BACKGROUND AND PURPOSE:

• Mello et al. (JAMA, 2020) assessed whether there is an association between malpractice liability risk and health care quality and safety

METHODS:

• Systematic review and meta-analysis
• Study inclusion criteria
  • Published between 1990 and 2019
  • Data includes relationship between malpractice liability risk measures and health outcomes or structural and process indicators of health care quality
• Study design
  • Data extracted by two reviewers
  • Studies summarized descriptively and assessed qualitatively
• Exposure measures
  • Physicians’ malpractice insurance premiums
  • State tort reforms
  • Frequency of paid claims and average claim payment
  • Physicians’ claims history
  • Total malpractice payments
  • Jury awards
  • Presence of an immunity from malpractice liability
  • CMS malpractice geographic practice cost index
  • Composite of above
• Outcome measures
  • Patient mortality
  • Hospital readmissions, avoidable admissions, and prolonged length of stay
  • Receipt of cancer screening
  • AHRQ patient safety indicators and other adverse event measures
  • Measures of hospital and nursing home quality
  • Patient satisfaction
• Primary outcomes
  • Associations between malpractice risk measures and health care quality and safety outcomes

RESULTS:

• Obstetrical care (16 studies)
  • No significant association between liability risk and outcomes (e.g. Apgar score and birth injuries): 9 studies
  • Limited evidence for association: 7 studies
• Non-obstetrical care settings (20 studies)
  • No significant association with liability risk: 15 studies
  • Limited evidence for association: 5 studies
• Hospital readmissions and avoidable initial hospitalizations (7 studies)
  • No significant association with liability risk: 7 studies
• Other measures, such as patient safety indicators, process-of-care quality measures, patient satisfaction (12 studies)
  • No significant association with liability risk: 7 studies
  • Significant associations in some analyses: 5 studies
    • Results were mixed: E.g., looking at cancer screening rates, 1 study found association between mean malpractice claim payments and mammography rates, while another study found no relationship between tort reforms and cancer screening rates

CONCLUSION:

• Majority of studies did not show a relationship between liability risk and outcomes, especially in obstetrics
• Authors recognize limitations, including some studies reporting vague information with varying detail
• Despite some evidence gaps, the authors conclude that greater tort liability is unlikely to be a deterrent or result in better health outcomes

Learn More – Primary Sources:

Malpractice Liability and Health Care Quality – A Review

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