医疗责任和医疗改革。

Leonard J Nelson, Michael A Morrisey, David J Becker
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摘要

我们研究了平价医疗法案(ACA)对医疗责任的影响,以及包括损害赔偿上限在内的联邦医疗改革是否能对医疗改革做出有益贡献的争议。通过保证以社区费率获得医疗保险,《平价医疗法案》可以减少因损害赔偿上限而导致的赔偿不足问题。然而,它也可能加剧医疗事故系统中索赔不足的问题,从而减少投资于预防损失活动的动机。将损失从责任保险公司转移到健康保险公司可能会进一步削弱医疗责任制度本已薄弱的威慑作用。国会中的共和党人和医生团体都推动将联邦损害赔偿上限作为医疗改革的一部分。医生对损害赔偿上限的支持可以用对保险周期和随之而来的市场不稳定的担忧来解释。我们自己在这里提出的研究表明,在对非经济损失设置上限的州,保险市场更稳定。国会共和党人认为,制定损害赔偿上限将降低医疗保健总成本。国会预算办公室(Congressional Budget Office)在估算联邦损害赔偿上限将带来的成本节约时,将减少医疗保健使用率所节省的成本包括在内。但是,尽管国会预算办公室最近提出了一些意见,但目前尚不清楚上限是否会显著降低医疗保健成本,或者是否会将节省的成本转嫁给消费者。《平价医疗法案》包括为一些有前景的改革提供州级示范项目资金,如报价和信息披露以及医疗法院,但目前这些改革的效益还不确定。有必要对这些问题进行进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Medical liability and health care reform.

We examine the impact of the Affordable Care Act (ACA) on medical liability and the controversy over whether federal medical reform including a damages cap could make a useful contribution to health care reform. By providing guaranteed access to health care insurance at community rates, the ACA could reduce the problem of under-compensation resulting from damages caps. However, it may also exacerbate the problem of under-claiming in the malpractice system, thereby reducing incentives to invest in loss prevention activities. Shifting losses from liability insurers to health insurers could further undermine the already weak deterrent effect of the medical liability system. Republicans in Congress and physician groups both pushed for the adoption of a federal damages cap as part of health care reform. Physician support for damages caps could be explained by concerns about the insurance cycle and the consequent instability of the market. Our own study presented here suggests that there is greater insurance market stability in states with caps on non-economic damages. Republicans in Congress argued that the enactment of damages caps would reduce aggregate health care costs. The Congressional Budget Office included savings from reduced health care utilization in its estimates of cost savings that would result from the enactment of a federal damages cap. But notwithstanding recent opinions offered by the CBO, it is not clear that caps will significantly reduce health care costs or that any savings will be passed on to consumers. The ACA included funding for state level demonstration projects for promising reforms such as offer and disclosure and health courts, but at this time the benefits of these reforms are also uncertain. There is a need for further studies on these issues.

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