We Need Legislation?
Why Do We Not See It in
the Market Already?
a. MCOs as Cost Internalizers
b. Liability Insurers as Cost
c. Government as Cost
d. Private Firms as Cost
B. Practical Medical Concerns
1. Medical Ethics
2. Good Medicine Requires Discretion
3. Not Enough Reliable Scientific
Information Exists To Make the
4. How Effective Will PRR Be
in Reducing Costs?
a. Misuse (Medical Errors)
C. Legal and Political Concerns
1. Are We Losing the Information
Updating Benefit that Tort Law
2. Would Private Regulation Lead to
Pulling the Plug on Grandma?
3. Could a Profit-Driven Regulatory
Regime Ever Win
V. BEYOND MEDICAL MALPRACTICE
"The more I have studied it, the more I believe that less discretion for doctors would improve patient safety."
Don Berwick (1)
Addressing the American Medical Association (AMA), President Obama described the healthcare system as a "ticking time-bomb for the federal budget." (2) He stressed the need "to improve the quality of medical information making its way to doctors and patients." He further noted that "it can take up to 17 years for this information to find its way to an exam room or operating table." (3)
Improving the quality of information channeled to doctors can further what legislators agree are healthcare reform's three main goals: increasing access for the uninsured, controlling rising costs, and improving patient safety by improving the quality of care. The main focus of the Patient Protection and Affordable Care Act (ACA), (4) a historic health care reform bill signed by President Obama on March 23, 2010, was the first of these goals--increasing access by providing insurance to thirty-two million uninsured Americans. …