Meducated

Rachel Lee, Walton High School (Marietta, GA)

While healthcare professionals strive to administer the best treatment method for their patients, results are not all perfect – mistakes from doctors’ negligence do happen. It goes without saying that the consequences of that can be severe. In certain cases, patients can decide to put the physicians’ negligence on trial, and such cases are called medical liability or medical malpractice cases. But here enters the topic of tort reform: changes in the civil justice system that, in the context of this medical malpractice issue, regulate how much a patient can sue physicians for their professional negligence. 

The emergence of tort reform in medical liability cases is not distinctly defined, but it can be attributed to California’s Medical Injury Compensation Reform Act (MICRA) in 1975. This act implemented noneconomic damage caps – a limit to the amount a physician can be sued for a patient’s pain, suffering, and other harms that is hard to put a financial value on. Since then, more than half of the states have implemented some type of tort reform, with damage caps being the most common way of enforcing it. 

Even now, as doctors continue facing an increasing rate of medical liability claims, tort reform stands as a controversial issue over both medical and legal fields. This article explores the main arguments and reasoning for tort reform. Supporters believe that with tort reform, current issues within the medical liability system can be resolved with the prevention of defensive medicine, increase in physician availability, and reduction of healthcare costs.

In systems without tort reform, doctors are more likely to practice defensive medicine. Defensive medicine can be understood as the behavior of doctors undertaking unnecessary medical procedures not to benefit a patient’s condition or aid in recovery, but to protect themselves against potential medical liability claims. In simple words, it is a “better safe than sorry” approach, and it is rooted deep in physician practice –“forty-two percent of US primary care physicians believe that patients in their own practice are receiving too much care…The most important factors physicians identified as leading them to practice more aggressively were malpractice concerns…” (Sirovich et al. 1)². Tort reform through damage caps reduces physicians’ burdens on malpractice concerns, which then, lessens the need for physicians to practice defensively. In the end, this leads to a reduction of unnecessary practices: a decrease in the number of excessive diagnostic tests and consultations, a decrease in overprescription of medication and treatment, and a decrease in the number of needless hospital admissions and referrals. By cutting down on unnecessary practices, this not only leads to hospital care resources being allocated in a more efficient manner, but also gives doctors more flexibility, allowing them to incorporate newer methods and tools in treatment that they otherwise would be more hesitant to use. A progressive, rather than defensive behavior of practice, increases room for medical innovation and growth – one of the most significant factors one can consider in a healthcare system of the 21^st century.

Tort reform through damage caps can also help in increasing doctor availability. A medical system without tort reform reduces physician supply mainly due to doctors becoming beyond cautious, and instead, more fearful of practice. These concerns often lead them to relocate to a state with tort reform that guarantees them a safer and lower-risk practice environment. A good example of this is demonstrated by the case of Illinois – after the Illinois Supreme Court decided to remove noneconomic damage caps, there was a decline in the supply of Illinois doctors. Recent medical graduates of Illinois cited the risk-heavy medical liability environment as a major reason why they decide to relocate and practice in another state instead (Paul)³. But what if states can flip this and use it to their advantage? Tort reform through noneconomic damage caps can act as a strategy for increasing physician availability, and it has already proven to be an especially beneficial and efficient strategy for rural areas that normally do not attract a lot of doctors. (From results of past studies and a difference-in-difference-in-differences estimation methodology that researchers Helland and Seabury used in their examination of physician supply in response to adopting non-economic caps, an increasing trend was observed. Past studies supported in general, about a 2.4 to 7% increase, depending on specialty and location rurality, and Helland and Seabury’s method supported a 1.5 to 6.6% increase in physician supply in high-risk specialties (Helland and Seabury)⁴.)

Tort reform’s most practical benefit is that it has the potential to reduce healthcare costs on both the supplier and patient sides. Currently, each individual’s US healthcare spending is relatively high, and experts believe that we can “bend the cost curve” by reducing unnecessary care – what tort reform accomplishes by reducing the need for defensive medicine (Sirovich et al. 1-2)². Therefore, by decreasing costs from unnecessary practices – excessive diagnostic tests and consultations, overprescription, hospital admissions and referrals – along with decreased physician hiring costs due to increased supply, the financial burden hospitals bear decreases immensely. Not only that, but individual doctors’ financial burdens are also reduced as they no longer have the need to invest in the costliest insurance, or “premiums”, in the case they get sued for medical malpractice – a more reasonable insurance would be enough. In their study, Kessler and McClellan state that “within three years after adoption, [however,] physicians from states adopting direct reforms show substantially and statistically significant lower trend growth in their real malpractice insurance premiums of approximately 8.4 percent” (98)⁵. Yet, what is most important is that through the reduced financial burden on the supply side of healthcare, this impact is also transferred upon the patient as well. That is, one can expect patient side costs to also be reduced. Tort reform is a logical and strong strategy to decrease per capita US healthcare spendings and the financial burden it has on patients, especially since it is a solution where both the supply and demand side of the service can end up benefiting.

The arguments for tort reform, specifically with noneconomic damage caps, highlights the potential tort reform can have in solving current issues within our medical liability system, as well as the need for action in more states for the implementation of damage caps. After all, through preventing the practice of defensive medicine, increasing physician supply, and decreasing healthcare costs, it is a promising outlook to the future of healthcare and its legal implications.  

References:

1. Howard, P. K. (2009, October 15). Why Medical Malpractice Is Off Limits. Wall Street Journal. https://www.wsj.com/articles/SB10001424052970204488304574432853190155972. Accessed 03 Aug. 2025.
2. Sirovich, Brenda E et al. “Too Little? Too Much? Primary Care Physicians’ Views on US Health Care: A Brief Report.” Archives of Internal Medicine, vol. 171, Archives of Internal Medicine, 2011, pp. 1-2, pmc.ncbi.nlm.nih.gov/articles/PMC3184847/. Accessed 28 Feb. 2025.
3. Paul, Marla. “Illinois Faces Critical Physician Shortage, New Study Warns.” Northwestern Feinberg News, 11 Nov. 2008, news.feinberg.northwestern.edu/2010/11/11/il_physician_shortage/. Accessed 03 Mar. 2025.
4. Helland, Eric, and Seth A. Seabury. “Tort Reform and Physician Labor Supply: A Review of the Evidence.” International Review of Law and Economics, vol. 42, Elsevier, Jun. 2015, pp. 192-202, www.sciencedirect.com/science/article/abs/pii/S0144818815000137. Accessed 03 Mar. 2025.
5. Kessler, Daniel P., and McClellan, Mark B. “The Effects of Malpractice Pressure and Liability Reforms on Physicians’ Perceptions of Medical Care.” Law and Contemporary Problems, vol. 60, Duke Law Journals, Winter 1997, p. 98, scholar ship.law.duke.edu/lcp/vol60/iss1/5/. Accessed 03 Mar. 2025.