What is the overall effect of malpractice litigation on the quality and cost of health care?
It depends on the legal regulations. Court proceedings have an impact on social insurance contracts that include health care establishments. This obviously affects the operating costs of the health service
The impacts are potentially both positive and negative. The positive ones however, relate to QI and improving professional practice following judgements and this can much better be achieved through good QI systems, patient feedback and clinical governance. Therefore the outcomes are mainly negative. Costs vary from country to country as does who bears them, but this is bound to cycle back into the overall cost of healthcare, reducing net resources where there is a ceiling on spend. But there are also very serious implications for patients and clinicians if practise becomes overly defensive, consuming resources and for some patients resulting in unnecessary interventions aimed at preventing rare negative outcomes amongst that particular patient group. In this way, quality as defined by the appropriate and least invasive/ most conservative treatment for patients could be impacted as well as cost. Also motivating and supporting clinicians to work in high litigation specialties may become difficult, which benefits no one. So my stance would be strengthen QI, measurement, complaints systems, clinical governance and try to contain litigation as much as possible without ultimately preventing citizens accessing the Courts as is their right, if they feel they have to.
Maybe the questions should be 'does malpractice litigation: lead to defensive medicine; and/or make doctors more careful; and/or waste resources on layering and disputing?'
and consider what differences are produced when no-fault compensations are introduced (as in New Zealand: https://www.newzealandnow.govt.nz/resources/acc%E2%80%93helping-to-meet-the-costs-of-personal-injury#:~:text=The%20Accident%20Compensation%20Corporation%20(ACC,your%20medical%20and%20rehabilitation%20costs.&text=ACC%20is%20paid%20for%20by%20employers. )
Are doctors less careful? Are patients better compensated?
Any medical malpractice case, alleged or as a matter of fact, always triggers a serious investigation in the hospital. Committees like the peer-review, risk management, quality assurance, etc. will get involved. A recent near-miss or actual negligent case will always heightened professional judiciousness and improved interpersonal relationships with the patient and family members. Obviously, these are good for the patient and hospital. But on one hand, physicians can resort to "defensive" medical practice. (I have written a short article this subject: "No to Defensive and Offensive Medicine." Philippine Journal of Internal Medicine Vol. 51 no. 2 2013)
The downside of "defensive" medicine is well known among healthcare professionals and the hospital industry and further undermines the value of clinical practice guidelines and professional judgement. Physicians become too accommodating with their patients and family members. Cases of medical malpractice which became news items compel patients and family members to consult "Dr. Google" and thus become armed with so much raw information when they consult their physicians. The cost of healthcare and insurance will go up, no doubt. The interplay of "avoidance (of malpractice litigation)", "professional self-preservation" "providing quality healthcare", healthcare laws and having viable business will continue and still with no constant universal equation in sight.
I suggest that you have asked the wrong question. For me, the more interesting question is whether or not medical malpractice premiums are necessarily tied to the number of claims and the amounts of pay out. The answer to those questions may lead you to the answer to the question that you are asking.
The fact is that that the total cost for medical malpractice claims in the United States is less than 1/3rd of 1% of the cost of all medical care. Another fact is that medical malpractice claims have been decreasing (per capita) for almost 20 years. For example, the number of paid claims dropped from almost 20,000 claims in 2001 to just about 10,000 claims today -- a near 50% drop -- and the total amount for those claims paid out dropped from almost $5 billion to just above $3.5 billion.
The $3.8 trillion in total health care costs in the US during 2019 simply dwarfs the number of claims and the costs of those claims.
The cost of medical malpractice insurance has been decreasing for almost 20 years. Nevertheless, the cost of health care continues to increase. Furthermore, the states with draconian restrictions on the amount that injured people may collect in a medical malpractice claim (like Massachusetts, New Mexico, or West Virginia) maintain very high medical malpractice costs but states where there are no restrictions (like Alabama, Minnesota, and Vermont) have very low malpractice costs.
I do not mean to suggest that the cost of malpractice insurance and the number and amount of claims paid out have no relationship to the cost and quality of health care. What I do mean to suggest is that the minimal cost drives improvements in medical services by improvement in the standard of care. If the direct cost of medical malpractice insurance is as low as 1/3rd of 1% of the cost of medical care and that minimal costs causes doctors and staff to check the batteries on devices more frequently or scan mammograms more thoroughly, then isn't that a cost worth the result?
Whether or not the cost of malpractice insurance drives defensive medicine, it strikes me that the question you ask begs the question. The real question is whether medical negligence is driving up the cost of medical care.
If the cost of malpractice insurance is decreasing, if the cost of all claims is decreasing, if care is improving, then perhaps the answer to all of the questions (yours and mine) is "not really."
Which country are you talking about. Really is simply the judiciary system and those in charge of monitoring and appraiser. Perhaps impact on the patients care rationalisation and timetable specialist availabity shortfalls will be high
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