Research News

Does Medical Malpractice Law Affect Health Outcomes?

IPR’s Michael Frakes examines state malpractice reforms and physician behavior

Do state-level medical malpractice reforms influence the quality of care a patient receives?

Over the last several decades, premiums for medical malpractice insurance have climbed sharply, prompting many states to enact tort reforms—laws that deal with injuries to people and property—to mitigate the costs of medical malpractice litigation. The traditional approach that states have employed in response to these developments is the imposition of caps on damages awards. Though arguably designed to address crises in the insurance market, one wonders whether the reductions in liability pressure following such reforms led, in turn, to deterioration in health care quality.  

Surprisingly little is known about the relationship between the medical liabililty system and quality of care, says IPR health and law scholar Michael Frakes. The research that does offer some insight, he added, typically comes from “studies that focus on the remedy side of things,” such as damage caps. More often than not, these studies find that tort reforms have little impact on physician behavior. 

Michael Frakes

In a recent IPR working paper, Frakes and co-author Anupam Jena of Harvard University consider the question using two surveys from the Centers for Disease Control and Prevention. The researchers analyze the effects of medical malpractice law on several nationally and internationally recognized measures of inpatient and outpatient healthcare quality, including risk-adjusted mortality rates for certain medical conditions, rates of avoidable hospitalization, and rates of medical errors for mothers during childbirth.

Their results reveal that damage caps have “at most, a modest role” in improving healthcare—findings that are consistent with current scholarship. In particular, caps on noneconomic damages, or damages awarded for pain, suffering, and loss of companionship, do not appear to affect the quality of care. 

However, the authors highlight the limitations of addressing this question solely from the lens of a damages cap analysis. Legislatures can modify tort rules in ways beyond just limiting the extent of the harm posed by the current system. They may attempt to adopt a new system altogether—for instance, a system that sets the standards to which physicians are held in an entirely different light. Scholars know even less about how physicians would respond to reforms of this nature. Frakes and Jena fill this gap in knowledge by testing for changes in healthcare quality when states used national standards to measuring physicians’ care, as opposed to the customary practices of nearby physicians.

In states where healthcare quality was rated more highly before using national standards, adopting national standard laws did not seem to change the quality of care. In states that initially had low-quality care, however, adopting national standards was linked to improvements in all of the quality measures.

Their findings offer a more revealing look into how doctors respond to next-generation reforms to malpractice laws that alter the clinical expectations being placed on physicians.

“When we change the structure to a meaningful degree—and we argue that these moves to local to national standards were sort of really meaningful changes—we see a sizeable response,” Frakes said. “So one of the takeaways [of our study] is that it might be a little premature to say that physicians are universally unresponsive to medical liability based solely on the results of those studies exploring responses to damages caps.”

Michael Frakes is associate professor of law and an IPR fellow. Anupam Jena is assistant professor of healthcare policy and medicine at Harvard Medical School. For more, read the IPR working paper “Does Medical Malpractice Law Improve Healthcare Quality?”

Top photo credit: Ashley Rose