title: The US Medical Liability System: evidence for legislative reform.
abstract: BACKGROUND
  Despite state and federal efforts to implement medical malpractice reform, there is limited evidence on which to base policy decisions. The National Practitioner Data Bank (NPDB) offers an opportunity to evaluate the effects of previous malpractice tort reforms on malpractice payments and premiums.
  
  
  METHODS
  For every state and the District of Columbia, we calculated the number of malpractice payments, total amount paid, and average payment from NPDB data reported from 1999 through 2001. We analyzed 44,913 claims using logistic regression to study associations between payments, physician premiums, and 10 state statutory tort reforms.
  
  
  RESULTS
  Wide variations exist in malpractice payments among states. The reforms most associated with lower payments and premiums were total and noneconomic damage caps. Mean payments were 26% lower in states with total damage caps (196,495.34 dollars vs 265,554.50 dollars, P = .001). Mean payments were 22% less in states with noneconomic damage caps (219,225.98 dollars vs 279,849.86 dollars, P = .010). Total damage caps were associated with lower mean annual premiums, especially for obstetricians (22,371.57 dollars vs 42,728.68 dollars, P <.001). Hard noneconomic damage caps were associated with premium reductions for obstetricians (30,283.75 vs 45,740.88; P = .039).
  
  
  CONCLUSIONS
  Significant reductions in malpractice payments could be realized if total or noneconomic damage caps were operating nationally. Hard noneconomic damage and total damage caps could yield lower premiums. If tied to a comprehensive plan for reform, the money saved could be diverted to implement alternative approaches to patient compensation or be used to achieve other systems reform benefiting patients, employers, physicians, and hospitals.
authors.affiliation: Tacoma Family Medicine Residency Program, Department of Family Medicine, University of Washington, Seattle, Wash 98405, USA. jguirgui@u.washington.edu
authors.forename: Janelle
authors.initials: J
authors.lastname: Guirguis-Blake
authors.forename: George E
authors.initials: GE
authors.lastname: Fryer
authors.forename: Robert L
authors.initials: RL
authors.lastname: Phillips
authors.forename: Ronald
authors.initials: R
authors.lastname: Szabat
authors.forename: Larry A
authors.initials: LA
authors.lastname: Green
mesh_terms: D003363:Cost Control; D006801:Humans; D016365:Liability, Legal / Q000191:economics*; D008318:Malpractice / Q000191:economics* / Q000331:legislation & jurisprudence*; D016749:National Practitioner Data Bank / Q000706:statistics & numerical data*; D011640:Public Policy; D012189:Retrospective Studies; D014481:United States