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ReformingMedicalLiabilityConventionalApproachesandBeyondRandallR.Bovbjerg,J.D.(Bó-berg)TheUrbanInstitute??Standarddisclaimerapplies

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Who’sMissing?PatientsPayers2

“RoadMap〞ofTalkAbitofhistoryProblemstoday:insurance“crisis,〞safetyCausesandimplicationsConventionalsolutions,mainlytortreformMorefundamentalchangestoimprovecompensationandsafety3

ABitofHistorySeriesofcrisesthathavechangedindustryTwolesserknowncrisesin50s60s:risingclaims,thenbetterrating,medicalsocietyplansFirstnationalcrisisinmid-70s:higherclaims,availabilityproblems,mutualsenter,tortreformSecondinmid-80s:higherclaims,affordability,otherlinestoo,shifttoclaims-made,tortreformThirdfromY2K:describedbelowRegulationbystates―solvencyrates exception:FederalRiskRetentionAct‘81,‘86.4

LatestInsuranceCrisisInsurerwithdrawal,retrenchmentPriceincreasesandselectiveunderwriting;variesbystateBigforsomeMD’s,can’tpassthroughLimitedaccessproblems―high-riskprovidersinhigh-riskregions,perhapslong-termshifts5

TrendsinPhysicianPremiumsSource:CBOanalysisofMedLiabilMonsurveys6

FactorsUnderlyingRiseLawyerssayit’sallinsurancecycle,interestratesandinsurermisbehaviorDoctorsandinsurersagreethere’scycle,buttrendinclaimspayoutswentupinmid-90sinsomestates,claimsupreinsuranceupBothpartlyright,doctors/insurersmore7

Crises:CyclesCostsUnderlyingtrendin“true”claimsandothercostsSuperimposedpricefluctuationfromcompetitivecycle$$$$$$Time8

ProblemsImplicationsMaincostofmalpracticeinsuranceismalpracticeclaims[Duh]Interestearningshaveeffectbecausethey’reanegativecostbutdon’tdrivecycleCrisisseemstobeabating,not“normalcy〞BigdifferencesacrossStates,evenwithinState9

NationalMalpracticeCostsTotalPhysiciansSource:Tillinghast(2004)$billions10

PotentialSolutionsToday’stopthree:tortreform,tortreform,andtortreformInsu