Paid Malpractice Claims Declined Over Past Decade

Michelle M. Mello, JD, PhD Professor of Law, Stanford Law School Professor of Health Research and Policy Stanford University School of Interview with:
Michelle M. Mello, JD, PhD
Professor of Law, Stanford Law School
Professor of Health Research and Policy
Stanford University School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Mello: In this report, we examined trends in the volume and cost of medical liability claims in the US, as well as liability insurance costs, and reviewed current initiatives to reform the liability system.

Examining publicly available data from the National Practitioner Data Bank, we found that the frequency and average cost of paid malpractice claims have been declining.  The rate of paid claims against physicians decreased from 18.6 to 9.9 paid claims per 1,000 physicians between 2002 and 2013, about a 6.3% annual average decrease for MDs. Among claims that resulted in a payment, the median payment increased from $133,799 in 1994 to $218,400 in 2007, but has been declining–by 1.1% annually, on average–since 2007.  In 2013 the median payment was $195,000.

When we looked a trends in insurance premiums in several markets, using data from the Medical Liability Monitor’s Annual Rate Survey, we found greater variation from place to place.  However, the overall picture was favorable. None of the locations we examined showed large increases over the last 10 years, and most showed flat or declining premiums.

Medical Research: What should clinicians and patients take away from your report?

Dr. Mello: Things have settled down in the liability environment.  But that’s unlikely to last: history teaches us that we experience regular cycles in insurance and claims costs.  During this period in which costs are relatively stable, there is a window of opportunity to thoughtfully address other problems in the liability system that badly need to be fixed. These include barriers to bringing claims, discordance between the merit of a claim and whether it attracts a payment, high overhead costs, and the protracted and adversarial nature of litigation.

In the article, we discuss several innovative approaches that have been tested in states and hospital systems over the last few years.  These include communication-and-resolution programs, judge-directed negotiation, and safe harbors for adherence to evidence-based clinical practice guidelines.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Mello: There is a need for further testing and evaluation of these promising approaches to improving the liability environment.  Many of them are things that can be done without legislation.  Some, like communication-and-resolution programs–can even be done by hospital systems and liability insurers on their own, a kind of “do-it-yourself” malpractice reform.  We need to learn more about how successful these novel approaches can be in different types of settings.


Medical Liability Climate and Prospects for Reform
Mello MM, Studdert DM, Kachalia A. The Medical Liability Climate and Prospects for Reform. JAMA. 2014;312(20):2146-2155. doi:10.1001/jama.2014.10705.