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Comment and Controversy

Want liability reform? Shift burden to patients

March 2005 · Vol. 17, No. 3

The American College of Obstetricians and Gynecologists (ACOG) hopes to alert the public to the liability insurance crisis through its “Who will deliver my baby?” advertising campaign. But nothing will change until patients are forced to put their money where their mouth is. I have a bold proposal: Have patients buy liability insurance for a specified medical event, the way they purchase flight or vacation insurance. The physician would be responsible for office coverage, which is relatively cheap, and the patient would buy a policy for a delivery or operation by a private physician.

No patient would be denied care. The woman who presents to a hospital in labor without the policy would be treated like a service patient: delivered by a resident under an attending physician’s supervision.

To reduce the costs of coverage, patients could elect arbitration versus adjudication, or opt for lower noneconomic awards—as proposed by California’s Medical Injury Compensation Reform Act (MICRA), only in this case it would be the patient’s own choice. If she felt strongly about being delivered by her private physician, she would be certain to pay her “mal-occurrence insurance.” Otherwise, she’d be delivered by the staff.

Hospital costs would not need to rise, since institutions could bill for the delivery. Just about every hospital has an on-call physician rotation, anyway—or they probably don’t do enough obstetrics to justify maintaining a labor suite. Eliminating these marginal facilities would make the system more efficient.

Our system would resemble that of Israel or other countries with socialized medicine, or patients would pay extra for their private physician.

This is how ACOG should present its campaign. Then see how fast the dynamics of the liability crisis change, once patients’ dollars are directly involved.

Mitchell Essig, MD
New York City

Dr. Barbieri responds:

I believe Dr. Paul Ogburn, director of maternal-fetal medicine at the State University of New York, Stony Brook campus, has proposed to ACOG a plan for patients to purchase insurance for adverse outcomes from a medical event. While there appears to be significant enthusiasm for the concept, I am not sure that actuaries have priced the insurance product to ascertain its economic impact on patients.

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