Family physicians want what's best for their patients, but their patients don't necessarily know what's best for their physicians. Case in point: The AAFP Environmental Scan -- an annual "snapshot" of the political and economic environment that affects medicine's legislative efforts -- and national surveys show medical liability reform tops physicians' list of federal legislative priorities, while the public sees the cost of and access to care as most important.
Reform Priorities Differ for Patients, Physicians; Educate Your Patients
Source: 2004 AAFP Environmental Scan
The difference bodes ill for medical liability reform, unless patients better understand the links among medical liability premiums, access to care and the cost of care, say political analysts. FPs have patients on their side, those analysts say. It's simply a matter of helping them understand the problem.
Multiple surveys indicate Americans list health care among the top three domestic issues. In a January survey by the Kaiser Family Foundation and Harvard School of Public Health, 63 percent of respondents said the government's top priority should be lower health care and insurance costs. Medical malpractice jury awards -- the only medical liability-related item that made the list -- ranked 10th out of 12 concerns.
This story first appeared in the March 2005 FP Report.
Public focus on cost and access reflects personal experiences with or awareness of medical debt and its impact on working- and middle-class America. A study in the Feb. 2 Health Affairs, "Illness and Injury as Contributors to Bankruptcy," reported medical debt contributed to or caused 54.5 percent of all bankruptcies in 2001. Health insurance didn't necessarily help: 75.7 percent of study subjects had insurance when the bankrupting illness or injury occurred.
Moreover, people realize medical bankruptcy can affect them: 80 percent in the Health Affairs study earned a middle- or working-class income; 55.8 percent had completed some college coursework; and 56.5 percent were homeowners or had recently lost their homes because of their indebtedness. Medical debt drove more than 20 percent to cut back on food; more than 30 percent failed to pay water or electricity bills; and more than 59 percent forfeited needed doctor or dentist visits.
That hits close to home, says J. Toscano, senior vice president of GMMB, a Washington-based political and public relations consulting firm that works with AAFP on various public health initiatives.
"If you ask what's wrong with health care, people think about cost and access, about prescription drugs. Liability reform is very abstract," he says.
Still, patients do recognize the impact of skyrocketing malpractice premiums. Asked specifically about medical liability, respondents to the Kaiser poll supported reform. Seventy-two percent favored independent review of malpractice lawsuits before claims could be filed, and 63 percent favored limited awards for pain and suffering.
"The public isn't pushing hard for malpractice reform but will be happy to have it if the lawyers, doctors, administration and Congress can agree to a plan," says Kaiser President Drew Altman, Ph.D., of the poll results.
At press time, one liability reform bill similar to one that failed last Congress had been introduced in the House and the Senate. Congress probably won't act on it or any of three other bills containing reform language this year, say analysts. By comparison, more than 15 bills addressed costs and access to health care.
Moreover, people realize medical bankruptcy can affect them: 80 percent in the Health Affairs study earned a middle- or working-class income; 55.8 percent had completed some college coursework; and 56.5 percent were homeowners or had recently lost their homes because of their indebtedness. Medical debt drove more than 20 percent to cut back on food; more than 30 percent failed to pay water or electricity bills; and more than 59 percent forfeited needed doctor or dentist visits.
That hits close to home, says J. Toscano, senior vice president of GMMB, a Washington-based political and public relations consulting firm that works with AAFP on various public health initiatives.
"If you ask what's wrong with health care, people think about cost and access, about prescription drugs. Liability reform is very abstract," he says.
Still, patients do recognize the impact of skyrocketing malpractice premiums. Asked specifically about medical liability, respondents to the Kaiser poll supported reform. Seventy-two percent favored independent review of malpractice lawsuits before claims could be filed, and 63 percent favored limited awards for pain and suffering.
"The public isn't pushing hard for malpractice reform but will be happy to have it if the lawyers, doctors, administration and Congress can agree to a plan," says Kaiser President Drew Altman, Ph.D., of the poll results.
At press time, one liability reform bill similar to one that failed last Congress had been introduced in the House and the Senate. Congress probably won't act on it or any of three other bills containing reform language this year, say analysts. By comparison, more than 15 bills addressed costs and access to health care.
Toscano's advice on resolving this discrepancy: Help patients understand the link between medical liability premiums and access to health care.
"It's critical that doctors do this in a way that's relevant to patients' care and quality of care," says Toscano. "People like their doctors, so doctors need to explain it so that people sympathize with what the doctor is going through."
Whether medical liability reform will see traction in Congress depends on pressure from the White House, said Kevin Burke, director of the AAFP Government Relations Division. "There will be no progress unless the White House pushes the issue," says Burke.
What can you do? Read more about the AAFP Environmental Scan online (Members Only). Then participate in the Patient's Voice in Washington program.
"It's critical that doctors do this in a way that's relevant to patients' care and quality of care," says Toscano. "People like their doctors, so doctors need to explain it so that people sympathize with what the doctor is going through."
Whether medical liability reform will see traction in Congress depends on pressure from the White House, said Kevin Burke, director of the AAFP Government Relations Division. "There will be no progress unless the White House pushes the issue," says Burke.
What can you do? Read more about the AAFP Environmental Scan online (Members Only). Then participate in the Patient's Voice in Washington program.
