High Med-Mal Standards May Not Tip Scale on Health Care Costs

The connection between wasteful health care spending and physicians’ fears of malpractice lawsuits may not be as significant as malpractice reform advocates suggest, according to a recent study published in the New England Journal of Medicine (NEJM). The study evaluated the effect of malpractice reforms in three states where malpractice standards for emergency care were raised to gross negligence. The findings revealed that the heightened legal standard had only a nominal effect on the intensity of the care provided in the emergency departments within those states.


The study was designed to evaluate the widespread belief that high health care costs are driven through a sort of defensive health care, where physicians provide unnecessary services in order to insulate themselves from malpractice liability. To examine the hypothesis, the study looked at Medicare fee-for-service beneficiaries in Texas, Georgia, and South Carolina, the three states that took on malpractice reform, as well as six neighboring states, which operated as controls. Using emergency department data from 1997 through 2001, the study compared patient outcomes from before and after the malpractice reforms. Specifically, the researchers looked at changes in the use of “computed tomography (CT) or magnetic resonance imaging (MRI), per-visit emergency department charges, and the rate of hospital admissions.”


The study revealed that for a significant majority of the patient outcomes evaluated there was no reduction in the intensity of care that could be meaningfully attributed to the changes in medical malpractice policy. The researchers found no reduction in CT or MRI utilization in any of the three reform states, and the only reduction in charges was found in Georgia, where the reforms were attributed to a 3.6 percent reduction in per-visit emergency department charges. As a result, the researchers concluded that substantial changes in medical malpractice standards for emergency physicians in Texas, Georgia, and South Carolina had little effect on the intensity of imaging rates, admission rates or average charges in those three states.