“Medical Adversity Insurance”: A No-Fault Approach to Medical Malpractice and Quality Assurance

A “no-fault” insurance system is proposed to replace the present adversary legal system for dealing with medical malpractice. Designed to obviate inquiries into providers’ blameworthiness wherever possible, the system has features which would bring certain adverse medical outcomes to light, compensate for them promptly though not lavishly, and generate incentives for providers to avoid relatively bad outcomes experience. The difficulty of specifying compensable events might dictate that, at least initially, only events which are relatively avoidable and easily identified when they occur could be made compensable, the remainder being left for adjudication under traditional principles. The system would be operated primarily by providers and would stimulate peer review, self-regulation, continuing education, and increased attention to clinical outcomes rather than inputs or processes. Direct regulation of the quality of care would be unnecessary in areas where the system proved workable, and medical decision-making would be left largely free from outside interference. Costs could appear high but would be manageable.

Author(s): Clark C. Havighurst; Laurence R. Tancredi

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Volume 51, Issue 2 (pages 125–168)
Published in 1973