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(September 2004) What’s the impact of the medical malpractice crisis on health care in Pennsylvania? Far reaching – certainly in the realm of public opinion, based on results from the latest IssuesPA/Pew Poll.

The skyrocketing cost of medical liability insurance is making headlines in Pennsylvania – and nationally. Though research shows medical malpractice is not a primary driver of health care costs, and there is no clear evidence that substantial numbers of doctors are fleeing the state because of rising medical malpractice rates, Pennsylvanians said they feel the impact of the medical malpractice crisis in the form of rising health care costs and difficulties with access to health care providers.

The impact on costs and access?

According to results from the recent IssuesPA/Pew Poll on Health Care in Pennsylvania, those surveyed said they believed medical malpractice (and drug company profits) are most responsible for driving up the costs of health care. And two-thirds favored capping non-economic damages in medical malpractice cases.

One in four Pennsylvanians polled said rising malpractice insurance costs have forced their family to change doctors in the past year, for a variety of reasons:

• Doctor has moved his or her practice outside of Pennsylvania: 16%
• Doctor has stopped providing certain medical services or treating certain illnesses: 10%
• Doctor has stopped practicing medicine altogether: 9%Doctor has moved his or her practice to a different part of the state: 8%
• Net: one or more of these reasons: 26%
  

There are regional differences. Those in the southeastern Pennsylvania (31%) were most likely to report changing doctors due to rising medical malpractice insurance costs. In south central Pennsylvania, only 19% said they changed doctors due to the rising costs of malpractice insurance.

Is this still a brewing storm?

Yes. The medical liability crisis has been described as The Perfect Storm: the confluence of advances in medical technology and concerns for patient safety, cost containment efforts, the influence of the legal system, a slow economy and a weakened insurance industry, changes in the insurance and health care industries, and increases in malpractice litigation. Add to that concerns about availability and rising costs of health care insurance, increases in Medical Assistance and Medicare spending, and Pennsylvania’s unique circumstances.

This storm came to a political standstill in July, when the legislature failed to pass language to amend Pennsylvania’s Constitution to allow the legislature to limit non-economic damage awards in medical malpractice cases. Lawmakers will have the opportunity to re-start the caps process after the new session begins in January 2005, a process that would take at least three years – two legislative sessions followed by a statewide voter referendum. Meanwhile, stakeholders watch as other policy initiatives take effect and concerns about other health care issues – particularly costs – loom large.

Pennsylvania already has made a number of adjustments to the medical liability system. The MCARE Act of 2000 and other changes to the state’s medical malpractice system include judicial reforms such as the elimination of joint and several liability, limits to venue shopping, and administrative changes including improved record keeping and data-gathering on medical malpractice cases. Many of these policy changes are just being implemented, so the impact and outcome on the health care system has yet to be determined. So far, there’s little evidence to show whether the changes are having the intended effect. Only time will tell.

What does all this mean?

There’s little doubt: the medical malpractice crisis in Pennsylvania is real. It impacts access to doctors across regions, communities and medical specialties. It impacts Pennsylvanians’ perceptions about the “state of health care” in Pennsylvania.

However, malpractice is only one facet of health care’s complex system. State policymakers have a window of opportunity to study the whole health care situation, examine other states’ reform efforts, and improve Pennsylvania’s health care system beyond the issue of caps on non-economic damages. Based on the IssuesPA/Pew Poll, Pennsylvanians are in part looking to government leaders to pursue this opportunity.