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1、Reforming Medical Liability,Conventional Approaches and Beyond,Randall R. Bovbjerg, J.D. (B - berg) The Urban Institute , Standard disclaimer applies,Bovbjerg # 1,Bovbjerg # 2,Whos Missing?,Patients Payers,Bovbjerg # 3,“Road Map” of Talk,A bit of history Problems today: insurance “crisis,” safety Ca

2、uses and implications Conventional solutions, mainly tort reform More fundamental changes to improve compensation and safety,Bovbjerg # 4,A Bit of History,Series of crises that have changed industry Two lesser known crises in 50s varies by state Big for some MDs, cant pass through Limited access pro

3、blems high-risk providers in high-risk regions, perhaps long-term shifts,Bovbjerg # 6,Trends in Physician Premiums,Source: CBO analysis of Med Liabil Mon surveys,Bovbjerg # 7,Factors Underlying Rise,Lawyers say its all insurance cycle, interest rates and insurer misbehavior Doctors and insurers agre

4、e theres cycle, but trend in claims payouts went up in mid-90s in some states, claims up reinsurance up Both partly right, doctors/insurers more,Bovbjerg # 8,Crises: Cycles calms insurance markets (somewhat) As “takeaways,” face challenges in court Improve insurance performance Sometimes add quality

5、 or safety regulation,Bovbjerg # 13,Caps Are Centerpiece,Design total award, only “pain and suffering” Doctors only caps are more than “band-aids” Lawyers unconstitutional, the worst hurt are hurt worst Insurers like caps, trade premium volume for claims predictability Scorecard in about 1/2 of Stat

6、es, push for national,Bovbjerg # 14,California MICRA need demonstration in willing locale,Bovbjerg # 33,Need State Experimentation,Proposed November 2002 in IOM report to DHHS Nonjudicial, patient-centered, safety-friendly new injury resolution system Federal liability reinsurance to encourage State

7、 action (cover very high level of losses) State legislation to try one of two approaches (akin to 4 & 5 above),Bovbjerg # 34,Summing Up,In short term, be more even handed In medium and long run, try more promising approaches, support demos Key standards throughout Fairer compensation Better safety,B

8、ovbjerg # 35,Final Thought,Ideally, caregivers would tell patients and families when problems occur. Reasonable compensation would follow for avoidable injuries, and safety management would constantly be informed by experience. Patients treated decently are mainly grateful, not vengeful. Practitioners need to worry more about patient outcomes than legal outcomes, and systems of accountability need to make it easier for caregivers and medical institutions to do the right thing.,Bovbjerg # 36,End,Questions,Bovbjerg # 37,$,$,Minor,Severe,Level of