States that have adopted caps on damage awards in malpractice cases have 12% more physicians per capita and experienced a more rapid increase in their supply of physicians than states with no cap, according to research released yesterday by the Agency for Healthcare Research and Quality, a division of HHS.
The study looked at state physician supply in 1970, before any states had laws limiting noneconomic damages in medical malpractice lawsuits, and found similar levels of physicians per 100,000 population per county among states that later adopted caps and those that did not.
In 2000, states that adopted a cap averaged 135 physicians per 100,000 citizens per county, while states without a cap averaged 120, the report finds. Additionally, the researchers conclude that states with higher caps were less likely to experience an increase in physician supply than states with lower caps.
"The robustness of these findings is quite remarkable," says AHRQ Director Carolyn Clancy, M.D., in a written statement. "Even when adjusting for numerous state characteristics, states with caps had a significantly higher number of doctors per person compared to states that didn't enact caps."
Researchers Fred Hellinger and William Encinosa adjusted for other factors believed to affect physician supply, such as per capita income and residency training programs.
The findings come amidst an escalating national debate on whether the federal government should extend caps on noneconomic awards to all states. Currently, 24 states have laws that limit damage payments in malpractice cases. President Bush supports a $250,000 cap on noneconomic damages, a proposal that won House approval in March.
Senate Republicans are moving this week to begin floor debate of S 11, a bill introduced by Sen. John Ensign (R-Nev.) that largely mirrors Bush's proposal. Majority Leader Bill Frist, M.D., (R-Tenn.) is working to force a vote to debate the legislation without first going through the normal committee process. Democrats are expected to filibuster the vote tomorrow.
Republicans, who admit they may not have the 60 votes needed to block the filibuster, nevertheless are eager to advance the issue.
Supporters of tort reform argue that large jury awards and settlements in medical malpractice cases are causing the recent steep increase in malpractice insurance premiums and that laws limiting damage awards would rein in these increases. They say high malpractice rates are driving physicians out of practice or to states with damage caps.
Opponents of medical liability reform blame poor quality and unsuccessful investments by insurance companies for the rise in malpractice premiums. Many say caps are unfair for the neediest patients who suffer the most damage.
The AMA, meanwhile, is campaigning hard for the Senate to approve Ensign's measure, using radio ads in key states such as Alabama, Arkansas, Nebraska, Pennsylvania and South Carolina, and grassroots efforts encouraging patients to communicate with senators about the extent of the access problem.
"Senators must understand that doctors are being forced to make hard choices: to limit procedures, refer high-risk cases and retire early," says AMA President Donald Palmisano, M.D., in a statement. "The AMA strongly supports S. 11 and urges the Senate to take action and not prevent a vote on medical liability reforms. Our patients' lives are at stake. Without federal legislation, patients will bear the brunt of this crisis as access to care in many high-risk medical specialties becomes limited."