Though rising malpractice premiums have affected healthcare services in some areas, they have not led to widespread access problems, according to a new report from the General Accounting Office.
The report, released to the public on Friday, also looks at caps on noneconomic damages and finds they generally limit growth in premiums and claims payments.
For its report, the GAO reviewed Medicare data and contacted providers that have reportedly been affected in five states with reported malpractice problems (Florida, Nevada, Pennsylvania, Mississippi and West Virginia) and in four states without reported problems (California, Colorado, Minnesota and Montana).
The agency says it found some "reduced access to hospital-based services affecting emergency surgery and newborn deliveries," but the problems were "in scattered, often rural, areas," where it also identified other long-standing causes for access problems.
For example, the report says that since three of five orthopedic surgeons left the only hospital in a rural Pennsylvania county in 2002, the hospital no longer has full orthopedic on-call coverage. Also, pregnant women in rural central Mississippi must travel 65 miles for deliveries because family practitioners at the local hospital stopped covering obstetrics due to high malpractice premiums.
In both instances, however, the GAO says problems operating in rural areas also contributed to difficulties recruiting physicians.
The report adds that while some physicians reported reducing certain services that are at risk for litigation, such as spinal surgeries and mammograms, the GAO did not find access to these services widely affected.
It concludes that "many of the reported provider actions were not substantiated or did not affect access to health care on a widespread basis."
"For example," the GAO says, "some reports of physicians relocating to other states, retiring or closing practices were not accurate or involved relatively few physicians."
The GAO also compared 12 states that have caps on noneconomic damages--four with a $250,000 cap and eight with higher caps of up to $500,000--to 11 states without caps.
Based on "limited available data," the GAO concluded that growth in malpractice premiums and claims payments from 1996 to 2002 was generally slower in states with the caps.
But the report adds that there was a "wide variation" in growth between states in any given year and within an individual states from year to year.
Finally, the GAO examined the impact of malpractice risks on "defensive medicine," when doctors order more tests to shield themselves from malpractice charges.
The AMA and other groups say that rising malpractice litigation adds to defensive medicine. But the report concludes that "the overall prevalence and costs of such practices have not been reliably measured."
This is the second recent GAO report on malpractice. A report released July 28 found that rising litigation, rather than insurers' poor business decisions, appears to be the main cause of malpractice premium hikes.