Doctors, Damages, and Deterrence


Book Description

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 the 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 decisionmaking.




Responsibility in Health Care


Book Description

Medicine is a complex social institution which includes biomedical research, clinical practice, and the administration and organization of health care delivery. As such, it is amenable to analysis from a number of disciplines and directions. The present volume is composed of revised papers on the theme of "Responsibility in Health Care" presented at the Eleventh Trans Disciplinary Symposium on Philosophy and Medicine, which was held in Springfield, illinois on March 16-18, 1981. The collective focus of these essays is the clinical practice of medicine and the themes and issues related to questions of responsibility in that setting. Responsibility has three related dimensions which make it a suitable theme for an inquiry into clinical medicine: (a) an external dimension in legal and political analysis in which the State imposes penalties on individuals and groups and in which officials and governments are held accountable for policies; (b) an internal dimension in moral and ethical analysis in which individuals take into account the consequences of their actions and the criteria which bear upon their choices; and (c) a comprehensive dimension in social and cultural analysis in which values are ordered in the structure of a civilization ([8], p. 5). The title "Responsibility in Health Care" thus signifies a broad inquiry not only into the ethics of individual character and actions, but the moral foundations of the cultural, legal, political, and social context of health care generally.




Making Healthcare Safe


Book Description

This unique and engaging open access title provides a compelling and ground-breaking account of the patient safety movement in the United States, told from the perspective of one of its most prominent leaders, and arguably the movement’s founder, Lucian L. Leape, MD. Covering the growth of the field from the late 1980s to 2015, Dr. Leape details the developments, actors, organizations, research, and policy-making activities that marked the evolution and major advances of patient safety in this time span. In addition, and perhaps most importantly, this book not only comprehensively details how and why human and systems errors too often occur in the process of providing health care, it also promotes an in-depth understanding of the principles and practices of patient safety, including how they were influenced by today’s modern safety sciences and systems theory and design. Indeed, the book emphasizes how the growing awareness of systems-design thinking and the self-education and commitment to improving patient safety, by not only Dr. Leape but a wide range of other clinicians and health executives from both the private and public sectors, all converged to drive forward the patient safety movement in the US. Making Healthcare Safe is divided into four parts: I. In the Beginning describes the research and theory that defined patient safety and the early initiatives to enhance it. II. Institutional Responses tells the stories of the efforts of the major organizations that began to apply the new concepts and make patient safety a reality. Most of these stories have not been previously told, so this account becomes their histories as well. III. Getting to Work provides in-depth analyses of four key issues that cut across disciplinary lines impacting patient safety which required special attention. IV. Creating a Culture of Safety looks to the future, marshalling the best thinking about what it will take to achieve the safe care we all deserve. Captivatingly written with an “insider’s” tone and a major contribution to the clinical literature, this title will be of immense value to health care professionals, to students in a range of academic disciplines, to medical trainees, to health administrators, to policymakers and even to lay readers with an interest in patient safety and in the critical quest to create safe care.




Medical Malpractice Litigation


Book Description

"Drawing on an unusually rich trove of data, the authors have refuted more politically convenient myths in one book than most academics do in a lifetime." —Nicholas Bagley, professor of law, University of Michigan Law School "Synthesizing decades of their own and others’ research on medical liability, the authors unravel what we know and don’t know about our medical malpractice system, why neither patients nor doctors are being rightly served, and what economics can teach us about the path forward." —Anupam B. Jena, Harvard Medical School Over the past 50 years, the United States experienced three major medical malpractice crises, each marked by dramatic increases in the cost of malpractice liability insurance. These crises fostered a vigorous politicized debate about the causes of the premium spikes, and the impact on access to care and defensive medicine. State legislatures responded to the premium spikes by enacting damages caps on non-economic, punitive, or total damages and Congress has periodically debated the merits of a federal cap on damages. However, the intense political debate has been marked by a shortage of evidence, as well as misstatements and overclaiming. The public is confused about answers to some basic questions. What caused the premium spikes? What effect did tort reform actually have? Did tort reform reduce frivolous litigation? Did tort reform actually improve access to health care or reduce defensive medicine? Both sides in the debate have strong opinions about these matters, but their positions are mostly talking points or are based on anecdotes. Medical Malpractice Litigation provides factual answers to these and other questions about the performance of the med mal system. The authors, all experts in the field and from across the political spectrum, provide an accessible, fact-based response to the questions ordinary Americans and policymakers have about the performance of the med mal litigation system.




Policy Studies: Review Annual


Book Description

Every editor of the Policy Studies Review Annual brings a unique perspective to bear in selecting articles to be included. This perspective reflects varying methodological and disciplinary judgments, varying judgments on what the field of policy studies or policy analysis is and where it should be going, and varying judgments regarding the quality of articles which are or claim to be in the field. Because it is the objective to assemble a set of essays which are both interesting and topical, there will be varying perspectives on these matters as well. The volume clearly reflects the editors perspectives. They are explicit about these judgments and perspectives, and then let the content of the volume speak for itself. First, we are both economists. As a result, the general topics selected and the articles chosen under each topic tend to emphasize economics more than the other disciplines involved in the field of policy studies—sociology, psychology, political science, law, and so on. This emphasis is clearly seen by comparing the contents of volume I (edited by Stuart Nagel, a political scientist) and volume II (edited by Howard Freeman, a sociologist) with that of this volume. Second, the editors have a particular view of what policy studies or policy analysis is. That view has several aspects. In the first place, they feel that the field of policy studies or policy analysis must define itself, and this definition will develop as researchers do just what the title of the field says—study or analyze policies. A corollary of this view is that we place a low weight on papers which discuss the policy process or reforms in policy-making, relative to papers which analyze a policy, a policy proposal, or a problem which leads to calls for policy action.










Understanding the Law for Physicians, Healthcare Professionals, and Scientists


Book Description

Many workers in medicine, healthcare administration, science, and technology, no matter how strong their academic degrees or how distinguished their careers, find themselves baffled, frustrated, and even angered by their encounters with the law. Some of those occasions may lead to the need for a lawyer. But many of the bafflements and frustrations arise from ignorance about what the law is, including how it operates. Over more than a half century of inquiry into the relations between law and science, and through numerous conversations with physicians, scientists, and healthcare professionals whose work rests on technological development, the author realized that they often desire more knowledge about the operations of the law and the legal system. This book seeks to provide basic knowledge about the law in realms where these professionals often encounter it, primarily in areas where activities pose risks of personal injury. This book discusses two basic types of law: civil litigation and other remedies afforded to persons who ascribe injuries to the conduct or product of others, and direct regulation by the government of the levels of safety in those areas. Principal practical applications of this knowledge lie in ways to minimize risk, both in the primary sense and in efforts to avoid litigation over injuries, and in how to present arguments about policy to government officials who write laws and regulations.




New Medical Devices


Book Description

In the past 50 years the development of a wide range of medical devices has improved the quality of people's lives and revolutionized the prevention and treatment of disease, but it also has contributed to the high cost of health care. Issues that shape the invention of new medical devices and affect their introduction and use are explored in this volume. The authors examine the role of federal support, the decision-making process behind private funding, the need for reforms in regulation and product liability, the effects of the medical payment system, and other critical topics relevant to the development of new devices.