• Even without malpractice caps, New York has added more doctors per capita than Texas Wednesday, January 15, 2014

    One of the things proponents of caps on compensation for victims of medical negligence (along the lines of California’s MICRA) want to make you believe is that these caps somehow increase “access to health care.” The reduced financial accountability for medical harm supposedly attracts doctors to work in states with caps, drawing them away from states that have no artificial limits on compensation as determined by a citizen jury that hears all the evidence presented by both sides.

    Opponents of a proposal to adjust California’s 38-year-old MICRA cap frequently invoke the example of Texas. In 2003 the Lone Star State implemented a cap very similar to California’s, and since then supporters of that cap have tried to make the case that the change has led to an unusual surge in access to health care for Texas citizens. A group opposed to adjusting California’s cap to reflect 38 years of inflation, an organization misleadingly named Californians Allied for Patient Protection, made the following claim on its Twitter account on Jan. 14:

    CAPP tweet Texas

    It’s true the number of doctors has increased in Texas since 2002, the year before “tort reform” brought about a cap on compensation for medical harm. But do these liability reforms get the credit for the increase?

    It’s hard to see why they should, because the rate of increase in the number of doctors in Texas has lagged behind the increase in the number of doctors nationally over that period. Let’s compare based on the number of doctors per 100,000 population, as reported by the American Medical Association. On that basis Texas increased from 221 in 2002 to 245 in 2011 (the last year for which data are available), an increase of 24. Nationally the number went from 288 to 322, an increase of 34. Again, this is a comparison on a per-capita basis, which is appropriate when talking about “access to health care” — what’s the ratio of doctors to population?

    At the opposite end of the spectrum from Texas is the state of New York, which has never had any limits on compensation for medical negligence. Cap advocates would have you think doctors would shun New York, with its unlimited liability, and race to Texas. But the reality? Not only does New York have nearly twice as many doctors per capita as Texas, it has seen a greater increase in the number of doctors since Texas implemented its vaunted “tort reform.”

    Texas vs New York 2002-11

    From 2002 to 2011 the number of doctors per 100,000 residents increased by 24 in Texas and by 37 in New York, from 417 to 454.

    We’re not going to make the mistake that MICRA supporters make and try to imply some sort of cause and effect; we won’t say the absence of damage award caps actually attracts doctors to New York. What we will say is that the presence or absence of these caps seems to be a very minor factor in determining where doctors choose to practice.

    That’s the conclusion of law professors David Hyman and Charles Silver in a study published in 2012. (Hyman is also a M.D.) They write:

    Physician supply appears to be primarily driven by factors other than liability risk, including population trends, where the physician has done her residency, job opportunities within the physicians’ specialty, life-style choices, and the extent to which the population is insured or uninsured.

    A condensation of their findings concerning the physician supply in Texas is available in this fact sheet from the Center for Justice & Democracy.

    –J.G. Preston

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