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Arnold School of Public Health

Study finds varying health outcomes among states with different medical malpractice liability laws

June 16, 2022 | Erin Bluvas, bluvase@sc.edu

Brian Chen, associate professor of health services policy and management (HSPM), has completed a ground-breaking study on a novel approach for assessing the health impacts of varying medical malpractice liability laws across different states. The team of HSPM researchers and alumni published their findings in BMC Health Services Research.

“Policy makers and legal scholars justify medical liability laws – which fall under tort law – because they can compensate individuals for harm, and the threat of costly awards encourages medical providers to follow safe practices,” Chen says. “However, the perception of rampant frivolous lawsuits led to states reforming their laws beginning in the 1990s to limit physician liability. As a result of these reforms, healthcare providers across states practice under different tort law environments.”

Previous research from Chen and his team demonstrated that these different tort law environments were associated with higher surgery rates for Medicare beneficiaries with shoulder conditions in states with laws that limit liability risk. The present study builds on this work by assessing how these variations in surgery rates associated with malpractice liability laws affect patient health outcomes.

In other words, do higher surgery rates improve access to needed care or do they increase the risk or adverse outcomes and mortality for vulnerable patients?

To investigate, the researchers analyzed data from nearly 68,000 Medicare beneficiaries with shoulder conditions, looking for patterns and associations related to adverse outcomes, mortality and treatment success rates. They found that higher rates of treatment success and mortality were associated with increasing rates of surgery in states with lower liability risk. Further, mortality rose more sharply for vulnerable groups, with mortality and treatment success rates being higher for younger Medicare patients.

“These results indicate a tradeoff between increased mortality risk and increased treatment success across states with different malpractice levels,” Chen says. “Surgeons are not likely to begin performing surgery indiscriminately even when their liability for negligence is reduced.”

The authors also point out that more vulnerable patients bear the brunt of the increased mortality while the less vulnerable groups benefit from increased success rates. These differences, they note, highlight the important risk-reward scenario not only for different liability environments but for different groups of patients as well. They concluded that looking at these impacts on health outcomes is an appropriate measure of the potential effects of tort law reform.


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