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Abstract
For many physicians, the prospect of being sued for medical malpractice is a singularly
disturbing aspect of modern clinical practice. State legislatures have enacted tort
reforms, such as caps on damages, in an effort to reduce the volume and costs of malpractice
litigation. Attempts to introduce similar traditional reform measures at the federal
level have so far failed. Much less prominent, but potentially more important, are
proposed alternative approaches for resolving medical injuries; a number of these
efforts are currently being tested in federally sponsored demonstration projects.
These nontraditional reforms have considerable promise for addressing some of the
system's most challenging issues, including high costs and barriers to accessing compensation.
In this Special Communication, we review recent national trends in medical liability
claims and costs, which indicate a sharp reduction in the rate of paid claims and
flat or declining levels in compensation payments and liability insurance costs over
the last 7 to 10 years. We discuss a number of nontraditional reform approaches--communication-and-resolution
programs, presuit notification and apology laws, safe harbor legislation, judge-directed
negotiation, and administrative compensation systems--and we conclude by describing
several forces likely to shape change in the medical liability environment over the
next decade.