Medical malpractice and physician discipline: Lessons from Indiana

Using data from Indiana, I investigate the functioning of two health care quality assurance mechanisms: medical malpractice (“med mal”) claiming, and the physician licensing/disciplinary system. In the mid-1970s, Indiana adopted a comprehensive package of med mal reforms, including a medical review panel, a total damages cap, and a patient compensation fund (“PCF”). Indiana also reorganized its licensing/disciplinary system at roughly the same time. I evaluate the post-reform performance of the systems over the past forty years, and the extent to which the two systems overlap in targeting problematic doctors. Despite enacting comprehensive med mal reforms, Indiana experienced significant premium increases – comparable to those experienced in states that did not enact med mal reforms. However, litigation trends (i.e., claiming and payout rates) in Indiana do not explain the observed premium trends. In combination, this suggests that factors outside the tort system have a significant effect on med mal premiums. I also find evidence that disciplinary and med mal risks are systematically predictable, and that an increased number and size of past (paid) med mal claims predicts higher disciplinary risk. But, very few doctors are actually “tagged” by both systems. Past disciplinary actions lower a physician’s med mal risk in the short-run, but show no significant effect in the long-run. Although the med mal and disciplinary systems operate independently, and may have different priorities and goals, my findings suggest an obvious model for the interaction of the systems. My findings also indicate that physicians who end up targeted by both the med mal and disciplinary systems are not randomly selected.

Name thesis:degree_name

J.S.D.

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Law

Grantor

University of Illinois at Urbana-Champaign

Year dc:date

2018

Author dc:creator

• Liu, Jing

Contributors dc:contributor

• Hyman, David A.
• Lawless, Robert M.
• Robbennolt, Jennifer K.
• Wexler, Lesley

• Medical malpractice
• Licensure
• Discipline
• Physician

Statement dc:rights

• Copyright 2017 Jing Liu

Language dc:language

en

Handle dc:identifier

http://hdl.handle.net/2142/99336

OAI identifier oai:identifier

oai:www.ideals.illinois.edu:2142/99336