Questions and answers on liability insurance.
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Economic pressures, awareness that physicians can be sued, improved medical care, and increased patient expectations have led to the skyrocketing liability insurance costs physicians face today. In the early days when the doctor could offer hope but little medicine, patients were not inclined to sue for medical "failures." But with the Great Depression, World War II, more recent medical advances changed the patient-physician relationship. Patients had gained the expertise of specialists, but often lost the personal relationship they once shared with their primary physician. Thus, when treatments were unsuccessful, the patient often-times blamed the physician. Insurance premiums (and patient costs) increased, while patients became even more aware that physicians were covered by insurance. This article reviews key economic, medical, and social events that led to the present medical liability insurance crisis.
A geographically stratified sample of Fellows and Junior Fellows of The American College of Obstetricians and Gynecologists (ACOG) responded to a questionnaire, describing the source, coverage, and cost of their professional liability insurance, and the effects this had on patterns of practice. Most physicians carry primary professional liability coverage, although 6% do not. The majority pay less than $8000/year for a wide variety of dollar coverages. Less than half of the surveyed obstetrician-gynecologists carry excess/umbrella liability insurance, and a majority pay less than $2000/year for this coverage. The liability problem has not had a substantial effect on restricting the number of obstetrician-gynecologists, but it has had a major effect on patterns of practice.
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Practice parameters are here to stay and will have, in fact already have had, a dramatic effect upon the practice of medicine. The effect of practice parameters upon professional liability and professional liability carriers is uncertain.