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Bovbjerg Slides used onsite Reforming Medical Liability Conventional Approaches and Beyond Who’s Missing? Patients Payers “Road Map” of Talk A bit of history Problems today: insurance “crisis,” safety Causes and implications Conventional solutions, mainly tort reform More fundamental changes to improve compensation and safety A Bit of History Series of crises that have changed industry Two lesser known crises in 50s 60s: rising claims, then better rating, medical society plans First national crisis in mid-70s: higher claims, availability problems, mutuals enter, tort reform Second in mid-80s: higher claims, affordability, other lines too, shift to claims-made, tort reform Third from Y2K: described below Regulation by states ― solvency rates exception: Federal Risk Retention Act ‘81, ‘86. Latest Insurance Crisis Insurer withdrawal, retrenchment Price increases and selective underwriting; varies by state Big for some MD’s, can’t pass through Limited access problems ― high-risk providers in high-risk regions, perhaps long-term shifts Trends in Physician Premiums Factors Underlying Rise Lawyers say it’s all insurance cycle, interest rates and insurer misbehavior Doctors and insurers agree there’s cycle, but trend in claims payouts went up in mid-90s in some states, claims up reinsurance up Both partly right, doctors/insurers more Crises: Cycles Costs Problems Implications Main cost of malpractice insurance is malpractice claims [Duh] Interest earnings have effect because they’re a negative cost but don’t drive cycle Crisis seems to be abating, not “normalcy” Big differences across States, even within State National Malpractice Costs Potential Solutions Today’s top three: tort reform, tort reform, and tort reform Insurance market interventions, other near-term reforms Broader reforms ― replace part or all of current liability system Conventional “Tort Reforms” Goals: insurance availability, affordability Legal cutbacks Caps on awards, shorter times to sue, no dou