Medical malpractice is a huge driver of medical costs . . . NOT!

[shira]

Yet another conservative talking point down the tubes. The CBO had previously estimated that reforming medical malpractice would save a scant 0.5% of total health care costs. That result was poo-pooed by the right-wing, who only cite the CBO when it serves their purposes.

Well, now comes Harvard with its own independent study. They find that the TOTAL cost of medical malpractice is 2.4% - $55 billion - of all medical costs. But that's not saying that reforming medical malpractice would SAVE 2.4% - that would occur only if there were no costs related to medical malpractice at all - no harmed patients needing expensive care, no defensive medicine to prevent lawsuits, no legal fees, no administrative costs. That would occur only if health care providers were made totally immune from lawsuits - and no one seriously advocates that. Even under the no-lawsuit scenario, all that would happen is that costs would shift - those damaged by malpractice would still need expensive medical and long-term care, and there would need to be a mechanism in place (with associated administrative costs) to oversee such a new system.

So that 0.5% CBO figure looks much more believable in light of this new study. Not that the righties are going to stop their misinformation campaign.

http://www.hks.harvard.edu/news-events/news/articles/chandra-medical-liability-sept10

Medical malpractice and efforts to manage its risks cost the national health care system more than $55 billion a year, about 2.4 percent of annual health care spending. That is the conclusion of a new study, published in the September 2010 issue of Health Affairs, co-authored by Harvard Kennedy School Professor Amitabh Chandra.

While many have argued that medical liability costs are one of the primary drivers of overall health care cost increases, Chandra and his co-authors note that there has been little academic evidence until now to support or refute that argument.

Chandra and colleagues at Harvard and Brigham and Women’s Hospital in Boston analyzed various components of the medical liability system, including payments made to malpractice plaintiffs; defensive medicine costs; administrative costs, such as lawyer fees; and the costs of lost clinician work time.

“Physician and insurer groups like to collapse all conversations about cost growth in health care to malpractice reform, while their opponents trivialize the role of defensive medicine,” said Chandra. “Our study demonstrates that both these simplifications are wrong—the amount of defensive medicine is not trivial, but it’s unlikely to be a source of significant savings.

“In our view, medical liability reform has only modest potential for bending the health care cost curve down; other reforms, such as changing the fee-for-service reimbursement system and its incentive for overuse of services, probably are more promising,” he says.

Chandra also argues the research has important implications for the future direction of health policy on a national level.

“The study is relevant to ongoing debates about whether our current system for responding to medical malpractice represents good value for money, or ought to be reformed simply because we’re spending too much and getting too little in return,” Chandra says. “For example, our study found that the U.S. spends over $4 billion per year just on administrative costs related to malpractice litigation – legal expenses, insurance overhead expenses, and the like.

“There are opportunities to trim these costs by emphasizing dispute resolution outside the trial setting—for example, through ‘disclosure-and-offer’ programs that expedite investigation and settlement of incidents and more aggressive pursuit of pretrial settlement negotiations by judges. These are among the ideas that are being tested in the recently funded federal demonstration projects of state-based liability reforms.”

The article, titled “National Costs of the Medical Liability System,” appears on the Health Affairs website. The study authors are Michelle M. Mello, professor of law and public health at the Harvard School of Public Health; Amitabh Chandra, professor of public policy at Harvard University’s John F. Kennedy School of Government; Atul A. Gawande, associate professor of surgery at Harvard Medical School and Brigham and Women’s Hospital and an associate professor in the Department of Health Policy and Management, Harvard School of Public Health; and David M. Studdert, professor at the University of Melbourne School of Law and School of Population Health, in Carlton, Victoria, Australia.

 

[dullard]

What we need is a voice of reason. We need mal-practice reform, but we need to realize that there will be virtually no money savings from that reform. The reform should be done just to fix the obvious flaws, and not to save money.

Democrats are idiots for opposing reform. Republicans are idiots for thinking that reform would solve any significant money issues. So, we have a political stalemate.

 

[spidey07]

Thread fail. It shows that medical malpractice adds unnecessary costs. Fix that and costs go down. It's not some magic bullet, but by common sense measures the costs and their underlying causes can be whittled down

 

[ElFenix]

what i want to know is why we cover a fraction of the population for what the euros cover everyone. we have bigger fish to fry than medmal.

