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PubMed1955

What price medical malpractice insurance?

The Medical Review and Advisory Board has been established as a committee of the Commission on Professional Welfare of the California Medical Association to make studies and recommendations toward solution of the growing problems of professional liability insurance and malpractice actions in California. The members of the Board are: Joseph F. Sadusk, Jr., Oakland, Chairman; Wilbur Bailey, M.D., Los Angeles, vice-chairman; Howard W. Bosworth, M.D., Los Angeles; H. I. Burtness, M.D., Santa Barbara; Paul W. Frame, Jr., M.D., Sacramento; Verne G. Ghormley, M.D., Fresno; Carl M. Hadley, M.D., San Bernardino; Joseph J. O'Hara, M.D., San Diego; William F. Quinn, M.D., Los Angeles; Rees B. Rees, M.D., San Francisco; and Bernard Silber, M.D., Redwood City; Mr. Rollen Waterson, 564 Market Street, San Francisco 4, is executive secretary, and Mr. Howard Hassard is legal counsel.

California↗
PubMed1976

The medical malpractice problem, and some possible solutions.

The solutions to the problems of medical malpractice and malpractice insurance coverage are primarily in the hands of state legislatures. Legislation enacted has been primarily palliative, to assure continued availability of professional liability insurance. Unfortunately, no limit can be placed on the costs of such coverage. Unfortunately, too, no long-term solution has been forthcoming. Any long-term solution must encompass some method or methods of reducing injuries to patients and at the same time changing the system from defense of the physician to compensation of the patient. If such changes are not forthcoming, physicians will become uninsurable and the private practice of medicine as we now know it will disappear in this country.

Anesthesiology↗
PubMed1988

Changes in resident physicians' collective bargaining outcomes as union strength declines.

This paper examines the effect of reductions in union bargaining strength on total compensation and compensation mix for resident physicians. The working conditions examined in this paper include hourly wages, life/health insurance, meals on the job, professional liability insurance, and employee grievance procedures. Data for resident physicians with and without collective bargaining agreements are examined for two distinct time periods. The findings suggest that as bargaining strength declined, resident physician unions were less able to deliver advantages in both total compensation and compensation mix. In addition, these unions were more willing to make concessions on fringe benefits than on wage earnings.

Collective Bargaining↗
PubMed1980

[Claims against dentists. A review of claims by 584 patients].

584 patient claims taken from the files of liability insurance agencies were evaluated and classified according to type and frequency, including the respective court decisions, when known. The different requirements for claims of negligence and lack of information were presented briefly. The results of this survey of liability claims which were actually raised in the practice provide helpful information on how liability damage may be avoided.

Dental Care↗
PubMed1996

Prevention should be the preferred insurance program for all physicians.

Recent fee increases announced to the Canadian Medical Protective Association (CMPA) and the Ontario government's plan to stop its CMPA rebate program for the province's physicians have put the spotlight on medical liability insurance. In this examination of the role played by the CMPA, Ottawa lawyer Karen Capen notes that quality service and attention to physician-patient communication will in most cases ensure a litigation-free professional life.

Canada↗
PubMed1992

The need for tail coverage in medical malpractice insurance.

In today's litigious society, it is more important than ever that physicians purchase "tail" coverage--that is, insurance for claims asserted after the period covered by their basic insurance arising from occurrences during the insured period. This article describes the tail of a medical malpractice insurance policy, the need for and purpose of tail coverage, the methods of pricing such coverage, and the problems associated with the tail coverage provisions of medical professional liability insurance.

Actuarial Analysis↗
PubMed1987

Preventing directors' and officers' liability exposure.

Increasingly concerned about unavailable or unaffordable directors' and officers' liability insurance (D & O), hospital trustees and CEOs are working to maximize coverage benefits, exploring self-insurance, and relying on indemnification provisions in hospital bylaws for protection. However, these approaches are limited because they focus on lessening the impact of a D & O claim after it is filed. This article examines how to prevent liability exposure in the first place.

Financial Management↗
PubMed1999

Choosing a malpractice insurance carrier. What you should know!

It's one of your most important decisions, because the insurance company you choose protects your financial assets and your good name. From financial strength to an aggressive defense, here's what you should know about selecting a professional liability insurance company.

Humans↗
PubMed1996

[Medical expert assessment in civil and criminal law from the legal liability viewpoint].

In view of the wide range of liability claims, expert medical reports constitute part of the basis of the work of liability insurers. However, the very different qualifications of experts often present the so-called "corporate physician" with great problems, since some expert reports are hardly acceptable, as the author discovered during many years of study of a large number of liability files. In addition, the most striking and frequently occurring criteria are discussed.

