Suchergebnisse

The principle of precaution, a fundamental, essentially legalistic, rule underpinning health care legislation in France, basically arose from environmental protection policies. This principle became the topic of a good deal of well-publicized debate following the decree concerning HIV contamination rendered in 1993 by the Conseil d'Etat, the supreme jurisdiction on legislative matters in France. This translation of a fundamental principle from one domain to another is not devoid of significance and could have an unexpected impact on the nature and meaning of health care itself. When applied to medicine, the principle of precaution must be confronted with the notion of risk, inherent in all acts of health care. This risk certainly implies patients' rights and informed consent to medical care, but also, in a reasonable search for an acceptable balance between risk and benefit, the freedom of biomedical research from overly-restrictive regulations. Consequently, in accordance with an ethical approach to medical care, legislative and judicial bodies must take into consideration the practical reality of medicine in order to integrate the scientific, economic, social, and psychological aspects of everyday medical practice into health care laws and regulations. Once faced with the reality of health care, the principle of precaution could appear contradictory to the fundamental principles of medicine. Indeed, every physician, every health care worker, makes daily evidence-based decisions that are never devoid of risk. Unrestricted application of the principle of precaution to a growing number of public domains, including medicine, as advocated by a large number of opinion leaders, could lead to an inextricable situation, in total contradiction with the goal of health care itself. In order to develop new truly ethical and adapted health care regulations, we must break down the barriers confining judges and legal representatives to a purely legalistic vision of health care and equally confining physicians to a purely ...

The principle of precaution, a fundamental, essentially legalistic, rule underpinning health care legislation in France, basically arose from environmental protection policies. This principle became the topic of a good deal of well-publicized debate following the decree concerning HIV contamination rendered in 1993 by the Conseil d'Etat, the supreme jurisdiction on legislative matters in France. This translation of a fundamental principle from one domain to another is not devoid of significance and could have an unexpected impact on the nature and meaning of health care itself. When applied to medicine, the principle of precaution must be confronted with the notion of risk, inherent in all acts of health care. This risk certainly implies patients' rights and informed consent to medical care, but also, in a reasonable search for an acceptable balance between risk and benefit, the freedom of biomedical research from overly-restrictive regulations. Consequently, in accordance with an ethical approach to medical care, legislative and judicial bodies must take into consideration the practical reality of medicine in order to integrate the scientific, economic, social, and psychological aspects of everyday medical practice into health care laws and regulations. Once faced with the reality of health care, the principle of precaution could appear contradictory to the fundamental principles of medicine. Indeed, every physician, every health care worker, makes daily evidence-based decisions that are never devoid of risk. Unrestricted application of the principle of precaution to a growing number of public domains, including medicine, as advocated by a large number of opinion leaders, could lead to an inextricable situation, in total contradiction with the goal of health care itself. In order to develop new truly ethical and adapted health care regulations, we must break down the barriers confining judges and legal representatives to a purely legalistic vision of health care and equally confining physicians to a purely scientific vision of their mission.

Abstract
Contingency fee laws are intended to reduce the amount of defensive medicine practiced by physicians, but their impact on such behavior is theoretically ambiguous. While nearly half of all states have adopted some type of contingency fee laws, very little empirical evidence exists with respect to related impacts, and no rigorous studies examine their potential impacts on health. We examine the impact of a particular contingency fee reform that occurred in Nevada in 2004 using synthetic control methods. Consistent with our expectations, we find a systematic increase in the C-section rate of less-educated mothers in Nevada after implementation of the reform. However, we find no systematic effect on infant mortality, suggesting that contingency reforms contribute to an increase in defensive medicine without a corresponding improvement in health.

In health care, overuse and underuse of medical treatments represent equally dangerous deviations from an optimal use equilibrium and arouses concerns about possible implications for patients' health, and for the healthcare system in terms of both costs and access to medical care. Medical liability plays a dominant role among the elements that can affect these deviations. Therefore, a remarkable economic literature studies how medical decisions are influenced by different levels of liability. In particular, identifying the relation between liability and treatments selection, as well as disentangling the effect of liability from other incentives that might be in place, is a task for sound empirical research. Several studies have already tried to tackle this issue, but much more needs to be done. In the present chapter, we offer an overview of the state of the art in the study of the relation between liability and treatments selection. First, we reason on the theoretical mechanisms underpinning the relationship under investigation by presenting the main empirical predictions of the related literature. Second, we provide a comprehensive summary of the existing empirical evidence and its main weaknesses. Finally, we conclude by offering guidelines for further research.

Twenty-eight states have laws that limit payments in malpractice cases, and several studies indicate that these laws reduce the frequency and severity of malpractice claims and lower premiums. Moreover, proponents believe that such laws reduce health care expenditures by reducing the practice of defensive medicine. However, there is a dearth of empirical evidence about the impact of these laws on the cost of health care.

A letter report issued by the General Accounting Office with an abstract that begins "The recent rising cost of medical malpractice insurance premiums in many states has reportedly influenced some physicians to move or close practices, reduce high-risk services, or alter their practices to preclude potential lawsuits (known as defensive medicine practices). States have revised tort laws under which malpractice lawsuits are litigated to help constrain malpractice premium and claims costs. Some of these tort reform laws include caps on monetary penalties for noneconomic harm, such as for plaintiffs' pain and suffering. Congress is considering legislation similar to some states' tort reform laws. GAO examined how health care provider responses to rising malpractice premiums have affected access to health care, whether physicians practice defensive medicine, and how growth in malpractice premiums and claims payments compares across states with varying tort reform laws. Because national data on providers' responses to rising premiums are not reliable, GAO examined the experiences in five states with reported malpractice-related problems (Florida, Nevada, Pennsylvania, Mississippi, and West Virginia) and four states without reported problems (California, Colorado, Minnesota, and Montana) and analyzed growth in malpractice premiums and claims payments across all states and the District of Columbia."

