Sloan Frank A, Shadle John H
Duke University and NBER, 302 Towerview Rd., Box 90253, Durham, NC 27708, United States.
J Health Econ. 2009 Mar;28(2):481-91. doi: 10.1016/j.jhealeco.2008.12.006. Epub 2008 Dec 25.
Proponents of tort reform applied to medical malpractice argue for change partly on the premise that the threat of lawsuits has made medical care more costly. Using U.S. longitudinal data from the National Long-Term Care Survey merged with Medicare claims and other data for 1985-2000, this study assesses whether tort reforms have reduced Medicare payments made on behalf of beneficiaries and the survival probability following an index event. Direct reforms (caps on damages, abolition of punitive damages, eliminating mandatory prejudgment interest, and collateral source offset) did not significantly reduce payments for Medicare-covered services in any specification. Indirect reforms (limitations on contingency fees, mandatory periodic payments, joint-and-several liability reform, and patient compensation funds) significantly reduced Medicare payments only in a specification based on any hospitalization, but not in analysis of hospitalization for each of four common chronic conditions. Neither direct nor indirect reforms had a significant effect on the health outcomes, with one exception. The overall conclusion is that tort reforms do not significantly affect medical decisions, nor do they have a systematic effect on patient outcomes.
主张将侵权法改革应用于医疗事故的人认为进行改革的部分前提是诉讼威胁已使医疗成本增加。本研究使用1985 - 2000年美国国家长期护理调查的纵向数据，并与医疗保险理赔数据及其他数据合并，评估侵权法改革是否减少了代表受益人支付的医疗保险费用以及指数事件后的生存概率。直接改革（损害赔偿上限、废除惩罚性损害赔偿、取消强制的判决前利息以及间接来源抵消）在任何设定下都未显著减少医疗保险覆盖服务的支付。间接改革（风险代理费限制、强制定期支付、连带责任改革以及患者赔偿基金）仅在基于任何住院情况的设定中显著减少了医疗保险支付，但在对四种常见慢性病各自的住院情况分析中并非如此。直接改革和间接改革对健康结果均无显著影响，但有一个例外。总体结论是侵权法改革不会显著影响医疗决策，对患者结果也没有系统性影响。
