Effect of physician strategies for coping with the US medical malpractise crisis on healthcare delivery and patient access to healthcare

The medical liability system in the USA is once again mired in a major malpractise crisis. Physicians have struggled to acquire liability coverage during the crisis, because malpractise insurance has been unaffordable and unavailable. This limited access to affordable liability coverage has prompted some physicians to utilize strategies that reduce their malpractise risk. These strategies have included eliminating high-risk services, defensive medicine, and establishing medical practises in states with affordable malpractise insurance. The fear of malpractise liability and possible financial ruin may justify the use of these strategies. However, these tactics could create a serious public health problem, because they are having a negative impact on healthcare delivery and patient access to healthcare. (C) 2008 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.