Cynics might easily dismiss the controversy over medical malpractice insurance as a conflict between well-paid physicians and insurance companies, with little direct impact on the average person. And in fact, Gallup findings indicate that interest in the medical malpractice controversy and support for malpractice reform are deepest among those most likely to be stakeholders -- whites and those in households earning more than $50,000 per year. (See "Politics Shape Views on Malpractice Award Limits" in Related Items.)
But Gallup data also point to significant concern about malpractice insurance among the general population. According to a January 2003 Gallup survey*, 58% of Americans follow the malpractice issue at least somewhat closely, and 74% feel it is either a major problem or a crisis. In fact, the issue affects all people, and may disproportionately harm poor and minority communities. As greater understanding of the issue evolves, support for malpractice insurance reform is likely to strengthen, although agreement on a specific solution may be slower in coming.
Loss of Physicians Means Loss of Access
One of the biggest concerns about malpractice liability is its impact as a disincentive to practice medicine. According to a recent article in the American Medical Association News, there are 24% fewer obstetricians and 25% fewer neurosurgeons practicing in New Jersey today than there were a year ago.
How does this affect the average health system? Take the example of Meridian Health System in Brick, N.J., which has one perinatologist to serve high-risk children and mothers. "High-risk" typically means high malpractice premiums. Were this perinatologist to leave because of excessive premiums, Meridian would no longer have the expertise needed to provide the program, and the community could lose access to this life-saving service.
Meridian is luckier than most hospitals. According to Frank D'Andrea, Meridian's vice president of risk management and health insurance, "Eighteen months ago, three specialists in medical malpractice insurance were hired, and since have helped over 200 physicians get insurance coverage they would not have otherwise obtained." However, D'Andrea notes, "The ability to find malpractice insurance is getting increasingly difficult." Despite these efforts, five OB/GYNs at Meridian have dropped maternity services.
What About the Small Hospitals?
Meridian is a large health system, and therefore able to obtain additional specialized resources. What about the typical small or rural hospital? A maternity program at a small hospital may be staffed by two OB/GYNs. If one drops maternity service because of malpractice insurance premiums, the community loses half its access to maternity services. The hospital may no longer find maternity services financially viable, and the remaining OB/GYN may lack coverage. Services could be discontinued altogether, in which case the community would lose all access to maternity services.
Implications for the Future
Though the problem of high malpractice insurance premiums is serious now, it has the potential to get much worse. Consider the case of a new medical school graduate in family practice, burdened with student loans. Loaded with debt, more young graduates may decide they can't afford the high malpractice premiums associated with various services and procedures, potentially leading to shortages in these areas, regardless of the current adequacy of physician supply.
Widening the Gap Between Haves and Have Nots
The Institute of Medicine has documented the gap in healthcare access between lower-income and higher-income patients, and between white and nonwhite patients. Dr. L. Natalie Carroll, the president of the National Medical Association, is already seeing the impact of malpractice premiums on healthcare access in poor and minority communities. Carroll notes, "In Texas, with … malpractice premiums of $90,000 and up, some physicians committed to serving poor and minority communities being forced to take second jobs." Hospitals and physicians serving these communities already have lower incomes and margins than their counterparts in more affluent areas, and less opportunity to pass on those costs.
While the physicians in these areas may have the option of changing practices or relocating, many residents in such communities do not. New physicians are difficult to recruit in poor and minority communities. If an existing physician leaves, the community loses access to needed care and health outcomes decline.
The current malpractice insurance crisis must be addressed in order to improve access and health outcomes for poor and minority populations. Yet while members of those populations are likely to be disproportionately affected, Gallup polling shows they are also less aware than other groups of the malpractice insurance issue. Members of the healthcare community who would like to see malpractice insurance reform would be well advised to take steps to educate low-income and minority communities about how this problems affects them.
*Results are based on telephone interviews with 1,006 national adults, aged 18 and older, conducted Jan. 20-22, 2003. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error is ±3%.
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