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Capping medical malpractice payouts would not significantly decrease U.S. health care costs. But cutting the number of medical malpractice cases—by reducing errors, shielding physicians from claims, or both—would.

That’s according to a new study by Johns Hopkins researchers. It found that jury malpractice awards of $1 million or more total only about $1.4 billion a year. That’s just 0.05 percent of the $2.7 trillion or so (depending on how you count) that the country spent on health care in 2012.

What does add up, according to the study, are extra tests that doctors order for fear that they’ll get hauled into court and accused of not doing everything possible to help the patient.

“The notion that frivolous claims are routinely resulting in $100 million payouts is not true,” said Martin A. Makary, MD, the study’s leader and senior author. He continued:

The real problem is that far too many tests and procedures are being performed in the name of defensive medicine, as physicians fear they could be sued if they don’t order them. That costs upwards of $60 billion a year. It is not the payouts that are bankrupting the system. It’s the fear of them.

Dr. Makary, an associate professor of surgery and health policy at the Johns Hopkins University School of Medicine, was quoted in a Johns Hopkins news release. The study was published online March 29 in the Journal for Healthcare Quality.

“Bankrupting the system” is a little strong; $60 billion is about 2.2 percent of $2.7 trillion. Nevertheless, a billion here and a billion there, and pretty soon you’re talking about health care costs consuming the entire economy.

The researchers used the National Practitioner Data Bank, which contains data on malpractice settlements and judgments since 1986. They looked only at what they called “catastrophic” medical malpractice payouts: those that totaled more than $1 million. The database includes only payments made on behalf of individual providers, not hospitals or other entities, meaning that, according to Dr. Makary, the study may underestimate the number of payouts by 20 percent.

From 2004 through 2010, catastrophic payouts represented 7.9 percent of all paid claims and 36.3 percent ($9.8 billion) of the $27 billion in total money paid. The largest single payout was $31 million.

Factors most often associated with catastrophic payouts were a patient age of less than 1 year; quadriplegia, brain damage, or the need for lifelong care as a result of the malpractice; and an anesthesia problem.

Dr. Makary said the findings suggest that reform efforts should focus not on malpractice award caps but rather on doctor protections designed to reduce defensive medicine. And he said the study points to a need for research on how to prevent the types of errors that most often result in catastrophic payouts. That would not only reduce costs but also improve patient safety.

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