Constantly rising malpractice premiums are having little impact on the way doctors practice, at least in Pennsylvania, researchers have found.


“When insurance becomes difficult for physicians to find or afford, policymakers worry that patients’ access to services will be compromised. However, our findings suggest that the supply of high-risk specialty care changed little, and that where changes did occur, their connection to the crisis was weak or not apparent,” they concluded.

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Led by Michelle M. Mello, JD, PhD, an associate professor of health policy and management at the Harvard School of Public Health in Boston, the research team used administrative data from the Pennsylvania state insurance department on 47,366 physicians. More than four out of five (82%) were in urology or other specialties with high liability risk.


The researchers analyzed how many of the doctors changed the scope of their practices or stopped practicing altogether from 1993 through 2002. They study split the decade between a “crisis period” of 1999-2002, when insurance rates shot up, and a “pre-crisis” period of 1993-1998.


“Overall, fewer than 3% (average annual percentage) of physicians performing major procedures shifted to minor procedures (0.7%) or no procedures (1.8%) during the malpractice crisis period, and 8.2% of specialists performing only minor procedures shifted to no procedures,” the study found. That picture was similar during the pre-crisis years, leading the researchers to conclude that the jump in premiums was not a factor. In addition, they noted, the actual number of doc-tors who made any practice-altering shifts was small.


“The overall supply of high-risk specialists did not drop in absolute or per capita terms during the malpractice crisis,” the researchers report. “Rather, it increased slightly, with declines in surgery and ob/gyn offset by increases in other specialties” (Health Affairs 2007;26:w425-w435).