Medical malpractice reform: When is it about money? Why is it about time?

摘要

Crisis, it is said, means both danger and opportunity. In medical liability reform, however, greater opportunity may lie in noncrisis. In this issue of JAMA, Mello and colleagues offer data suggesting that no crisis of the conventional sort currently exists in the medical malpractice system. In the mid-1970s, mid-1980s, and early 2000s, physicians' liability insurance became suddenly unavailable, unaf-fordable, or both. Crisis was undisputed, with the potential for serious disruption of access to medical services. So was the direction of reform, which targeted the marketability of liability insurance, primarily by restricting lawsuits and limiting damages. The causal pathway between these "tort reforms" and physicians' premiums was admittedly tenuous, and other significant failings of the malpractice system with respect to patient safety and compensation for injury were increasingly evident. When each insurance crisis eventually abated, however, tort reformers declared victory.