The role of physician-owned insurance companies in the detection and deterrence of negligence

Article Abstract:

The investigation and prevention of negligent medical behavior is an important issue. A study was conducted which focuses on the physician-owned insurance industry, which supplies about 40 percent of insurance coverage to physicians who provide patient care. The study surveyed the 40 companies that comprise the Physician Insurers Association of America (PIAA) as of 1985, and analyzed the peer-review process. Physician-owned insurance companies are powerful; they are able to detect and discipline negligence-prone physicians. Research results indicate that in 60% of the companies, physicians reviewed the competence of their colleagues who had been sued. The study found that physician- owned companies, and their members, play an important role in the detection and prevention of negligent behavior. They accomplish these important goals by imposing financial penalties and exerting the right to terminate coverage. No more than 0.08 percent of U.S. physicians lost their right to practice (e.g., license suspension or revocation) because of negligent behavior in 1985. By contrast, nearly 0.66 percent of PIAA physicians were viewed as sufficiently negligence-prone to warrant termination of their insurance coverage. Furthermore, disciplinary actions were taken against 3.2 percent of insured physicians whose performance was viewed as substandard. This suggests that negligence-prone behavior can be identified by PIAA companies and acts as an effective means of deterring substandard behavior.

Research, Medical malpractice, Physician Insurers Association of America

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Physicians who have lost their malpractice insurance: their demographic characteristics and the surplus-lines companies that insure them

Article Abstract:

A demographic study of 920 physicians who had lost their malpractice coverage was conducted, in order to develop a better understanding of physicians whose insurance is terminated because they have had behavioral problems or adverse claims histories problems. One segment of the insurance industry, the so-called "surplus- lines" companies (e.g., the Warschaw Insurance Agency, the agency providing surplus-line coverage for physicians in this study), is willing to provide coverage to these physicians, but at several times the rate that is usually charged for physicians who do not have high adverse claims histories or behavioral problems. The following categories of physicians are more likely than other groups to use surplus line companies for insurance coverage: neurosurgeons and plastic surgeons, obstetricians and gynecologists, and physicians between the ages of 45 and 54 years. It is estimated that over 2,000 physicians lose their insurance each year because of medical negligence. Some of these physicians may give up patient care, while others may choose to practice without insurance. Physicians who operate without insurance are unlikely to qualify for hospital privileges, and are therefore unlikely to handle complex or difficult cases. Surplus lines companies, in contrast to joint underwriting associations, impose high premiums, large deductibles, and restrictions on practice. These aspects of surplus line insurance are designed to reduce the frequency of negligent behavior.

United States, Economic aspects, Insurance, Malpractice insurance

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No evidence of an emerging physician surplus: an analysis of change in physicians' work load and income

Article Abstract:

A decade ago a number of different sources, including the Graduate Medical Education National Advisory Committee, predicted that by 1990 there would be a surplus of physicians in the United States. A current analysis of the physician's workload and income suggests that this has not taken place. Data contained in surveys published by the American Medical Association provide the source material for this analysis. The data indicate that the number of hours spent in patient care per physician has increased between 1982 and 1987, contrary to what would be expected if a physician surplus were brewing. It is worthy of noting that the number of patient visits per physician has in fact declined; this is apparently due to the increasing amount of time a modern physician spends with an individual patient. Also indicated by the data is the fact that not only has the net income of physicians risen over the period examined, but the real income, adjusted for inflation, has also risen. The authors suggest that these trends are likely to continue and state that only extensive rationing of medical services would be expected to change this projection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medicine, Forecasts and trends, Supply and demand, Practice, Medical practice, Medical fees, Graduate Medical Education National Advisory Committee

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