Patient Safety, Just Compensation, and Medical Liability Reform

Randall R. Bovbjerg, Brian Raymond

The current, well-publicized medical liability insurance "crisis" highlights the case for tort reform, but heated reform debates obscure more fundamental system needs. A variety of nontraditional approaches offer alternatives to expensive and adversarial litigation for resolution of avoidable medical injuries. These alternatives emphasize a new rationale and framework for accountability that promotes patient safety. This paper delineates the flaws in the current medical liability system—particularly in patient safety and access to fair compensation—and describes potential reforms, including "early-offer," medical courts, avoidable classes of events (ACEs), and alternative compensation systems that make compensation fairer and more predictable while facilitating learning from past errors to prevent future ones. State-based demonstrations of alternatives should test such broader solutions. (Report for Roundtable "Creating a Tort System to Support Improved Patient Safety," sponsored by the Kaiser Permanente Institute for Health Policy, the Milbank Memorial Fund, and the Reforming States Group, January, 2003.)

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