Improving Malpractice Prevention and Compensation Systems

An RWJF National Program

Dates of Program: October 1992 through August 1999

Field of Work: Exploring new, non-tort mechanisms to prevent negligent medical occurrences and to compensate patients injured by medical care.

Problem Synopsis: Medical malpractice—how to identify it and compensate patients injured by it—has long been a difficult issue confronting American health care. The tort system, the traditional arena for resolving malpractice complaints, provides relief to relatively few.

Synopsis of the Work: Improving Malpractice Prevention and Compensation Systems (IMPACS) was intended to translate lessons learned from earlier studies of medical malpractice into demonstration projects that would test alternatives to the tort system and, thus, help move malpractice reform from the drawing board to the real world.

Key Results

  • Of the five demonstrations initiated by the national program, only one—an intervention project Vanderbilt University Medical Center—was implemented. The other four did not progress beyond the planning stage. As a result, the program's objective—to develop a new generation of mechanisms to prevent and compensate for medical malpractice—went largely unmet.

  • IMPACS produced research that may benefit policymakers and researchers when the next malpractice crisis or other development sparks an interest in reform.

  • A new system developed with national program funding has promise of reducing malpractice complaints and costs. The Vanderbilt demonstration showed significant potential for replication.

  • IMPACS-funded analysis was used to estimate the incidence of medical error in the nation's health system. A 1999 Institute of Medicine report on the quality of care To Err is Human: Building a Safer Health System cited the program's findings as one of two sources for an estimate that medical mistakes kill 44,000 to 98,000 people annually in American hospitals.

  • The national program provided a forum for experts in the malpractice field to exchange and explore new ideas.

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