Rosenblatt R A, Detering B
Department of Family Medicine, University of Washington School of Medicine, Seattle 98195.
Fam Med. 1988 Mar-Apr;20(2):101-7.
Rapidly rising malpractice premiums have profoundly altered patterns of obstetrical practice. In the summer of 1986, the state of Washington enacted major tort reform legislation intended to stabilize the costs of liability insurance. Following passage of the legislation, we surveyed obstetricians, family physicians, and midwives in the state to assess the likely impact of tort reform on future practice patterns. Largely because of malpractice concerns, 40% of family physicians, 15% of obstetricians, and 27% of midwives had discontinued obstetrical practice. Although obstetrical participation has decreased most dramatically for family physicians, the mean number of deliveries per physician has increased to the extent that the proportion of deliveries attended by family physicians has remained stable at about 30%. However, as fewer family physicians practice obstetrics, the availability of care has diminished in rural areas. The passage of tort reform legislation has induced one-third of those respondents currently practicing obstetrics to at least temporarily continue to practice obstetrics. Despite tort reform, however, the majority of respondents either do not provide or ration care to the medically indigent. The major deleterious social impact of the professional liability problem is reduced access to care in rural areas and a severe curtailment of care to the medically indigent. Tort reform alone will not solve these problems.
医疗事故保险费的迅速上涨已深刻改变了产科医疗模式。1986年夏，华盛顿州颁布了重大侵权行为改革立法，旨在稳定责任保险成本。该立法通过后，我们对该州的产科医生、家庭医生和助产士进行了调查，以评估侵权行为改革对未来医疗模式可能产生的影响。很大程度上出于对医疗事故的担忧，40%的家庭医生、15%的产科医生和27%的助产士已停止从事产科医疗工作。尽管家庭医生参与产科医疗的情况下降最为显著，但每位医生的平均接生数量有所增加，以至于家庭医生接生的分娩比例仍稳定在约30%。然而，随着从事产科医疗的家庭医生减少，农村地区的医疗服务可及性降低。侵权行为改革立法的通过促使三分之一目前从事产科医疗的受访者至少暂时继续从事产科医疗工作。然而，尽管有侵权行为改革，大多数受访者要么不向医疗贫困者提供医疗服务，要么对其进行医疗资源配给。职业责任问题的主要有害社会影响是农村地区医疗服务可及性降低以及对医疗贫困者的医疗服务严重缩减。仅靠侵权行为改革无法解决这些问题。
