Doctors are paying dramatically more for malpractice insurance while earning less for patient care, a squeeze between costs and income that could eventually limit some medical services.
There is general agreement in describing the problem. But the principals differ strongly on whether legislators should solve it by imposing regulations on patients, doctors or the insurance industry.
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From 1991 through 2000, the national average premium for medical malpractice fell by 32 percent even as medical inflation rose by 51 percent, according to Americans for Insurance Reform's calculation of figures from the National Association of Insurance Commissioners.
Better documented research by the Consumer Federation of America found average payouts nearly flat through the '90s, said Joanne Doroshow, executive director of the Center for Justice and Democracy.
Including dismissals, settlements and million-dollar verdicts, the CFA said payouts averaged $42,607 in 2000 and $39,093 in 1990.
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But using average premiums instead of totals, the Center for Justice and Democracy found California's increased twice as fast as the rest of the country's in 1991-99. Only CJ&D published its raw data. Hunter examined all states for 1985-1998, looking for any correlation between restrictive tort laws and insurance claims costs. Restrictive laws made "no difference," he said. With or without them, some states had lower costs and some had higher.
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