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noneconomic damages

An August 2003 National Bureau of Economic Research paper by Katherine Baicker and Amitabh Chandra found that (1) “increases in malpractice payments made on behalf of physicians do not seem to be the driving force behind increases in premiums”; (2) “increases in malpractice costs (both premiums overall and the subcomponent factors) do not seem to affect the overall size of the physician workforce, although they may deter marginal entry, increase marginal exit, and reduce the rural physician workforce”; and (3) “there is little evidence of increased use of many treatments in response to malpractice liability at the state level, although there may be some increase in screening procedures such as mammography.”[49]

A 1996 study by Daniel P. Kessler and Mark McClellan analyzing data on elderly Medicare beneficiaries treated for two serious cardiac diseases in 1984, 1987, and 1990 determined that “malpractice reforms that directly reduce provider liability pressure lead to reductions of 5 to 9 percent in medical expenditures without substantial effects on mortality or medical complications.”[50]

A a 2004 Congressional Budget Office (CBO) report using data from a private actuarial firm and the Centers for Medicare and Medicaid Services (CMS) found that malpractice costs (excluding “defensive medicine”) account for less than 2 percent of health care spending.[51] A 2006 PriceWaterhouseCoopers report for America’s Health Insurance Plans (a health-insurer trade association) used the 2 percent figure and an extrapolation from the Kessler and McClellan report to estimate that the combined cost of insurance and defensive medicine accounts for 10 percent of total health care costs in the U.S.[52]

In 2009, the CBO “concluded that implementing a package of five malpractice reforms would reduce national health spending by about 0.5 percent.”[53][54]

A study by Michelle M. Mello and others published in the journal Health Affairs in 2010 estimated that the total annual cost of the medical liability system, including “defensive medicine,” was about 2.4 percent of total U.S. health care spending.[53] The authors noted that “this is less than some imaginative estimates put forward in the health reform debate, and it represents a small fraction of total health care spending,” although it was not “trivial” in absolute terms.[53]

A study by RAND Corp. researchers published in October 2014 in the New England Journal of Medicine concluded that laws restricting medical-malpractice suits do not reduce the amount of “defensive medicine” or reduce health-care costs. The researchers, led by Daniel A. Waxman, examined 3.8 million Medicare patient records from hospital emergency departments from 1997 to 2011, comparing care in three states that enacted strict malpractice reform laws about a decade earlier (GeorgiaTexas and South Carolina) to care in neighboring states that did not enact such laws. The study found that the laws had no effect on whether doctors ordered resource-intensive care (e.g., CT or MRI scans and hospitalization)