FEW TOPICS in health care policy generate more contentious commentary than medical malpractice. To some, the recent trend of increasing liability awards and malpractice insurance premiums is a major crisis that affects the organization and practice of medicine. To others, it is a sign that the medical profession has not yet developed adequate controls to sanction deviations from standard practice. In either case, the escalation in medical professional liability awards raises important public policy issues concerning the underlying reasons for the awards and the potential effects on medical practice and service delivery.
While the full dimension of the crisis is difficult to specify, rising malpractice insurance premiums and increased claim frequency and award severity have been, until recently, its primary manifestations. Various explanations for these trends have been proposed, with little agreement as to the nature or causes of the problem.1-8
Although lawyers, the legal system, the medical profession,