Public Release: 

Professor awarded $1.2 million NIH grant to study malpractice and 'defensive medicine'

What happens to the quality of care delivered when physicians face no threat of malpractice?

Northwestern University

CHICAGO -- What happens to the quality of care delivered when physicians face no threat of malpractice? Does the presence of malpractice pressure lead to "defensive medicine" -- the delivery of tests or treatments that may not necessarily be in the best interest of the patient but can serve to shield the physician from threats of liability? These questions directly address two important aspects of the health care system in the United States: quality of care and cost of treatment.

The National Institutes of Health awarded Northwestern University School of Law Professor Michael Frakes a $1.2 million grant to conduct a four-year study entitled, "The Impact of Exempting Medical Providers from Malpractice Protection." The study will examine questions related to the impact of medical malpractice on health care outcomes.

Frakes, who will serve as the project's principal investigator, joined the Northwestern Law faculty in 2014. A noted expert in law and economics, his research includes health law, with a particular focus on how certain legal and financial incentives affect decision making in health care, and innovation policy, with a focus on the relationship between the financing of the U.S. Patent and Trademark Office and its decision-making processes. Frakes holds a BS and a Ph.D. from the Massachusetts Institute of Technology and a JD from Harvard Law School.

To conduct this research, Frakes will work with a unique data set from the Military Health System (MHS): extensive information on treatment, outcomes, and patient satisfaction from active duty personnel, dependents and retirees.

"Under federal law, active duty patients who are negligently harmed while receiving treatment at military facilities cannot sue for medical malpractice," Frakes said. "But malpractice laws do apply to the treatment of dependents and retirees at these same facilities."

These rules, along with certain other features of the MHS, provide a crucial input for this study -- the observation of a group of patients whose doctors face no malpractice pressure.

"By comparing health care outcomes for patients that pose no malpractice threat to those of comparable patients who can sue for negligent medical care, we can identify the impact of liability pressure on practice patterns, medical costs and patient outcomes," Frakes said.

This research is part of a larger body of empirical research on how malpractice law affects health outcomes. In another recent project, Frakes collaborated with Anupam Jena, a professor at Harvard Medical School, to study how reforms to medical liability standards, along with state mandated damage caps on malpractice awards, influence physician behavior. They found "that damage caps have 'at most, a modest role' in altering physician practices, while reforms to the way in negligence standards are determined have the potential to meaningfully redirect physician behavior."

"The research this grant makes possible is of enormous importance to the ongoing debate about the effect legal and regulatory structures have on health care delivery in this country," said Northwestern Law Dean Daniel B. Rodriguez. "This is solid empirical research that will certainly inform policy discussions in useful ways."

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