Med mal premiums in Mass., 1975-2005

Marc Rodwin, one of the most innovative and consistently interesting health law scholars around, has published (with others) in the May/June issue of Health Affairs a very useful study of med mal premiums in Massachusetts (described as "a high-risk state") over the 30-year period of 1975-2005. Here's the abstract:

Massachusetts has the fourth-highest median malpractice settlement payments for all states. The American Medical Association (AMA) declares it a crisis state. As a test case, we analyzed its premiums from 1975 to 2005. In 2005 mean premiums were $17,810 for the coverage level and policy type most frequently purchased. Most physicians paid lower inflation-adjusted premiums in 2005 than in 1990. Mean premiums increased in only three specialties comprising 4 percent of physicians: obstetrics, neurology, and orthopedists–spinal surgery. However, because of discounts and surcharges, in 2005 premiums within the three highest-risk specialties varied nearly threefold, and nearly one-third paid less than in 1990.

Not exactly what the AMA would have you believe . . . .

American College of Physicians: E-Health Recommendations

The ACP's new report, E-Health and Its Impact on Medical Practice, is presented on their news page. The challenge of moving physicians to electronic health records is daunting. This is from the press release:

Health care may be the fastest growing industry, but it has been slow to adopt the use of technology. While orders at fast food chains are now entirely automated, most physician offices and hospitals still maintain their records on paper.

In [the ACP's] new position paper . . . , the nation’s largest medical specialty organization says that collaboration among physicians, patients, technology developers, and policymakers must occur if e-health activities like electronic communication between physicians and their patients, remote monitoring of patients, personal and electronic health records, and patients seeking health information online are to transform health care in the U.S.

In other words, don't hold your breath.

Two Versions of End-of-Life Care

The New York Times had an interesting article Friday (In New York City, Two Versions of End-of-Life Care) on variations in end-of-life care -- not the usual comparison of EOL expenditures between geographically disparate locations, but this time between well-off private hospitals and public facilities a couple of miles apart within the same city. The data come from the Dartmouth Atlas of Health Care. The Times article suggests that "more" is not necessarily "better" and explores some of the reasons -- primarily structural and financial -- behind the disparities.