 

[her209]

Medical malpractice and efforts to manage its risks cost the national health care system more than $55 billion a year, about 2.4 percent of annual health care spending. That is the conclusion of a new study, published in the September 2010 issue of Health Affairs, co-authored by Harvard Kennedy School Professor Amitabh Chandra.

In other words, insurance companies take out a bigger slice of the pie in profits.

LOL

 

[ElFenix]

In other words, insurance companies take out a bigger slice of the pie in profits.

LOL

but if they made the pie smaller by more than those profits?
(not to mention that even if you get rid of those profits and salary for all insurance co management we're still spending a fvckload more than the euros to cover fewer people. think bigger.)

 

[Double Trouble]

So lets say 1/2 of those costs could be avoided by reforming malpractice. That's close to 30 billion dollars a year we could save. It certainly is not the silver bullet many make it out to be, but doesn't it make sense that if there was something we could do that could actually save us all tens of billions per year that we should take a hard look at it?

 

[JSt0rm]

Thread fail. It shows that medical malpractice adds unnecessary costs. Fix that and costs go down. It's not some magic bullet, but by common sense measures the costs and their underlying causes can be whittled down

stfu inbred. .5% and of that .5% how much is ACTUALLY medical malpractice.

 

[Double Trouble]

but if they made the pie smaller by more than those profits?
(not to mention that even if you get rid of those profits and salary for all insurance co management we're still spending a fvckload more than the euros to cover fewer people. think bigger.)

You can't compare the population of european countries to the population of the US, since the societies are very different in a multitude of ways. Also, when you say "euros", you're covering a vast array of different types of socialized medicine, each with it's own pros and cons. Having lived in (and experienced the medical system) in at least 3 western European countries, I can assure you that I much prefer the US system, even if it's going to cost more. There are tons of ways to cut costs from the system, bull all involve trade-offs.

 

[JSt0rm]

oh wait spidey has been brainwashed into think ALL medical malpractice suits are bad.

 

[her209]

So lets say 1/2 of those costs could be avoided by reforming malpractice. That's close to 30 billion dollars a year we could save. It certainly is not the silver bullet many make it out to be, but doesn't it make sense that if there was something we could do that could actually save us all tens of billions per year that we should take a hard look at it?

Doubt that it will save us anything, but rather just increase profits.

 

[Fern]

Yet another conservative talking point down the tubes. The CBO had previously estimated that reforming medical malpractice would save a scant 0.5% of total health care costs. That result was poo-pooed by the right-wing, who only cite the CBO when it serves their purposes.

Well, now comes Harvard with its own independent study. They find that the TOTAL cost of medical malpractice is 2.4% - $55 billion - of all medical costs.
-snip-

Most studies find between 5-10%, not 2.4% (these figues are cited in Wiki if you wanna see them). (And this whole 'medical malpractice doesn't cost much' line has been pushed by this author for years now.)

Studies by the New Jounal of Medicine show even higher costs.

I think framing it as a medical malpractice issue is incorrect and leads to confusion.

The problem is, unlike literally every other profession, physicians lack standardization. As the NE Journal of Medicine found, similar patients, in similar conditions receive wildly different care for no medically valid reason, with the costs varying by 6 figures. Yeah, some of this may be due to defensive medicine reasons, some may be so physicians can soak the HI industry etc., some just be because the patients demand it.

But by having physicians develop standards you ARE going to impact medical malpractice as well. If a physicians follows those standards they become a defense to malpractice, and the trial lawyers don't wanna see that. Presently with no standards there is little to prevent a suit etc. Malpractice suits would likely to shift to proving/disproving that the standards were followed properly, instead of just "oh look somebody died, let's sue".

Fern

 

[ElFenix]

You can't compare the population of european countries to the population of the US, since the societies are very different in a multitude of ways. Also, when you say "euros", you're covering a vast array of different types of socialized medicine, each with it's own pros and cons. Having lived in (and experienced the medical system) in at least 3 western European countries, I can assure you that I much prefer the US system, even if it's going to cost more. There are tons of ways to cut costs from the system, bull all involve trade-offs.