Expert Testimony↗
PubMedDate not supplied

Hospitals' behavior in a tort crisis: observations from Pennsylvania.

Pennsylvania, like many states around the country, is in the throes of a "tort crisis." The cost of professional liability insurance for physicians and hospitals is escalating rapidly, as its availability shrinks. Many hospitals are poorly situated to bear these rising costs, especially in an environment of flat reimbursement rates and poor investment returns. This paper examines the impact of the liability crisis on Pennsylvania hospitals and the strategies being used to weather the storm, including alternative risk financing and closer ties between hospitals and affiliated physicians. It concludes by connecting these trends to larger medical malpractice policy issues.

Economics, Medical↗
PubMed1985

Physician medical malpractice.

Malpractice insurance premiums for physicians have increased at an average rate of over 30 percent per year. This rate is significantly higher than health care cost inflation and the increase in physician costs. Trends indicate that malpractice related costs, both liability insurance and defensive medicine costs, will continue to increase for the near future. Pressures to limit physician costs under Medicare raise a concern about how malpractice costs can be controlled. This paper presents an overview of the problem, reviews options that are available to policymakers, and discusses State and legislative efforts to address the issue.

Insurance, Liability↗
PubMedDate not supplied

Availability of school physical activity facilities to the public in four U.S. communities.

PURPOSE: This study documents the public availability of school physical activity facilities, reasons facilities were not made available to the public, and the barriers and benefits associated with having facilities available. DESIGN: Cross-sectional. SETTING: All schools located in four geographic locations (Washington County, Maryland; northwest suburbs of Minneapolis, Minnesota; Jackson, Mississippi; and Forsyth County, North Carolina). SUBJECTS: The survey was completed by 289 school representatives for a response rate of 82.3% (289/351 schools). For the nonrespondents, 61 of 62 schools were visited to obtain information on outdoor facilities. MEASURES: Information on indoor and outdoor physical activity facilities available to the public was collected for all schools (public, private, and colleges) using a telephone survey. Site visits were made to schools that did not participate in the survey to collect information on outdoor facilities only. RESULTS: The schools in the four geographic areas owned a wide range and number of physical activity facilities for their students. For the schools, 27% had no indoor facilities and 11% had no outdoor facilities. Private schools and colleges were less likely to have indoor or outdoor facilities compared to public schools. Outdoor facilities were available more often to the public than indoor facilities overall, across sites, and by school type (public, private, college). Among the 313 schools with outdoor facilities, 240 (77%) allowed at least some public use, and among the 210 schools with indoor facilities, 134 (64%) allowed at least some public use. Some reasons that facilities were not made available included: for student use only, supervision and personnel requirements, safety concerns, insurance, liability, and a private or church-owned status. The most common benefits of allowing the public to use the facilities included providing a space to keep youth active and good publicity for the school. CONCLUSION: These findings suggest that safety, insurance, and liability concerns are barriers that need to be addressed with schools before indoor and outdoor facilities can be made available to the public. Furthermore, emphasizing the benefits that we found, such as providing a space to keep youth active and good publicity for the school, would also be important.

Community Participation↗
PubMed1979

[Dental injuries during general anaesthesia and their forensic consequences (author's transl)].

145 dental injuries in 83 patients occuring during general anaesthesia are classified on the basis of the material from a liability insurance company. These mainly affected the upper incisors. In childhood only luxations occured, in other ages no characteristic distribution of different types of damage could be found. Besides intubation, 20 per cent of injuries were caused by Guedel oral airways. Damage to teeth is the main cause of claims in tort from its total number. Damage of healthy teeth generally is due to carelessness, whereas an injury to teeth damaged by other reasons before administration of general anaesthesia causes liability of the anaesthesiologist because of inadequate examination and exploration.

Anesthesia, General↗
PubMed1985

[Frontal collision in the reclining-sitting position. Medical and legal aspects].

An account is given of a head-on collision involving a sleeping female who was a front-seat passenger in a sitting-reclining position and who was not wearing a safety belt. Biomechanical, clinical and radiological findings are reported (longitudinal fracture at the L3, vertebral compressions, intervertebral disc lesions, vertebral arch lacerations and incomplete paraparesis from L2 distally. In the course of several lawsuits leading up to the Federal Supreme Court, two judgments were pronounced that outline the legal obligations of the driver towards sleeping front-seat passengers. In this case, there was a conviction on account of "neglect." A district (LG) and an appellate court (OLG) acknowledged the liability of the driver for injury to person and property damages. The fact that he had not awakened the women passenger to draw her attention to the necessity of fastening the safety belt in a sitting position and in this way giving her the opportunity to make her own responsible decision was considered as "at least contributory" towards the damages sustained in the accident. The settlements regarding the private insurance liability are also derived from these rulings.

