Academic journal article Frontiers of Health Services Management

Editorial

Academic journal article Frontiers of Health Services Management

Editorial

Article excerpt

WHEN CONSIDERING CAUSES of and solutions to the medical malpractice crisis, it is tempting, as Captain Louis Renault says at the end of the classic movie Casablanca, to "round up the usual suspects." Certainly, there has been no lack of finger pointing as reasons are sought to explain the rise in medical malpractice insurance rates. Instead of finding fault with one group or another, however, we need to think about medical malpractice in a different way, by looking to the root causes of the problem and thinking about systemic approaches to crafting a more global solution. Applying a quick fix does nothing but shift the problem to another part of the system.

Some observers suggest that there actually is no medical malpractice crisis at all and that the reason for the increase in costs has more to do with bad investment decisions on the part of malpractice insurance companies. These same people would also argue that those doctors who are incompetent deserve to be punished for their mistakes. However, Avery (2000) notes that 70 percent of malpractice actions relate to communication issues in the relationship between provider and patient, such as lack of time to talk to patients, attitude of the physician, and lack of caring and concern for the patient's problems. Only 7 percent of the malpractice cases were attributable to poor quality of care. Thus, this issue of Frontiers works on the assumption that the crisis is real and needs to be addressed.

In the spirit of developing a more systems-oriented approach to the medical malpractice crisis, we have asked Karen Ignagni, president and ceo of the American Association of Health Plans, to share her thoughts and ideas. She is widely known for her tireless work and prolific writing on reform of the U.S. healthcare system. In her lead article, Ignagni goes beyond framing the issue of medical malpractice and asks whether patients receive better care as a result of the current litigation activity. She finds no support to the affirmative and much evidence to the contrary. One of the important points Ignagni makes is that defensive medicine is one of the detrimental consequences of both the increasing volume of medical malpractice cases and size of the awards. Physicians are ordering tests, treatments, and referrals to specialists not for any particular clinical reason but rather "because not doing so could expose the practitioner to a heightened risk of being sued."

Ignagni recommends that state and federal government engage in an effort to enact limits on noneconomic damages. …

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