The report synthesizes published evidence on 8 reforms widely used by states:
- Caps on non-economic damages
- Pretrial screening panels
- Certificate of merit requirements
- Attorney fee limits
- Joint and several liability rule reform
- Collateral source rule reform
- Periodic payment
- Statutes of limitation or repose
These reforms are evaluated based on their effects on frequency and cost of malpractice claims, medical liability system overhead costs, health care providers’ liability costs, defensive medicine (including utilization and spending), supply of health care services (including physician supply and patient health insurance coverage), and quality of care.
The report also reviews 6 other, more innovative but largely untested medical malpractice reforms:
- Schedules of non-economic damages
- Health courts
- Disclosure and offer programs
- Safe harbors for physician adherence to evidenced-based clinical practice guidelines
- Subsidized reinsurance that is made conditional upon meeting particular patient safety goals
- Enterprise medical liability
Based on theoretical predictions, the authors suggest that most of these latter reforms are promising enough to merit demonstrations.
The study was commissioned by the Medicare Payment Advisory Commission (MedPAC) and produced by Michelle M. Mello, JD, PhD, professor of law and public health at the Harvard School of Public Health and Allen Kachalia, MD, JD, assistant professor at the Harvard Medical School and medical director for quality and safety, Brigham and Women’s Hospital.