UK, France, and Germany all spend about the same per capita (not just per covered person).

the US spends that much per capita covering just retirees and kids (the 'socialized' part of US medicine. 'socialized' medical spending in the US is now more than the non-'socialized' portion).

and we're arguing about a couple billion dollars over a decade. we're not missing the forest for the trees, we're missing the forest for the chlorophyll on the underside of one leaf.

 

[Fern]

oh wait spidey has been brainwashed into think ALL medical malpractice suits are bad.

Physician advocacy groups say 60% of liability claims against doctors are dropped, withdrawn, or dismissed without payment. However even those cases have a price, costing an average of more than $22,000 to defend in 2008 ($18,000 in 2007). Physicians are found not negligent in over 90% of cases that go to trial - yet more than $110,000 (2008 estimate, $100,000 in 2007) per case is spent defending those claims

I have personally seen cases where I think the physicians surely deserved to be sued, mistakes are made, and they are not rare enough IMO.

But obviously, we have far too many frivilous suits being filed, and they are expensive.

No one can legitimately argue that real improvement isn't needed.

Fern

 

[Fern]

-snip-
Well, now comes Harvard with its own independent study.

Independent?

Is it "independent" because you say so?

Where do you get that, it's not in the article.

Who funded it?

Fern

 

[JSt0rm]

I have personally seen cases where I think the physicians surely deserved to be sued, mistakes are made, and they are not rare enough IMO.

But obviously, we have far too many frivilous suits being filed, and they are expensive.

No one can legitimately argue that real improvement isn't needed.

Fern

I'm not saying there aren't frivolous suits brought against doctors for the sole purpose of making money but in our country we have a court system that is set up so that you can take anyone to court for any reason. If its ridiculous enough to not even be heard by a jury then I think the judge has the ability to toss it fast.

Once we start stripping away peoples rights to sue where do we stop? The actual court room is where we figure out what is right and what is wrong not some panel before hand.

 

[rudder]

Shira.. tell me which is cheaper... a caesarian birth or natural birth? Thanks to John Edwards and convincing the courts that natural birth can cause cerebal palsy and a host of other issues.. many of the doctors in the area where he conducted over 60 malpractice suits... would simply not do natural child birth for fear of a lawsuit. Malpractice suits have forced large numbers of OB/GYN docs to leave that specialty. In some areas of the U.S. there are no OB/GYN within reasonable distance.

I say your thread is fail and that talking point is more than valid.

Not related to Edwards... but still... fear of lawsuits is why 33% of all births are the much more expensive c-section.
http://www.cleveland.com/healthfit/index.ssf/2010/01/post_26.html

 

[Fern]

-snip-
and we're arguing about a couple billion dollars over a decade. we're not missing the forest for the trees, we're missing the forest for the chlorophyll on the underside of one leaf.

Perhaps I'm misunderstanding you, but from another article on this study:

The researchers said their estimate includes $45.6 billion in what's known as defensive medicine costs -- when doctors prescribe unnecessary tests or treatments to avoid lawsuits.

Defensive medicine alone, at $46.5B annually, over a decade would be half a trillion $'s.

Fern

 

[Fern]

I'm not saying there aren't frivolous suits brought against doctors for the sole purpose of making money but in our country we have a court system that is set up so that you can take anyone to court for any reason. If its ridiculous enough to not even be heard by a jury then I think the judge has the ability to toss it fast.

Once we start stripping away peoples rights to sue where do we stop? The actual court room is where we figure out what is right and what is wrong not some panel before hand.

The problem I brought up - a lack of standards - has nothing whatsoever to do with "stripping away peoples rights to sue"

Also, I can see you've never been involved in any serious litigation. A "judge has the ability to toss it fast"? WTH? Before you ever get in front of the judge all the litigation work, other than arguing before teh court, must be done and paid for. As I've shown above that averaged $110K in 2008.

You may be interested to know that being a defendant in such a case is extremely time consuming, and that cost will not show up in these figures because you can't charge for lost time at work etc in these suits.

Edit: And why the h3ll would a court room be place the right place to figure out right and wrong in a medical malpractice suit? A jury of non-medical professional trying judge a malpractive suit? That sounds F'd up to me, they haven't a clue.

