Product Description

Honorable Mention, Economics category, 2008 PROSE Awards presented by the Professional/Scholarly Publishing Division of the Association of American Publishers.

Most experts would agree that the current medical malpractice system in the United States does not work effectively either to compensate victims fairly or prevent injuries caused by medical errors. Policy responses to a series of medical malpractice crises have not resulted in effective reform and have not altered the fundamental incentives of the stakeholders. In Medical Malpractice, economist Frank Sloan and lawyer Lindsey Chepke examine the U.S. medical malpractice process from legal, medical, economic, and insurance perspectives, analyze past efforts at reform, and offer realistic, achievable policy recommendations. They review the considerable empirical evidence in a balanced fashion and assess objectively what works in the current system and what does not.

Sloan and Chepke argue that the complexity of medical malpractice stems largely from the interaction of the four discrete markets that determine outcomes—legal, medical malpractice insurance, medical care, and government activity. After describing what the evidence shows about the functioning of medical malpractice, types of defensive medicine, and the effects of past reforms, they examine such topics as scheduling damages as an alternative to flat caps, jury behavior, health courts, incentives to prevent medical errors, insurance regulation, reinsurance, no-fault insurance, and suggestions for future reforms. Medical Malpractice is the most comprehensive treatment of malpractice available, integrating findings from several different areas of research and describing them accessibly in nontechnical language. It will be an essential reference for anyone interested in medical malpractice.

Product Details

• Amazon Sales Rank: #436969 in Books
• Published on: 2008-02-29
• Original language: English
• Number of items: 1
• Binding: Hardcover
• 464 pages

Review
"...[Medical Malpractice] certainly will be of interest not only to medical and legal policy makers but to physicians interested in this oftentimes most personal of topics. For some in the medical community much of the research and many of the conclusions may prove difficult to accept, but by explaining and expounding on a perceived medical malpractice crisis, Sloan and Chepke just might help slowly change that perception."
— Journal of American Medical Association

"Medical Malpractice will almost certainly become the definitive general reference for policymakers and scholars interested in the important problem of medical malpractice and our legal system. The book is not only written by experts in the field, it is also comprehensive in its coverage, balanced in its judgments, and oriented toward data and evidence rather than the expression of opinion. Finally, the book is unusual in its accessibility—no one will have trouble understanding it."
—Steve Shavell, Samuel R. Rosenthal Professor of Law and Economics, Harvard Law School

"Controversy over the modern medical malpractice system has raged ever since the first malpractice crisis took place in 1975, but it is only during the past few years that empirical studies have generated the data that are necessary to produce an accurate understanding of how the system works. Frank Sloan and Lindsey Chepke pull these data into a comprehensive picture in this book, and unlike many other commentators, they do so with commendable objectivity.... it is a scholarly masterpiece and is easily the definitive work on its subject."
— New England Journal of Medicine

"Frank Sloan and Lindsey Chepke have written an outstanding book on medical malpractice. Their comprehensive and clear-headed analysis sifts carefully through what we know and don't know about the workings of the system. The discussion of liability insurance markets and insurance regulation is particularly impressive, and surely stands as the finest analysis of these issues to date. Medical Malpractice should be essential reading for doctors, lawyers, policymakers, and managers of health care institutions and professional indemnity companies. Patients with a special interest in the topic will find the book more accessible than previous treatments of the topic. The book will help all of these stakeholders sort fact and evidence from the myth and exaggeration that too often poison debate in this area."
—David Studdert, Professor and Federation Fellow, Faculty of Law, and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne

"This is top-flight work. I expect this book will be a watershed in the literature of medical malpractice. I have seen nothing so capacious nor so well done."
—Edward A. Dauer, Dean Emeritus, and Professor of Law, Sturm College of Law, University of Denver

About the Author
Frank A. Sloan is J. Alexander McMahon Professor of Health Policy and Management and Professor of Economics at Duke University. He is the coauthor of The Price of Smoking (MIT Press, 2004) and author or editor of many other books on health economics.

Lindsey M. Chepke, an attorney, is a Research Associate at the Center for Health Policy at Duke University.

Customer Reviews

Interesting
A good book on a contentious topic. Written by an experienced health care economist and an attorney, the authors attempt to provide a broad perspective on medical malpractice. Sloan and Chepke agree that there are serious problems with medical malpractice, but not the problems generally discussed in most public forums. The intermittant public attention paid to this issue is driven often by intermittant malpractice 'crises' in which insurers withdraw from markets, premiums escalate sharply, and there is fear of consequent physician withdrawal from states with sharply rising premiums. A common popular perception of these crises is that they are driven by excessive tort litigation and awards. In fact, there is little evidence for this explanation and recurrent malpractice insurance crises apparently have their roots in other phenomena, notably cyclical features of the insurance industry. Another common public point of discussion is that malpractice litigation is a significant contributor to rising health care costs. The available evidence, however, suggests that malpractice torts have at best a modest effect on health care costs.
Where Sloan and Chepke see major problems with malpractice torts is their apparent failure to have an impact on the high rate of serious medical errors in the USA. In addition, the data cited by Sloan and Chepke indicates that the tort system does a poor and inefficient job of compensating individuals injured through negligence. Sloan and Chepke discuss the first generation of tort reforms which are mainly caps on awards. The major effects of these reforms has been indeed to reduce awards, claims, and insurance premiums with the primary beneficiaries being physicians and insurers. It appears that first generation reforms are a stereotypical example of successful interest group lobbying of state legislatures with modest general public benefits.
Much of the book is a systematic discussion of proposed reforms including such topics as alternative dispute resolution, specialized health courts, no-fault procedures, and a number of others. These discussions are generally thorough, contain nice summaries of the usually limited evidence, and discouraging in the sense that Sloan and Chepke demonstrate the uncertainties that any proposed reforms will work and point out the pragmatic political obstacles to most of these proposed reforms.
Sloan and Chepke conclude with a chapter proposing a series of modest reforms, particularly focused on making hospitals or hospital systems the focus on malpractice litigation in the hope that this will produce incentives to improve patient safety. This is reasonable and approaches like the one proposed are used by some academic hospital systems where physicians are employees.
Sloan and Chepke may make a couple of errors. As they point out, the tort system does a poor job of identifying and compensating meritorious claims. At the same time, a lot of claims pursued do lack merit. But this irrational element is one of the things that physicians most dislike about the present system. While the tort system may not be the 'lottery' claimed by many critics, its irrational enough to be worrisome to health care providers. There is also some recent evidence that some forms of torts do reduce medical errors. Nonetheless, Sloan and Chepke's analysis is convincing and their modest suggestions for reform quite reasonable.