1. Health Economics & Policy 3 rd Edition James W. Henderson Chapter 12 The Legal System and Medical Malpractice

2. Tort Law in the United States l Basis in English common law l Development in the U.S.

3. Purpose of Tort Law l Compensation l Deterrence l Retribution

4. Medical Malpractice l Frequency of claims l Severity of claims l International differences

5. Claims Frequency by Specialty

6. Severity of Medical Injuries

7. Tort Reform l Cost of malpractice l Causes of increased litigation

8. Malpractice Premiums by Specialty

9. Causes of Increased Litigation l Increased supply of lawyers l Increased litigiousness in US l Increased medical cost and physicians’ salaries l Breakdown of physician-patient relationship l Pro plaintiff trend in common law doctrine l Size of damage awards l Increased technology in medicine

10. Rent-seeking Behavior

11. Rent-seeking Behavior: Silicone Implant Litigation l Using scarce resources to secure monopoly profits l Reports linking implants to illness l National class action lawsuit with thousands of plaintiffs l $4.25 billion settlement with 40% going to attorneys l Junk science v. scientific evidence

12. Suggestions for Reform l Caps on noneconomic damages l Awards adjusted for collateral sources l Periodic payment mechanism l Limits on punitive damages l Changes in certain rules l Establish ADR mechanism l Limits on contingency fees l Establish English rule of costs l Establish medical courts to hear all medical malpractice cases

13. Summary and Conclusions l Does the current system fulfill its objectives? l Too many lawsuits? l Too few? l Is it worth the trouble? l Is there a better way?