The Impact of Exempting Medical Providers from Malpractice Liability

其他项目信息-项目概要/摘要 免除医疗服务提供者医疗过失责任的影响 美国医疗保健系统最具争议的方面之一是医疗保健的影响。 医疗事故制度对病人治疗和医疗保健费用的影响。防御性药物是一种意外的效果， 责任制度，其中医生订购额外的测试，程序和其他服务的结果， 担心医疗责任。然而，关于这些成本究竟有多大的争论仍在继续。 在试图解决这一争论的文献中，一直缺少一个真正的医疗“治疗”小组。 如果发生疏忽护理，则根本无法追究责任的遭遇。我们的目标是 在R 01 AG 049898中，我们进一步分析了军队的体制特征 卫生系统（MHS），以估计免疫提供者的责任，促进 对我们系统中防御性医疗的全面评估是前所未有的。我们建议 继续这项研究，推动文献超越目前的重点是住院治疗，并把影响 通过比较责任与其他方法，特别是需求方的影响， 方法，以规范医疗接触。我们的重点将是调查某些政策的影响 与年龄有关的疾病，如心血管疾病，糖尿病和癌症。 拟议的延续将实现四个目标。首先，我们将探讨医疗责任压力的影响 “高价值”门诊护理，同时通过同样探索对 接受“低价值”护理（利用目前医疗保健中强调的高价值和低价值措施）， 文学）。第二，利用MHS数据的一个独特特征，我们建议比较高 和低价值的护理收据源于医疗责任制度-一个经典的供应方的方法， 监管供应商行为-与那些从经典的需求方的方法来监管 医患关系：对患者的信息披露。第三，我们将独立强调 执行责任分析所必需的比较的一个关键方面-即， 通过一个协调的直接提供系统在基地提供的护理的质量和数量， 通过MHS的购买护理系统提供。第四，我们将探讨每一个方面， 上述目标特别是在MHS人群中使用阿片类药物的背景下，同时比较 责任压力和信息披露对阿片类药物使用的影响， 讨论了基于国家的阿片类药物用途：处方药监测计划。

OTHER PROJECT INFORMATION – Project Summary/Abstract THE IMPACT OF EXEMPTING MEDICAL PROVIDERS FROM MALPRACTICE LIABILITY Among the most controversial aspects of the U.S. health care system are the impacts of the medical malpractice system on patient treatments and health care costs. Defensive medicine is an unintended effect of the liability system in which physicians order extraneous tests, procedures and other services as a result of fears over medical liability. The debate continues, however, regarding just how large these costs really are. Missing from the literature's attempts to resolve this debate has been a true “treatment” group of medical encounters with respect to which there is no liability recourse at all in the event of negligent care. We aim to further the analysis begun under R01AG049898, in which we drew on institutional features of the Military Health System (MHS) to estimate the effects of immunizing providers from liability, facilitating an unprecedented assessment of the full extent of defensive medicine operating in our system. We propose to continue this research to push the literature beyond its present focus on inpatient care and to place the effects of liability in perspective by comparing liability's effects with other approaches, especially demand-side approaches, to regulating medical encounters. Our focus will be on investigating the impacts of certain policy levers on age-related diseases such as cardiovascular disease, diabetes, and cancer. The proposed continuation will address four aims. First we will explore the impact of medical liability pressure on “high-value” outpatient care, while placing these estimates into perspective by likewise exploring effects on the receipt of “low-value” care (drawing on high- and low-value measures currently emphasized in the medical literature). Second, drawing on a unique feature of the MHS data, we propose to compare the effects on high- and low-value care receipt stemming from the medical liability system – a classic supply-side approach to regulating provider behavior – with those resulting from a classic demand-side approach to regulating the physician-patient relationship: information disclosure to patients. Third, we will place independent emphasis on one of the key dimensions of comparison necessary to execute the liability analysis – that is, the difference in quality and quantity of care provided on the base through a coordinated direct-delivery system with that provided off the base through the MHS's purchased-care system. Fourth, we will explore aspects of each of the above aims specifically in the context of opioid use among the MHS population, while comparing the effects of liability pressure and information disclosure on opioid use with the effects of one of the most oft- discussed stated-based approaches to regulating opioid use: Prescription Drug Monitoring Programs.