Changing the malpractice liability system

Article Abstract:

The most common kind of reform suggested for improving the medical malpractice liability system is a change in the tort system, that part of the legal code pertaining to wrongful acts, injuries, or damage. Suggestions include pretrial screening, limitation of attorneys' fees, and regulation of expert witnesses' qualifications. But a more fundamental problem stems from assuming that juries can fairly and accurately determine whether negligence has occurred. This often requires a level of professional judgment which jurors do not possess. Even if this problem were solved, most patients do not even reach the trial stage of a trial because of the high costs, and thus the usefulness of the system is further limited. A better approach is a no-fault system, discussed in the March 1, 1990 issue of the New England Journal of Medicine, where people with adverse outcomes from medical care are compensated for economic loss without raising concerns about negligence and fault. While administrative costs of such a plan would be high, award size and legal costs would be dramatically reduced. A less extreme proposal has been made by the American Medical Association/Specialty Society Liability Project. This involves a fault-based administrative system to determine whether negligence occurred, and utilizes expert witnesses and a jury trial in some cases. However, such an agency would only handle cases with known associations to negligence. Other plans are discussed. Any alternative to tort litigation will face challenges on the basis of constitutional rights and must take into consideration such factors as the prevalence of treatment outcomes and incidence of negligence. The Harvard Medical Practice Study is currently conducting a study of these issues. Finally, physicians must take seriously public concerns about malpractice and do their part to prevent negligence. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Physicians, Liability insurance, Medical malpractice

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The changing demography of the medical profession

Article Abstract:

An increase in the number of women entering medicine was first observed by the author 10 years ago and the trend has continued. The number of women in medical school has risen from approximately nine percent between 1969 and 1970, to 28 percent by the end of the Seventies, to 38 percent in the '80s. This trend and related issues are reviewed and summarized in the light of two articles appearing in the New England Journal of Medicine. A survey by Levinson et al. contained interesting data on how female physicians coped with the demands of a career and family. In another article, Eisenberg attributed the preservation of medical school standards to the influx of women, which has compensated for the lower numbers of men entering medical school and has kept the acceptance-to-applicant ratios at the desired low levels. The author of that article points out that despite the increased number of women, the ratio of acceptances to applications is higher than it has ever been. Eisenberg has also identified possible reasons for the reduced interest in medical school by white men in the United States, citing concerns regarding economic opportunities, autonomy, and the rising costs of medical education. Also, traditionally women have gravitated toward salaried positions and primary care medicine. Both of these situations are becoming more prevalent in medicine as more emphasis has been placed on efforts to control health care costs. In the future, the profession will most likely become more representative of society, employing more women and minorities, and salaries will be more modest.

Social aspects, Medicine, Demographic aspects, Medical college applicants, Medical school applicants, Women in medicine

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Universal health insurance: its time has come

Article Abstract:

Two plans for instituting a national health program are reviewed. The first plan suggests that health plans compete for contracts with employers or state sponsors and that the plans would pay hospital costs. Medicare and Medicaid, which would continue, would also pay hospital costs. Employers would be responsible for health plan coverage for all full time employees and would pay an eight percent payroll tax on uncovered employees. An income tax would pay for coverage of other individuals. The Physicians for National Health group proposes that a general pool of money pay for a single public insurance system. That program would pay an annual sum to hospitals and nursing homes to cover expenses and physicians would be paid on a fee schedule or by salaries based on a per capita assignment system. The coverage would be complete and private insurance would be eliminated. Neither program would be government-owned owned and therefore not socialized medicine. It is suggested that any new reform incorporate ways in which to improve technology and quality, include malpractice reorganization, keep costs low, and be provided for everyone.

Research, Planning, National health insurance, Enthoven, Alain, Himmelstein, David U.

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