Schwartz W B, Komesar N K
N Engl J Med. 1978 Jun 8;298(23):1282-9. doi: 10.1056/NEJM197806082982304.
Damages awarded in a malpractice suit must be viewed not only as compensating the victim but also as deterring health-care providers from negligent behavior. Economic analysis of the malpractice system indicates that awards can send a signal to providers that informs them how much to invest in avoiding mishaps. The malpractice system is beset by difficulties, but not the ones commonly incriminated. The signal to the physician, as determined by the number of claims and size of awards ("expected damages"), appears to be insufficient for ideal deterrence. Moreover, the deterrence signal is attenuated because malpractice premiums are set for groups of physicians, not for individuals according to their record of previous malpractice incidents. Replacing the present tort system with a no-fault insurance scheme would not necessarily be cheaper, and might well abolish the deterrent signal or distort clinical decision making.
医疗事故诉讼中判定的损害赔偿不仅应被视为对受害者的补偿，还应被视为对医疗服务提供者疏忽行为的威慑。对医疗事故制度的经济分析表明，赔偿可以向提供者发出一个信号，告知他们在避免事故方面应投入多少。医疗事故制度困难重重，但并非通常所指责的那些困难。由索赔数量和赔偿金额（“预期损害赔偿”）所决定的给医生的信号，似乎不足以实现理想的威慑。此外，威慑信号被削弱了，因为医疗事故保险费是为医生群体设定的，而不是根据个人以前的医疗事故记录为个人设定的。用无过错保险计划取代现行的侵权制度不一定会更便宜，而且很可能会消除威慑信号或扭曲临床决策。
