No Widespread Malpractice Impact On Care: GAO

By Steven Brostoff, Washington Editor

NU Online News Service, Sept. 3, 3:36 p.m.EDT?Many reports of malpractice insurance costs drivingphysicians to relocate to other states, or close their practices,are either inaccurate or involved relatively few physicians,according to research by the United States General AccountingOffice.

The agency's report, released late last week, found that themedical malpractice liability system does not appear to have awidespread impact on access to health care, but that medicalmalpractice concerns have contributed to localized health careaccess problems.

On the issue of defensive medicine, which is often cited as amajor health care cost escalator, GAO says that the overallprevalence and costs of this practice have not been reliablymeasured.

Studies designed to measure defensive medicine, GAO says, focuson physician behavior in specific clinical situations.

Because of this limited scope, GAO says, the study resultscannot be generalized to estimate the extent and cost of defensivemedicine practices across the health care system.

The new GAO report, Number 03-836, is the second major analysisreleased by the Congressional watchdog in the past few months. Anearlier report, number 03-702, which drew strong praise fromindustry groups, said that increased costs, rather than insuranceindustry practices, are largely responsible for medical malpracticepremium rate hikes.

But industry groups were less praiseworthy of the new report.Larry Akey, a representative of the Washington-based HealthInsurance Association of America, said that the new GAO reportreinforced what HIAA has been saying all along, which is that highmedical malpractice insurance rates are affecting access toselected health care providers in some locations.

However, Mr. Akey said, the GAO sets a very high standard in itsdiscussion of the impact of defensive medicine.

Study after study has shown that defensive medicine is a majorfactor in driving up insurance costs, he said. While the studiesmay not be as concrete as GAO would like, Mr. Akey said, all thestudies point in that direction.

In the new report, GAO focuses on five states that have reportedaccess problems due to medical malpractice costs-- Florida, Nevada,Pennsylvania, Mississippi and West Virginia. GAO says it confirmedinstances in these five states where malpractice pressures ledphysicians to take actions that reduced access to servicesinvolving emergency surgery and newborn deliveries.

However, GAO says, these instances were not concentrated in anyone geographic area and often occurred in rural locations, wheremaintaining an adequate number of physicians is a longstandingproblem.

Moreover, GAO says, many of the reported provider actionsrelating to malpractice pressures, such as relocating, were eitherunsubstantiated or did not widely affect access to health care.

GAO acknowledges, however, that it is essential to continuemonitoring provider responses to rising medical malpracticepremiums.