Malpractice Influence on Health Care

FAQs: Malpractice Influence on Health Care

 

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Question 1: What is written about the history of malpractice litigation?

Answer 1:

Very little has been written about the history of malpractice insurance.

However, according to James Mohr (2000) at the University of Oregon, medical

malpractice litigation appeared in the United States around 1840. It appears

that the reason medical malpractice came about was related to the lack of

quality control toward medical practitioners at that time. Mohr contends there

are several factors contributing to why medical malpractice litigation has

sustained itself, including the pressures for innovation on American medicine and the spread of uniform standards.

Question 2: Who is required to purchase medical malpractice insurance?

Answer 2: Individual licensed practitioners and licensed health care facilities

are required by law to maintain a minimum level of insurance. States require

practitioners and facilities to obtain insurance for the welfare of patients;

however, rather than settling for the minimum legal standard of the law,

practitioners and facilities should assess and purchase the insurance they truly

need. Medical malpractice insurance purchased by facilities is obtained for the

purpose of covering all those who perform services within the facility (e.g., social workers and technicians) in addition to the licensed professionals.

Question 3: Is malpractice insurance provided for a practitioner by the organization or facility sufficient coverage?

Answer 3: This depends on the individual. All practitioners should consult with

a risk manager to learn their medical malpractice health insurance’s coverage

and limitations. The practitioner should carefully evaluate if the insurance is

sufficient and, if not, purchase additional insurance. If the individual performs

any medical practice not associated with the facility, he or she should have

separate insurance to cover those services because those services will not be covered under the facility insurance.

Question 4: How is malpractice insurance purchased?

Answer 4: Most often, individual practitioners access insurance through

national associations like the American Medical Association or American

Psychiatric Association. Facilities generally utilize insurance brokers to obtain

insurance. The broker is responsible for representing the facility to the

insurance company. An insurance broker can assemble all the necessary

 

 

FAQs: Malpractice Influence on Health Care

 

 

 

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information regarding an organization to present to the insurance company.

Question 5: What impacts the costs of malpractice insurance?

Answer 5: Several factors impact the cost of acquiring medical malpractice

insurance. First, the amount of previously paid claims impacts the cost of future

insurance. The higher the amount of past claims paid out, the higher the

increase in future premiums. Another factor that impacts the cost of medical

malpractice insurance is the insurance company’s ability to make a profit with

its investments. If investment profits are down, costs of insurance will rise, and if profits are up, the cost of insurance will level or reduce.

Question 6: What is the current debate about the rising costs of malpractice insurance?

Answer 6: Many attribute the rising trends in medical malpractice to the surge

in the number of claims filed and the astronomical rise in the amount of claims

paid. Others contend that insurers had to increase premiums because of the

lack of profitability of their investments in the stock market over the past several years.

Question 7: How is insurance regulated?

Answer 7: All states have laws regulating the insurance industry and

insurance departments to perform regulatory functions. Insurance agents or

brokers must be licensed and are required to pass an examination and obtain ongoing education.

Question 8: Do insurance companies have to insure any health care provider that requests malpractice health care insurance?

Answer 8: Individual state laws determine this. Some states require that an

insurance company insure all individuals who request to be insured, while other

state laws are silent about this and allow insurance companies to select the individuals they will cover.

Question 9: Is an insurance company obligated to make payments to individuals who file medical malpractice insurance claims?

Answer 9: No, an insurance company is not obligated to make a payment to

all individuals who file medical malpractice insurance claims. Claims depend on

policy specifics and legal considerations. In most cases, a claimant must prove

 

 

FAQs: Malpractice Influence on Health Care

 

 

 

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that a mistake was made, that an injury occurred, and that damages were

sustained (e.g., lost wages, medical bills, or agony). Generally, the claimant

will need a lawyer or another expert to calculate and present these damages in court.

Question 10: What is tort reform?

Answer 10: Tort reform pertains to the enactment of laws to limit the amount

of payment that could be made on a medical malpractice claim. Some states

have enacted such legislation. Many maintain that these tort reform laws are

solving the malpractice insurance cost crisis by reducing the cost of medical

malpractice insurance. Others argue that there is no crisis and reform efforts

are just a way for large companies to further their own agenda of reducing

their financial risk. There are many health care think tanks studying both sides of this issue.

References

Medical malpractice: Quick reference. (n.d.). Retrieved from Consumer Action

and Information Center of Hawaii Web site:

http://www.consumerlaw.com/medical.html#prove

Mohr, J. C. (2000). American medical malpractice litigation in a historical

perspective. The Journal of American Medical Association, 283(13), 1731–1737.

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