Brooks Robert G, Menachemi Nir, Hughes Cathy, Clawson Art
Division of Health Affairs, College of Medicine, Florida State University, Tallahassee 32306-4300, USA.
Arch Intern Med. 2004 Nov 8;164(20):2217-22. doi: 10.1001/archinte.164.20.2217.
Almost half of the US states face serious problems with professional liability insurance (PLI). Despite this, little is known about how this crisis is affecting access to care, particularly in rural areas.
We surveyed physicians practicing in rural Florida in 2003. The primary assessment was on changes in health care delivery by service type and specialty. Secondary outcomes included changes in PLI premiums and the effect of changes in premiums on service delivery and practice satisfaction.
Four hundred eleven (52.6%) of 781 physicians decreased or eliminated health care services during the past year. Overall, 73 (61.3%) of 119 decreased or eliminated vaginal deliveries; 60 (52.6%) of 114, cesarean sections; 186 (51.7%) of 360, hospital-based surgical procedures; 209 (46.4%) of 450, emergency department coverage; 103 (41.7%) of 247, endoscopic procedures; 187 (40.9%) of 457, office-based surgical procedures; and 105 (34.5%) of 304, mental health services. Elimination of services was highest for general surgeons (78.4%), surgical specialists (73.6%), and obstetricians/gynecologists (70.2%). Premiums for PLI rose a mean of 93.5%. Difficulty finding or paying for PLI was listed as an important factor by those reducing or eliminating services and by those planning to leave the community within the next 2 years.
The current crisis in medical PLI in Florida has a major impact on the availability and delivery of health care services to rural areas. Given the number of states that are experiencing similar insurance market upheavals, adverse effects on access to care are likely occurring nationwide.
美国近半数州面临职业责任保险（PLI）的严重问题。尽管如此，对于这场危机如何影响医疗服务的可及性，尤其是在农村地区，人们了解甚少。
我们于2003年对在佛罗里达州农村地区执业的医生进行了调查。主要评估内容是按服务类型和专业划分的医疗服务提供方面的变化。次要结果包括职业责任保险保费的变化以及保费变化对服务提供和执业满意度的影响。
在781名医生中，有411名（52.6%）在过去一年减少或取消了医疗服务。总体而言，119名医生中有73名（61.3%）减少或取消了阴道分娩；114名中有60名（52.6%）减少或取消了剖宫产；360名中有186名（51.7%）减少或取消了住院手术；450名中有209名（46.4%）减少或取消了急诊科值班；247名中有103名（41.7%）减少或取消了内镜检查；457名中有187名（40.9%）减少或取消了门诊手术；304名中有105名（34.5%）减少或取消了心理健康服务。普通外科医生（78.4%）、外科专科医生（73.6%）以及妇产科医生（70.2%）取消服务的比例最高。职业责任保险保费平均上涨了93.5%。难以找到职业责任保险或支付保费被列为减少或取消服务的医生以及计划在未来两年内离开该社区的医生的一个重要因素。
佛罗里达州当前的医疗职业责任保险危机对农村地区医疗服务的可及性和提供产生了重大影响。鉴于有多个州正在经历类似的保险市场动荡，全国范围内医疗服务可及性可能受到不利影响。