Fern

 

[ElFenix]

Perhaps I'm misunderstanding you, but from another article on this study:



Defensive medicine alone, at $46.5B annually, over a decade would be half a trillion $'s.

Fern

well i guess i was wrong about that (usually stuff like this is over the next decade in order to make figures look bigger). but on top of a 3 trillion dollar industry annually that really is a drop.

The problem I brought up - a lack of standards - has nothing whatsoever to do with "stripping away peoples rights to sue"

Also, I can see you've never been involved in any serious litigation. A "judge has the ability to toss it fast"? WTH? Before you ever get in front of the judge all the litigation work, other than arguing before teh court, must be done and paid for. As I've shown above that averaged $110K in 2008.

You may be interested to know that being a defendant in such a case is extremely time consuming, and that cost will not show up in these figures because you can't charge for lost time at work etc in these suits.

Fern

yes, there is a huge misconception that judges can just toss out litigation willy-nilly. the only time that can happen is if there is a serious defect in pleadings. even then it requires a responsive pleading to point out the defect, a hearing before the court, and then a refusal by the other side to amend.

there's summary judgment but most judges are fairly reluctant to grant it before any discovery has been done (not to mention that summary judgment is defeated by the sworn affidavit of the opposing expert that the doc's actions were not up to the standard of practice). because all the evidence is in the hands of one side (doctor and hospital), they're going to bear most of the burden of discovery. and discovery is a huge part of the cost of litigation.

 

[Hayabusa Rider]

what i want to know is why we cover a fraction of the population for what the euros cover everyone. we have bigger fish to fry than medmal.

Europe has a higher population density, a more homogenous population and a generally healthier lifestyle. BTW you'll find that many nations are having a higher rate of inflation than we are.
They'll catch up to us in several years if things remained the same.

 

[woolfe9999]

So lets say 1/2 of those costs could be avoided by reforming malpractice. That's close to 30 billion dollars a year we could save. It certainly is not the silver bullet many make it out to be, but doesn't it make sense that if there was something we could do that could actually save us all tens of billions per year that we should take a hard look at it?

I think the OP has made a persuasive case that the CBO number of .5% is pretty close to accurate, so we're talking about less than half the number you mentioned. Even so, it's a cost savings, but there is a tradeoff. When people are injured by other people's mistakes, they have a right to compensation, but if it's a doctor making the error, the right to compensation is curbed, but why? Well you could justify it if there was significant total cost savings, but when the cost savings are miniscule? I don't see why med mal plaintiffs should just have to live with their injuries uncompensated because we can save what amounts to pocket change in macro economic terms.

If "tort reform" could save more, even in the vicinity of 4-5% of our medical costs, I'd be all for it, but not at this level of savings.

- wolf

 

[Fern]

-snip-
because all the evidence is in the hands of one side (doctor and hospital), they're going to bear most of the burden of discovery. and discovery is a huge part of the cost of litigation.

Man, that's the truth.

I've sat in front of lawyers about a case and their big strategy was to "discovery the hell" out of the other party.

Fern

 

[Hayabusa Rider]

I think the OP has made a persuasive case that the CBO number of .5% is pretty close to accurate, so we're talking about less than half the number you mentioned. Even so, it's a cost savings, but there is a tradeoff. When people are injured by other people's mistakes, they have a right to compensation, but if it's a doctor making the error, the right to compensation is curbed, but why? Well you could justify it if there was significant total cost savings, but when the cost savings are miniscule? I don't see why med mal plaintiffs should just have to live with their injuries uncompensated because we can save what amounts to pocket change in macro economic terms.

If "tort reform" could save more, even in the vicinity of 4-5% of our medical costs, I'd be all for it, but not at this level of savings.

- wolf

Why is this particular study superior to the ones Fern cited?

 

[dainthomas]

oh wait spidey has been brainwashed into think ALL medical malpractice suits are bad.

Yep, it only makes sense that if your quack doctor cuts off your leg instead of taking out your appendix, then you should only be able to sue for the cost of your wheelchair. Otherwise you're a drain on the system and greedy. And so is your lawyer.