Medical malpractice crises: Direct stakeholders' perspectives in North and South Carolina.

摘要

Most researchers of medical malpractice crises used secondary data such as insurance claims and hospital discharges as a baseline for research studies. This qualitative inquiry with mixed-method analysis included two Delphi brainstorming-survey rounds of primary data from 12 stakeholders (i.e., physicians, hospital administrators, insurance underwriter, and litigators) in North and South Carolina. This study focused on gaining stakeholder consensus on the perceived-effects of the crises, perceived-factors, prevention, and potential solutions for the recurring medical malpractice crises. Most stakeholders in the study completely agreed that patient compensation for injuries from medical mistakes and collaboration among stakeholders were necessary for establishment of consistent policies. Stakeholders disagreed with theorists that spikes in medical malpractice premiums had no direct effect on hospital profit margins and all stakeholders could become victims during a crisis. Both stakeholders and researchers frequently referred to the "broken system." Perspectives of stakeholders in North and South Carolina reflected the need for integrated patient-compensation and tort systems that shifted the focus to adequate compensation for injuries from medical mistakes. The recommendation included formal recognition of three possible and distinct systems, and suggested unbundling these subsystems to focus future medical malpractice crisis research on economic "capital reserve-like systems", while administrators and policymakers focused on integrated-systems that would improve patient safety and low patient-compensation rates of less than two percent for medical errors.