The Impact of Exempting Medical Providers from Malpractice Liability

其他项目信息-项目摘要/摘要 免除医疗服务提供者医疗事故责任的影响 美国医疗保健系统最具争议的方面之一是医疗保险的影响 医疗事故制度对病人的治疗和医疗费用。防御性医学是一种意外的效果 责任制度，在这种制度中，医生因以下原因而订购无关的测试、程序和其他服务 对医疗责任的担忧。然而，关于这些成本到底有多大，争论仍在继续。 在文献中试图解决这一争论的过程中，遗漏了一个真正的医疗组 在疏忽照顾的情况下，根本没有责任追索权的遭遇。我们的目标是 此外，从R01AG049898开始的分析，其中我们借鉴了军队的机构特征 卫生系统(MHS)评估免疫提供者免除责任的影响，促进 史无前例地评估了防御性医学在我们系统中的全面运作。我们建议 继续这项研究，推动文献超越目前对住院护理的关注，并将其影响 通过将责任的影响与其他方法，特别是需求方面的方法进行比较，来透视责任 管理医疗接触的方法。我们的重点将是调查某些政策的影响 与年龄相关的疾病，如心血管疾病、糖尿病和癌症的杠杆。 拟议的延续将涉及四个目标。首先探讨医疗责任压力的影响 关于“高价值”的门诊护理，同时通过同样探索对 接受“低价值”护理(采用目前在医疗保健计划中强调的高价值和低价值措施 文学)。其次，利用MHS数据的一个独特特征，我们建议比较两种方法对HIGH的影响。 和来自医疗责任制度的低价值护理收据-这是一种经典的供应方方法 规范供应商行为--使用经典的需求侧方法来规范供应商行为 医患关系：向患者披露信息。第三，我们将独立强调 执行责任分析所必需的关键比较维度之一--即 通过协调的直接提供系统向基地提供护理的质量和数量 通过MHS的购买护理系统在基地外提供。第四，我们将探索每个方面的 上述报告专门针对卫生部人群中的阿片类药物使用情况，同时比较了 责任压力和信息披露对阿片类药物使用的影响 讨论了规范阿片类药物使用的国家方法：处方药监测方案。

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.