An article appearing in JAMA Network on January 28, 2020 entitled “Malpractice Liability and Health Care Quality: A Review” concluded: “Although gaps in the evidence remain, the available findings suggested that greater tort liability, at least in its current form, was not associated with improved quality of care.”
The researchers asked the question “Is greater risk of malpractice liability associated with better quality of care?” and attempted to answer that question by searching multiple databases for studies published between January 1, 1990 and November 25, 2019 in order to examine the relationship between malpractice liability risk measures and health outcomes or structural and process indicators of health care quality. The researchers ultimately reported “Most studies in this review found no association between greater risk of malpractice liability and health care quality.”
The researchers analyzed 37 studies of which 28 examined hospital care only and 16 focused on obstetrical care. The researchers examined 20 studies of patient mortality in nonobstetrical care settings.
The researchers found that with regard to the studies of nonobstetrical care cases, 15 found no evidence of an association with liability risk and 5 found limited evidence. With regard to 7 studies that examined hospital readmissions and avoidable initial hospitalizations, none found evidence of an association between liability risk and outcomes. With regard to 12 studies of other measures such as patient safety indicators, process-of-care quality measures, and patient satisfaction, 7 of the studies found no association between liability risk and these outcomes (5 of the studies identified significant associations in some analyses).
The researchers found that with regard to the studies of obstetrical care cases, 9 found no significant association between liability risk and outcomes such as Apgar score and birth injuries, and 7 of the studies found limited evidence for an association.
The researchers concluded: “In this systematic review, most studies found no association between measures of malpractice liability risk and health care quality and outcomes … Our systematic review suggests that notwithstanding these theoretical mechanisms, malpractice liability risk may not be effective in preventing substandard care.”
The researchers noted, however, “The first (and perhaps largest problem) is that most instances of medical negligence that cause harm never become malpractice claims, whereas many claims of uncertain or no merit are filed. The poor fit between claims and negligence introduces noise into the deterrent signal, reinforcing physicians’ perceptions that claims do not convey valid information about their quality of care.”
An editorial discussing the article cited above states, in part: “the goals of tort law are not limited to deterring negligence. They include compensating financial losses consequent to injury and requiring transfers from those who have caused harm to those who have been harmed (corrective justice). Ideally, tort law also provides voice and dignity to injured patients whose harms society should acknowledge, and independent courts enable individuals to hold accountable even large and powerful institutions (a social recourse function). Tort law communicates that people have duties to behave with care toward each other (an expressive or cultural function), and the discovery process in a lawsuit can reveal facts about why someone was injured (an information function). These purposes echo interpersonal and social aspects of health care quality that matter in addition to technical safety.”
“Liability will not change physicians’ behavior for the better, and it may make things worse, unless physicians believe that providing good care avoids lawsuits … Even with a clear relationship between actual negligence and tort claims, the deterrent influence of tort reform will make little difference if physicians do not know the law in their states or how the law may have changed.”
“For individual physicians, standard economics predicts that tort law deters errors by making negligence expensive and therefore physicians will be motivated to avoid damages, higher premiums, and the time spent defending claims.”
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