Ambrose Jan M, Carroll Anne
La Salle University.
J Health Polit Policy Law. 2007 Oct;32(5):843-65. doi: 10.1215/03616878-2007-032.
In response to recent and past medical malpractice insurance crises, most states have implemented reforms meant to stabilize premiums and coverage availability. The importance of understanding whether these reforms implicitly affect the behavior and incentives of plaintiffs, attorneys, medical providers, and malpractice insurers in the intended way is crucial to policy makers, if they are to achieve their goal. This study specifically examines the effect of reforms on the claims defense efforts of insurers, given that defense expenses account for approximately 30 percent of malpractice premiums. Using state data for the period 1998-2002, we regress claims defense expenses against a variety of reform variables. These include seven tort reforms (noneconomic damage caps, punitive damage limits, attorney fee limits, modified collateral source rule, modified joint and several liability doctrine, mandatory pretrial screening, and statute of limitations) and two government-sponsored insurance mechanisms (joint underwriting associations and patient compensation funds). Claims defense expenses are found to be higher in the presence of noneconomic damage caps, punitive damage limits, and attorney fee limits--an unintended and counterproductive effect of reform--but are lower with mandatory pretrial screening and patient compensation funds.
为应对近期及过去的医疗事故责任保险危机，多数州已实施改革措施，旨在稳定保费并确保保险覆盖范围。如果政策制定者想要实现目标，那么了解这些改革是否以预期方式隐性影响原告、律师、医疗服务提供者及医疗事故责任保险公司的行为和激励措施至关重要。鉴于辩护费用约占医疗事故责任保险保费的30%，本研究特别考察了改革对保险公司理赔辩护工作的影响。利用1998 - 2002年的州数据，我们将理赔辩护费用与多种改革变量进行回归分析。这些变量包括七项侵权法改革（非经济损害赔偿上限、惩罚性损害赔偿限额、律师费限额、修正的间接来源规则、修正的连带责任原则、强制审前筛选以及诉讼时效）和两种政府资助的保险机制（联合承保协会和患者赔偿基金）。研究发现，在存在非经济损害赔偿上限、惩罚性损害赔偿限额和律师费限额的情况下，理赔辩护费用较高——这是改革产生的意外且适得其反的效果——但在实行强制审前筛选和患者赔偿基金的情况下，理赔辩护费用较低。