As a critical examination of the pervasive tension existing between defensive medicine and good, ethical patient care, this book investigates the impact of legalities on medical treatment. Physicians today are apprehensive about the threat of malpractice suits. Kapp explores the extent to which this fear is justified. He examines where physicians get their ideas about what the law forbids and requires, how physicians' perceptions of the law and medicine affect medical care, and whether these behavioral manifestations benefit or hurt a physician's ability to practice ethically. Kapp then sugges

This article uses the tools of law & economics analysis to assess the recent evolution in liability concerning medical malpractice. This evolution has led to the insurance crisis that France has experienced following the 2002 Kouchner law & that the US is still suffering from. What is at stake is greater safety in real medical practice, through the setting up of a decentralized regulation system. Courts & insurance companies are now in charge of designing safety & quality standards & of reducing healthcare costs. Law & economics allows estimation & discussion of the expected economic consequences of medical liability rules. According to economic literature, applying the negligence rule is justified by its promotion of appropriate prevention implemented by physicians, the resulting low administrative costs, the specificity of the medical profession & the existence of asymmetric information in the care contract. Despite the fact that theoretically it is not possible to insure for medical malpractice, insurance is nevertheless considered as a private system of liability law. Indeed, the insurance industry has written up specific contracts: they do not require deductibles, premiums are based on medical specialization or on location. The law & economics basic model concludes that, if the definition of the standard of care is based on efficiency, there should be no negligence, no claim & no demand for insurance. A number of authors have expressed doubts about the definition of the standard of due care & they point out the costs induced by defensive medicine & growing lawyerization. This demonstrates that the negligence rule for medical malpractice is irrelevant & calls for reforms of medical malpractice legal rules. Extending liability to hospitals may solve the physician's judgement proof problem. This risk may become insurable & defensive medicine may decline, provided that amounts are limited & statutes of limitations are set. References. Adapted from the source document.

Malpractice insurance premiums for physicians have increased at an average rate of over 30 percent per year. This rate is significantly higher than health care cost inflation and the increase in physician costs. Trends indicate that malpractice related costs, both liability insurance and defensive medicine costs, will continue to increase for the near future. Pressures to limit physician costs under Medicare raise a concern about how malpractice costs can be controlled. This paper presents an overview of the problem, reviews options that are available to policymakers, and discusses State and legislative efforts to address the issue.

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the effects of laws in Virginia, Maryland, and the District of Columbia, focusing on: (1) the rationale behind selected reforms states have made to their medical malpractice tort law; (2) whether selected tort reforms have reduced malpractice insurance costs and the costs associated with defensive medicine; (3) the extent to which the District, Maryland, and Virginia have adopted selected tort reforms; and (4) comparing malpractice claim payments, insurance premiums, and numbers of physicians in the District; Baltimore, Maryland; and Richmond, Virginia."

The lack of legislation governing medical malpractice issue has placed doctors in Indonesia in vulnerable position. They may easily be exposed to the criminal litigation when medical treatment goes wrong. Negligence which results in injury or death amounts to criminal prosecution according to the existing law as it can be seen in Dr. Ayu's case. The infliction of criminal punishment upon three obstetricians in the late 2013 (in Dr. Ayu's case) was both controversial and phenomenal. It has stimulated the national action of strike among doctors and skepticism about law and its enforcement in Indonesia. Trembling with fear of criminal prosecution may encourage doctors in Indonesia to practice defensive medicine. This paper will make analyses on the implication of the criminal prosecution of doctors from socio-juridical perspective.

IMPORTANCE: The US Government Accountability Office has changed its estimate of the annual costs of defensive medicine, largely because it has been difficult to objectively measure its impact. Evaluating the association of malpractice claims rates with hospital admission rates and the costs of admitting patients with low-risk conditions would help to document the impact of defensive medicine. Although syncope is a concerning symptom, most patients with syncope have a low risk of adverse outcomes. However, many low-risk patients are still admitted to the hospital, with associated costs of more than $2.5 billion per year in the US. OBJECTIVE: To assess whether hospital admission rates after emergency department visits among patients with lower-risk syncope are associated with state-level variations in malpractice claims rates. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of emergency department visits among patients with lower-risk syncope used deidentified data from the Clinformatics Data Mart database (Optum). Lower-risk syncope visits were defined as those with a primary diagnosis of syncope and collapse based on International Classification of Diseases, Ninth Revision, Clinical Modification code 780.2 or International Classification of Diseases, Tenth Revision, Clinical Modification code R55 that did not include another major diagnostic code for a condition requiring hospital admission (such as heart disease, cancer, or medical shock) or an inpatient hospital stay of more than 3 days. These data were linked to publicly available data from the National Practitioner Data Bank pertaining to physician malpractice claims between January 1, 2008, and December 31, 2017. The 2 data sets were linked at the state-year level. Data were analyzed from October 2, 2019, to September 12, 2020. MAIN OUTCOMES AND MEASURES: The association between the rate of hospital admission after emergency department visits among patients with lower-risk syncope and the rate of physician malpractice claims was assessed at ...