When experts discuss health policy, they typically mean the factors that affect access to medical care, its quality, and its cost. The first medical malpractice crisis of the twenty-first century began in 2001 and continues into 2006. Previous malpractice crises occurred in the 1970s and 1980s. Until the current crisis, few connections have been drawn between the medical malpractice reform movement and overall health policy.

Malpractice crises are defined by rapidly rising liability insurance premiums for physicians, sometimes accompanied by difficulty obtaining insurance coverage at any price. Because lawsuits are upsetting as well as financially costly to physicians, and because armies of white-coated demonstrators make good political theater, hand-wringing over physicians leaving practice and hospitals closing their doors is standard fare for “tort reformers” in crisis years. During the longer intervals between crises, when insurance premiums are stable, malpractice reformers sustain momentum for their cause by suggesting that physicians' fear of litigation leads them to waste health care resources on “defensive medicine” and contributes significantly to overall medical inflation. For the most part, however, these issues have been voiced as political rhetoric and not incorporated seriously into policy making.

BARRIERS TO POLICY INTEGRATION

There are several reasons why medical malpractice has not been integrated with health policy. Malpractice insurance is an intense but intermittent agony for physicians and tends to be ignored by health care policy makers when coverage is cheap and plentiful. Malpractice litigation is so deeply enmeshed in professional rivalries that outsiders hesitate to interfere.