Our legal system is hosed up, basically encouraging frivolous litigation that only raises costs for everyone. This is certainly true in health care, where malpractice exposure has the potential to raise costs, create access issues and make doctors’ lives miserable. A large body of research suggests that the level of malpractice exposure, which can vary from state-to-state, is associated with the practice of defensive medicine and raises health spending. You might think that if doctors have more malpractice exposure they might be more careful and therefore deliver higher quality care. According to a review in the Journal of the American Medical Association, you would be wrong. (JAMA Article) The authors conducted a literature search spanning from 1990 to the present, finding 37 studies, largely relating to inpatient care or obstetrics. There were 16 studies related to obstetrics and they basically found no relationship between the level of malpractice exposure and several outcome measures relating to births. There were 20 studies in a non-obstetrics context that examined patient mortality in relation to malpractice exposure level. 15 found no effect. The remainder had what might be considered more equivocal findings, but suffered from methodological or other weaknesses. Some of these studies also looked at readmissions and avoidable hospitalizations and found no link with malpractice exposure. Other research looking at process measures of care or patient satisfaction similarly found no association.
The review led the authors to conclude that higher malpractice exposure did not lead to better quality of care. It is pretty obvious why the level of malpractice exposure doesn’t seem to influence quality. The legal system is very arbitrary and irrational; it isn’t good at all at determining whether care was or wasn’t consistent with well-defined standards of care. Juries are basically just swayed by emotion. So when a system is arbitrary, what difference does it make how careful you are; you still can get sued and endure the financial and reputational hit. But gee, guess what, plaintiffs’ lawyers make huge political contributions to ensure that the laws don’t change to take away the absurd amounts of money they take from settlements or judgments. So, once again, don’t expect changes any time soon.