Malpractice Reform as a Health Policy Problem

Calling malpractice reform a health policy problem means that we should analyze it in terms of the quality of health care, access to health care, and the cost of health care-the basic health policy triad with which we all are familiar. We immediately recognize patient safety as a health policy problem because it is obviously about quality. We may believe there is so much slack in the health care system that we can make major improvements in patient safety without excessive cost. But ultimately, there are going to be cost-safety tradeoffs, which are also health policy concerns. We tend not to think about patient safety as an access problem because we assume that health services have been received; but I suspect at some point we will start talking about the access-related causes of medical errors. On the other hand, beyond the sweeping assertion that physicians will quit practice if lawsuits are not restricted, medical malpractice reform is not typically dealt with as a health policy problem. Is this not odd? Here we have two things, patient safety and medical liability, that are logically connected, but one is debated in health policy terms and the other is not. When they do appear together in the same sentence, or more likely in the same piece of legislation, one gets a strong sense that the juxtaposition is more for rhetorical effect than for substance