Addressing the Problem of Medical Malpractice

In the mid 1970s, physicians became concerned about the difficulty of obtaining medical malpractice liability insurance and, where coverage was available, the high premiums. The medical malpractice "crisis" of the 1970s led to legislative changes in many states and to reforms within the insurance industry. Although these reforms seemed to alleviate the situation for a time, it worsened again in the 1980s, raising concern about a new crisis. Although nobody was certain about the extent or the causes of the problem, various legislative and regulatory solutions involving tort reform were proposed. At the time, few funders were supporting research and demonstrations on medical malpractice insurance.

In 1985, the Robert Wood Johnson Foundation began its support of a range of initiatives on the topic. The Foundation's efforts represent a sustained attempt to understand the problems associated with malpractice and to help foster innovations in the way insurance issues are handled at the state level. Two national programs were supported: the first focused on research to document and explain the situation, and the second supported demonstrations and evaluations of actual reform efforts.

More than a 100 journal articles and reports have been written based on the research undertaken under the two national programs. In many ways, the efforts of those involved in the various projects supported by the Foundation defined a field of research directed at addressing a long-standing problem. In this chapter, key people involved in the initiatives synthesize the findings and examine the implications of the Foundation's efforts.

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