Major research efforts probe malpractice, insurance issues

Research and time. Both are necessary now to judge how successful have been the efforts of many states in the past two years to deal with the much-publicized perception that medical malpractice cases and insurance rates are soaring. Three major research efforts are in process. The United States Department of Health and Human Services (HHS) has just announced a task force to study the overall problem and recommend action next March. The Robert Wood Johnson Foundation, of Princeton, N.J., soon is to provide grants to research programs into the medical malpractice liability issue.

And the US General Accounting Office (GAO), in a report soon to be released, raises doubt about the dimension of the problem. The report finds that, on average, medical insurance premiums for physicians absorb a modest percentage of their salaries. In 1984, physicians averaged earnings of $211,000, 4 percent of which went for buying malpractice insurance, the report says. But some specialists paid more. Obstetricians, for instance, paid 8 percent.

Yet the GAO report may be of limited value, as it is based heavily on statistics from 1984 and mid-1985, before physicians in some states reported the meteoric rises in their malpractice insurance that led to the current round of national concern. Health-care specialists hope the HHS and Johnson Foundation studies can provide more current information.

``There really isn't a lot of research available,'' Richard Merritt says, to help planners learn what approach to dealing with the problem works best. Mr. Merritt, project director of the Intergovernmental Health Policy Group at George Washington University, says that ``about half of the states have passed some kind'' of measure to deal with the problem, ranging from piecemeal approaches to California's effort to put a legal cap on the size of jury awards.

Although several bills have been introduced in Congress, it is the individual states that have acted in this case, as increasingly is the case in social issues nowadays.

As a result, says Mr. Merritt, ``it's hard for researchers to sort out . . . what's the most effective strategy to take.''

What health-care specialists seek is research that will point to the best way of handling the problem in the future. And they want to know, in the words of one specialist, ``what is driving the [insurance] rates up: lawyers, the insurance industry, greedy consumers, or physicians.''

The medical liability problem may be receding for the moment, but few here believe that it has been dealt with permanently. Yet even as additional research is sought, evidence continues to be collected on the impact that the problem has had in specific areas, and upon individuals. The firm that insures two-thirds of Maryland's physicians paid a record $23 million in malpractice claims during the first seven months of this year -- more than during all of last year.

And in some areas physicians in a few specialties, faced with soaring insurance rates, are leaving the profession. In some instances consumers who seek medical assistance have become concerned as to whether competent medical help would always be available.

The issue goes beyond statistics to the relationship between physician and patient. ``I'm glad I got to practice in the old days,'' says one obstetrician who retired this year, in part because of rising malpractice insurance rates. ``Then there was real trust between a doctor and her patients. That's all gone: Now patients are suspicious, and doctors are so afraid of being sued that they order all kinds of tests that aren't necessary.''

The coming GAO report notes this increase in ``defensive medicine,'' as it is widely called. The report says the new relationship requires physicians to keep more detailed records, and order more tests than in the past. The American Medical Association says that in 1985 defensive medicine cost $15 billion.

Some observers, like the retired obstetrician, hold that this increased emphasis on paper work gets in the way of providing proper assistance to patients. Others, including some trial lawyers, hold that defensive medicine actually is only careful medicine, which ought to be practiced routinely.

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