Accidents, Traffic↗
PubMed1997

The search for the elusive electronic medical record system--medical liability, the missing factor.

Over the past few years, the traditional paper-based medical record system has come under close scrutiny by every participant in the healthcare industry. Some groups, especially federal agencies such as Medicare and Medicaid, HMOs, and other third party payors, have begun to demand changes in medical record documentation, and have become very assertive as to what goals and objectives will be met. In contrast, the medical liability insurance industry has remained almost invisible during this period of transition. At a recent electronic medical records (EMR) conference participants attending a software development workshop were asked if they had their systems reviewed from a medicolegal standpoint by a malpractice insurance carrier. In response to this inquiry, not one software vendor raised their hand to indicate this had been accomplished, or was even contemplated. In the author's opinion, the key missing factor in the current quest for a paperless medical office system rests in the domain of those who represent the medical liability industry. All of these gate-keepers of medical loss and risk prevention will eventually be called upon, either by choice or necessity, to validate every working EMR system that is used in medical practices in the future. This article will explore the best information published from this currently silent sector of the industry, and proposes an active involvement by the medical liability industry in the current EMR design and development processes taking place. In addition, there are 10 minimum EMR design criteria contained in this article that are recommended for implementation based upon 16 years of medical malpractice experience and loss prevention input.

Humans↗
PubMed1987

Injury as externality: an economic perspective of trauma.

Economists emphasize the costs in dollars or other desirable outcomes of additional safety in contrast to safety experts who remind people to design safe products and operate them safely. Society loses emotionally and financially from traumatic injury. The emotional loss must be balanced against allowing individuals free choice and encouraging them to develop judgment. Individuals are viewed as making their own best safety decisions, although they must have good information and face the correct indentives. Currently, society subsidizes risk taking in many ways, thereby discouraging safety. Health and life insurance ought to be required along with liability insurance, to correct the incentives to drivers. In addition, regulation is required to deal with physical externalities.

Cost-Benefit Analysis↗
PubMed2004

Medicare--substitute HMOs--reimbursement from other insurance. Care Choices HMO v. Engstrom.

The federal statute that permits Medicare-substitute HMOs to seek reimbursement from other insurers does not provide the HMOs with a private federal remedy for reimbursement. It permits Medicare-substitute HMOs to provide in their policies that they are entitled to reimbursement in cases where other insurance, such as the third-party liability insurance of a party responsible for causing an injury, is available. The HMO must sue in state court for its contractual right to reimbursement. It may not sue in federal court under the federal statute that merely allows it to provide for reimbursement in their policies.

Health Maintenance Organizations↗
PubMed2001

Medical malpractice and legal resolution systems in Japan.

Medical malpractice claims and dispute resolution systems have been examined in Western societies for their impact on the quality of care and efficient compensation for injured patients. However, little is known about the Japanese malpractice environment because claim information has been closely guarded. Based on data from the Japanese Supreme Court, the Ministry of Health, Labor, and Welfare (formerly the Ministry of Health and Welfare), and the Japan Medical Association (JMA), which provides malpractice insurance to 43.5% of Japan's 250 000 physicians, we review Japanese malpractice liability systems and the frequency of claims during the last 30 years. Annual premiums for physician professional liability insurance are relatively low (454 dollars-491 dollars). Although the frequency of claims in Japan is lower than that reported in the United States, England, and Germany, the number of claims is increasing in Japan. According to publicly available data from the Japanese Supreme Court, the annual number of medical malpractice suits filed in district courts has increased from 102 in 1970 to 629 in 1998 (from 0.09 to 0.25 per 100 physicians). The proportion of awards greater than 89 dollars 300 increased from 13.6% in 1976 to 65.4% in 1987. Among JMA members, claims increased 31% from 1987 to 1999, but the frequency of claims has remained at approximately 0.3 per 100 JMA members. The JMA's professional liability program offers a nonbinding out-of-court review of claims that is faster and less expensive than judicial resolution (a few months with no attorney required vs 35 months and attorney fees), but is a poor means of deterrence or discipline. Since JMA data represent only 43.5% of Japanese physicians, generalizations cannot be made about all Japanese physicians and institutions. The lack of data on all claims hinders adequate evaluation of dispute resolution methods, development of appropriate risk management activities, and proactive education for Japanese physicians.

Insurance, Liability↗