Lawthers A G, Localio A R, Laird N M, Lipsitz S, Hebert L, Brennan T A
Harvard University.
J Health Polit Policy Law. 1992 Fall;17(3):463-82. doi: 10.1215/03616878-17-3-463.
We explore the deterrent effect of the tort system by assessing physician perceptions of the risk of being sued and the impact of those perceptions on their own practice. The data are from a mailed survey conducted in 1989 of a random sample of physicians who were practicing in New York State in 1984. The survey results were compared to the actual risk of suit using the between-group (Wald) test and logistic regression methods. We also surveyed physicians about practice changes undertaken in the last ten years, factors influencing practice standards, and the costs of being sued and included these in the analysis. On average, physicians estimate that 19.5 out of one hundred of their colleagues will be sued in a given year, approximately three times the actual rate, with significant differences by specialty, location, and suit history. Perceived risk is associated with self-reported changes in test-ordering frequency and reduction in practice scope. The median number of days lost from practice to defend a malpractice suit was three to five, and 6 percent of the physicians surveyed incurred some out-of-pocket expenses. These findings suggest that physicians respond to the messages sent by litigation in a manner consistent with the deterrent theory of tort litigation.
我们通过评估医生对被起诉风险的认知以及这些认知对其自身医疗行为的影响，来探究侵权责任制度的威慑作用。数据来自于1989年对1984年在纽约州执业的医生进行随机抽样的邮寄调查。使用组间（ Wald ）检验和逻辑回归方法，将调查结果与实际被起诉风险进行比较。我们还就医生在过去十年中所做的医疗行为改变、影响医疗行为标准的因素以及被起诉的成本对医生进行了调查，并将这些纳入分析。平均而言，医生估计在某一年中，每百名同事中有19.5人会被起诉，这大约是实际发生率的三倍，且在专业、地点和诉讼历史方面存在显著差异。感知到的风险与自我报告的检查开单频率变化以及医疗行为范围缩小有关。因医疗事故诉讼而导致的停诊天数中位数为三到五天，6%的受访医生产生了一些自付费用。这些发现表明，医生对诉讼发出的信息的反应方式与侵权责任诉讼的威慑理论相一致。
