Professional Liability and the Quality of Mental Health Care
Any lawyer in a gathering of health professionals, especially physicians, can expect to be bombarded by complaints about the law of professional liability and the high cost of malpractice insurance. It is well-established, of course, that the number of medical malpractice claims significantly increased in the 1960s, precipitating the first insurance crisis in the early 1970s, and leading to a wave of legislative reforms.' Now, after a quiescent period, the number of claims filed and the cost of insurance are rising again,' and the legislatures have responded with a new wave of reforms.
According to the American Medical Association's socio-economic monitoring system, the number of claims filed against physicians increased from an average annual rate of 3.2 per 100 physicians before 1981 to 8.2 from 1981-1984 and to 10.1 in 1985. The annual cost of insurance premiums, which had increased only by 4 percent per year from 1976 to 1982, increased by an annual average of 21.9 percent between 1983 and 1985. The cost of insurance represents about 4 percent of the gross revenues of the average self-employed physician.
There can be little doubt that these trends in the malpractice system have reached critical proportions for some medical specialties, notably obstetrics. As yet, however, mental health professionals are not facing an insurance crisis. Data provided by the insurance industry show that claims filed against psychiatrists represent about 0.3 percent of all medical malpractice claims even though psychiatrists represent about 6 percent of the nation's physicians and see approximately 2 percent of the patients. Although the annual rate of claims filed against psychiatrists, now about 4 per 100, has increased somewhat since 1981, it still remains far below the rate for other physicians. Similarly, while the cost of insurance has increased about 14 percent over the past three years," it is minuscule in comparison with other medical specialties, both in absolute terms and as a percentage of income. The average premium paid by psychiatrists in 1985 was $2600, significantly lower than any other medical specialty and less than one-tenth of the average premium paid by obstetricians.