Medical malpractice reform

M uch of the d i s cus s ion of hea l t h pol icy reform h a s focused on f inanc ing a n d del ivery m e c h a n i s m s , appropr ia te ly so, given the c r i s i s in access to care. But the major hea l th care bi l ls cons ide red by Congress in 1994 all con t a ined s ign i f i can t s ec t ions on medica l malpractice. 1--3 They s h a r e d a two-pronged s t ra tegy. The first p rong is federal p r e e m p t i o n of s t a t e law in a var ie ty of doct r ina l areas . These changes in doc t r i ne s a re des igned to l imi t c l a ims by pa t i en t s . S i m i l a r re forms have been passed by s t a t e leg is la tures , b u t never by the federal government . The s econd p r o n g is e x p e r i m e n t a t i o n wi th a l ternat ives to tor t l i t iga t ion , w h i c h could lay the founda t ion for more sweep ing changes in the way we preven t and c o m p e n s a t e medica l in jur ies . If the Repub l i can -controlled Congress p u r s u e s hea l th care reform in 1995, it is likely ma lp rac t i ce reform will be a cen t ra l p a r t of any package. The e m p h a s i s on e x p e r i m e n t s w i t h a l t e r n a t i v e m e c h a n i s m s at the federal level will l ikely give fu r the r impe tus to efforts a l ready u n d e r way a t the s t a t e level. Two s ta tes have growing exper ience w i th no-faul t mecha n i s m s for neona t a l neuro logie in jur ies . A n o t h e r s ta te has had a sys tem in place for i n t e g r a t i n g medica l practice gu ide l ines in to ma lp rac t i ce l i t iga t ion , a n d o the r s a re now following sui t . Two o the r s t a t e s are c o n s i d e r i n g provider p roposa l s to expe r imen t wi th no-faul t c o m p e n s a t ion for all medica l in jur ies . The a m o u n t of in te res t in ma lp rac t i ce reform is no t surpr i s ing . Medical ma lp rac t i ce p r e m i u m s r e p r e s e n t 1% of the total hea l th care costs , 4 b u t p rov ide r conce rns abou t l awsui t s have often t ended to p u s h tor t re form to the front of legislat ive agendas , a n d likely ma lp rac t i ce modi f ica t ions will con t inue to d r aw more a n d more atten t ion bo th in Wash ing ton , DC, a n d in s t a t e capi ta l s .