Malpractice: provider risk or consumer protection?

The National Practitioner Data Bank (NPDB) began operation in September 1990 as a clearinghouse for adverse action, licensure, and malpractice information in an effort to protect consumers and promote quality in health care. This study analyzed 66,107 and 1291 records of payments made for 50,396 physicians and 1218 nurses, respectively, from 1994 through 1998, to describe characteristics, trends, and risk factors of malpractice payment for physicians and nurses. The median payments, more often settlements paid by insurance companies than judgments in courts of law, were higher for physicians than for nurses. Mean payments were higher for residents than for non-resident physicians; median payments for residents were slightly lower than other physicians when adjusted for number of providers included in the payment. On the state level, correlation analyses suggested a significant positive association between the nurse rate of malpractice payments that were made and median per capita income, number of physicians per 1000 residents, and number of attorneys per 1000 residents; analysis revealed a significant negative association between this rate and the percentage of residents residing in rural areas and the number of nurses per 1000 residents. Although findings suggested that payment trends remained stable, there was great regional variation in the risk of malpractice payment for both physicians and nurses. The physician risk ranged from a low of 0.73% per physician per year in Alabama to a high of 3.7% in Wyoming, and the nurse risk ranged from a low of 0% per nurse per year in Vermont to a high of 0.075% in the District of Columbia. If the quality of health care provided by physicians and nurses does not vary geographically in the United States, then such a great discrepancy seems to challenge the notion that the risk of malpractice litigation consistently promotes the quality of health care.