Nader Group Urges Improving Patient Safety, Removing Dangerous Doctors
National News • January 17, 2007
Despite claims by business and medical lobbying interests, there is no medical malpractice lawsuit crisis in America, according to analysis released by Ralph Nader's national group, Public ...
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Subject: Flaws to this study
Posted On: January 18, 2007, 10:40 am CST
Posted By: LLCJ
Comment:
The flaws to this study are staggering, and (to me) calls in to question the integrity of the Public Citizen Group.
-It uses medians in its claims, when rates are based on means. Means are significantly higher, and more statistically relevant. Even Kevin Drum, an opponent of tort reform, calls the use of medians evidence of an "axe to grind".
-Study adjusts for inflation, when medical costs have increased far more than inflation. Admittedly, this increase is due in part to Med mal, but the ommission is noteworthy.
-The study starts its cut-off date at 1991, but fails to note that reformers thought malpractice costs were too high in 1991. From 1975 (the earliest data available) to 1991, medical malpractice costs increased 2.2 times as fast as GDP, while medical inflation grew as fast as GDP.
-The study makes a big deal of some declines that began after 2003, but fails to note the large increases from 1991 to 2003 that prompted the renewed complaints. It also fails to note that 2003 is too "green", much of the cases reported in 03 to now are still in litigation or in settlement talks.
-The page designer very effectively used a lot of nifty tricks to dampen the visual effect of increases over time: big thick lines and points that obscure where the points actually are; in some graphs, there is an artificially-elongated Y-axis with lots of white space to dampen the trend line.
-Even with all of these dampening adjustments, the actual data in the Public Citizen report shows a huge increase in median judgment from 1991 to 2005 (and an even larger one from 1995 to 2001) consistent with what reformers are claiming. Solution? Just caption the graph "Judgments Constant When Adjusted For Inflation [sic]" even when the graph shows nothing of the sort, and announce that reformers are committing a "hoax."
-The study talks of "million-dollar judgments", but adjusts it for inflation, while eliding whether it's talking about "million-1991-dollar judgments" or "million-2005-dollar judgments." If it's the former misleading figure, as one guesses given the consistency in statistical choices in the rest of the paper, the "million-dollar judgments" are really two-million-dollar judgments because of the artificially high deflator used.
-By focusing on payments to patients, Public Citizen ignores the largest part of the malpractice cost, which is payments to attorneys, which has been rising even faster than payments to patients.
-The study conflates "medical errors" with "medical malpractice", even though the two are different. Of course, the study trots out the discredited Institute of Medicine statistic, which has become wildly popular through repetition if not accuracy. (It's ironic that many of the anti-reformers who parrot the IOM statistic criticize Towers Perrin for its annual measurements of tort costs, even though Towers Perrin is forthright about their study's narrow scope and limitations.)
-The study repeats the standard trope of "small percentage of doctors responsible for large percentage of malpractice" without making any adjustments or cross-checks to see if these numbers are within the range of risk-adjusted random statistical chance.
(Source http://www.pointoflaw.com/archives/003416.php)
Subject: Flaws to this study
-It uses medians in its claims, when rates are based on means. Means are significantly higher, and more statistically relevant. Even Kevin Drum, an opponent of tort reform, calls the use of medians evidence of an "axe to grind".
-Study adjusts for inflation, when medical costs have increased far more than inflation. Admittedly, this increase is due in part to Med mal, but the ommission is noteworthy.
-The study starts its cut-off date at 1991, but fails to note that reformers thought malpractice costs were too high in 1991. From 1975 (the earliest data available) to 1991, medical malpractice costs increased 2.2 times as fast as GDP, while medical inflation grew as fast as GDP.
-The study makes a big deal of some declines that began after 2003, but fails to note the large increases from 1991 to 2003 that prompted the renewed complaints. It also fails to note that 2003 is too "green", much of the cases reported in 03 to now are still in litigation or in settlement talks.
-The page designer very effectively used a lot of nifty tricks to dampen the visual effect of increases over time: big thick lines and points that obscure where the points actually are; in some graphs, there is an artificially-elongated Y-axis with lots of white space to dampen the trend line.
-Even with all of these dampening adjustments, the actual data in the Public Citizen report shows a huge increase in median judgment from 1991 to 2005 (and an even larger one from 1995 to 2001) consistent with what reformers are claiming. Solution? Just caption the graph "Judgments Constant When Adjusted For Inflation [sic]" even when the graph shows nothing of the sort, and announce that reformers are committing a "hoax."
-The study talks of "million-dollar judgments", but adjusts it for inflation, while eliding whether it's talking about "million-1991-dollar judgments" or "million-2005-dollar judgments." If it's the former misleading figure, as one guesses given the consistency in statistical choices in the rest of the paper, the "million-dollar judgments" are really two-million-dollar judgments because of the artificially high deflator used.
-By focusing on payments to patients, Public Citizen ignores the largest part of the malpractice cost, which is payments to attorneys, which has been rising even faster than payments to patients.
-The study conflates "medical errors" with "medical malpractice", even though the two are different. Of course, the study trots out the discredited Institute of Medicine statistic, which has become wildly popular through repetition if not accuracy. (It's ironic that many of the anti-reformers who parrot the IOM statistic criticize Towers Perrin for its annual measurements of tort costs, even though Towers Perrin is forthright about their study's narrow scope and limitations.)
-The study repeats the standard trope of "small percentage of doctors responsible for large percentage of malpractice" without making any adjustments or cross-checks to see if these numbers are within the range of risk-adjusted random statistical chance.
(Source http://www.pointoflaw.com/archives/003416.php)