Segal Jeffrey J, Sacopulos Michael
Medical Justice Services, Inc., PO Box 49669, Greensboro, NC 27419, USA.
Clin Orthop Relat Res. 2009 Feb;467(2):420-6. doi: 10.1007/s11999-008-0577-9. Epub 2008 Nov 1.
Medical professional liability in the United States, as measured by total premiums paid by physicians and healthcare facilities, costs approximately $30 billion a year in direct expenses, less than 2% of the entire annual healthcare expenditures. Only a fraction of those dollars reach patients who are negligently injured. Nonetheless, the tort system has far-reaching effects that create substantial indirect costs. Medical malpractice litigation is pervasive and physicians practice defensively to avoid being named in a suit. Those extra expenditures provide little value to patients. Despite an elaborate existing tort system, patient safety remains a vexing problem. Many injured patients are denied access to timely, reasonable remedies. We propose a no-fault system supplemented by a variation of the traditional tort system whereby physicians are incentivized to follow evidence-based guidelines. The proposed system would guarantee a substantial decrease in, but not elimination of, litigation. The system would lower professional liability premiums. Injured patients would ordinarily be compensated with no-fault disability and life insurance proceeds. To the extent individual physicians pose a recurrent danger, their care would be reviewed on an administrative level. Savings would be invested in health information technology and purchase of insurance coverage for the uninsured. We propose a financial model based on publicly accessible sources.
在美国,以医生和医疗机构支付的总保费衡量,医疗职业责任每年的直接费用约为300亿美元,不到全年医疗总支出的2%。这些钱中只有一小部分给到了因医疗过失而受伤的患者。尽管如此,侵权责任制度仍产生了深远影响,带来了巨大的间接成本。医疗事故诉讼很普遍,医生采取防御性医疗行为以避免被起诉。这些额外支出对患者几乎没有价值。尽管现有的侵权责任制度很完善,但患者安全仍然是一个棘手的问题。许多受伤患者无法获得及时、合理的赔偿。我们提议建立一个无过错制度,并辅以传统侵权责任制度的一种变体,以此激励医生遵循循证指南。提议的制度将保证大幅减少但不会消除诉讼。该制度将降低职业责任保险费。受伤患者通常将通过无过错残疾保险和人寿保险获得赔偿。对于个别反复构成危险的医生,将在行政层面审查其医疗行为。节省下来的资金将投资于健康信息技术,并为未参保者购买保险。我们提议建立一个基于公开可用数据来源的财务模型。