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Medical malpractice as an epidemiological problem

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  • Mello, Michelle M.
  • Hemenway, David

Abstract

The notion that the tort liability system deters negligence in health care has been invoked to make the "business case for patient safety." However, existing data on the relationship between hospital adverse events and malpractice claims typically are interpreted as evidence that the tort system does not deter negligence because of the poor fit between those who are negligently injured and those who sue. Using a familiar analogy from epidemiology--the problem of false positives in screening tests for rare diseases--and data from two large studies of medical injuries and malpractice claims in the United States, this paper presents an argument that the standard interpretation overlooks a complexity in the data. Although most malpractice claims do not actually involve a negligent injury, a patient who suffers a negligent injury is more than 20 times more likely, on average, to file a claim than a patient who does not. However, because malpractice claiming is a rare event with many false positives, for the average hospital or group practice, even substantial improvements in rates of negligent injury will not lead to a large reduction in claims rates. These findings suggest that the strength of the business case for patient safety depends on the perspective from which one views the data.

Suggested Citation

  • Mello, Michelle M. & Hemenway, David, 2004. "Medical malpractice as an epidemiological problem," Social Science & Medicine, Elsevier, vol. 59(1), pages 39-46, July.
  • Handle: RePEc:eee:socmed:v:59:y:2004:i:1:p:39-46
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    Cited by:

    1. Chin, Marshall H. & King, Paula T. & Jones, Rhys G. & Jones, Bryn & Ameratunga, Shanthi N. & Muramatsu, Naoko & Derrett, Sarah, 2018. "Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States," Health Policy, Elsevier, vol. 122(8), pages 837-853.
    2. Buzzacchi, Luigi & Scellato, Giuseppe & Ughetto, Elisa, 2016. "Frequency of medical malpractice claims: The effects of volumes and specialties," Social Science & Medicine, Elsevier, vol. 170(C), pages 152-160.
    3. Harrington, David E. & Sayre, Edward A., 2010. "Managed care and measuring medical outcomes: Did the rise of HMOs contribute to the fall in the autopsy rate?," Social Science & Medicine, Elsevier, vol. 70(2), pages 191-198, January.
    4. Panthöfer, Sebastian, 2016. "Tort Reform and the Length of Physician Office Visits," UC3M Working papers. Economics 23861, Universidad Carlos III de Madrid. Departamento de Economía.
    5. Pesko, Michael F. & Cea, Meagan & Mendelsohn, Jayme & Bishop, Tara F., 2017. "The effects of malpractice non-economic damage caps on the supply of physician labor: Heterogeneity by physician age and risk," International Review of Law and Economics, Elsevier, vol. 50(C), pages 7-14.
    6. Jessica Wolpaw Reyes, 2010. "The Effect of Malpractice Liability on the Specialty of Obstetrics and Gynecology," NBER Working Papers 15841, National Bureau of Economic Research, Inc.
    7. Dalton, George D. & Samaropoulos, Xanthia F. & Dalton, Augustine C., 2008. "Improvements in the safety of patient care can help end the medical malpractice crisis in the United States," Health Policy, Elsevier, vol. 86(2-3), pages 153-162, May.

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