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NEJM: Medical Malpractice Reform Has No Impact on Cost of Patient Care in Emergency Room

Tort reform advocates argue that fear of lawsuits drive up the cost of emergency room care by prompting doctors to order unnecessary and expensive tests. A recent study in the New England Journal of Medicine, however, undercuts this notion. Waxman, "The Effect of Malpractice Reform on Emergency Department Care," N Eng J Med, 2014; 371: 1518-1525 (Oct. 16, 2014).

The study looked at the impact of malpractice

reform in three states--Texas, South Carolina,

and Georgia. Each state enacted laws to shield emergency department doctors from lawsuits unless the patient could prove that the doctor consciously disregarded the need to use reasonable care with the knowledge that their actions were likely to cause serious injury. Because these laws shielded emergency room doctors from suit, tort reform advocates presumed that the cost of emergency care would be reduced as doctors no longer would feel compelled to order unnecessary and expensive tests to avoid a malpractice lawsuit.

Researchers compared the cost of emergency department care for over 3 million patients in states other than Texas, South Carolina and Georgia to the cost of care in those three states. The study concluded that the tort reform measures failed to reduce costs in Texas and South Carolina and only minimally reduced costs in Georgia. The study further found that the tort reform measures had no impact on the rate at which emergency doctors ordered MRI or CT scans, expensive studies that tort reform advocates had claimed were being ordered by doctors practicing defensive medicine.


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