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. 2019 Aug;54(4):851-859.
doi: 10.1111/1475-6773.13157. Epub 2019 Apr 16.

The impact of tort reform on defensive medicine, quality of care, and physician supply: A systematic review

Rajender Agarwal  1   2 , Ashutosh Gupta  1   3 , Shweta Gupta  1   4
Affiliations

The impact of tort reform on defensive medicine, quality of care, and physician supply: A systematic review

Rajender Agarwal et al. Health Serv Res. 2019 Aug.

Abstract

Objective: To evaluate the impact of tort reform on defensive medicine, quality of care, and physician supply.

Data sources: Empirical, peer-reviewed English-language studies in the MEDLINE and HeinOnline databases that evaluated the association between tort reform and our study outcomes.

Study design: We performed a systematic review in accordance with the PRISMA guidelines.

Data collection/extraction methods: Title and abstract screening was followed by full-text screening of relevant citations. We created evidence tables, grouped studies by outcome, and qualitatively compared the findings of included studies. We assigned a higher rating to study designs that controlled for unobservable sources of confounding.

Principal findings: Thirty-seven studies met screening criteria. Caps on damages, collateral-source rule reform, and joint-and-several liability reform were the most common types of tort reform evaluated in the included studies. We found that caps on noneconomic damages were associated with a decrease in defensive medicine, increase in physician supply, and decrease in health care spending, but had no effect on quality of care. Other reform approaches did not have a clear or consistent impact on study outcomes.

Conclusions: We conclude that traditional tort reform methods may not be sufficient for health reform and policy makers should evaluate and incorporate newer approaches.

Keywords: defensive medicine; noneconomic damages; systematic review; tort reform.

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Figures

Figure 1
Figure 1
PRISMA flow diagram
See this image and copyright information in PMC

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