The impact of tort reform on defensive medicine, quality of care, and physician supply: A systematic review

OBJECTIVE: To evaluate the impact of tort reform on defensive medicine, quality of care, and physician supply. DATA SOURCES: Empirical, peer-reviewed English-language studies in the MEDLINE and HeinOnline databases that evaluated the association between tort reform and our study outcomes. STUDY DESIGN: We performed a systematic review in accordance with the PRISMA guidelines. DATA COLLECTION/EXTRACTION METHODS: Title and abstract screening was followed by full-text screening of relevant citations. We created evidence tables, grouped studies by outcome, and qualitatively compared the findings of included studies. We assigned a higher rating to study designs that controlled for unobservable sources of confounding. PRINCIPAL FINDINGS: Thirty-seven studies met screening criteria. Caps on damages, collateral-source rule reform, and joint-and-several liability reform were the most common types of tort reform evaluated in the included studies. We found that caps on noneconomic damages were associated with a decrease in defensive medicine, increase in physician supply, and decrease in health care spending, but had no effect on quality of care. Other reform approaches did not have a clear or consistent impact on study outcomes. CONCLUSIONS: We conclude that traditional tort reform methods may not be sufficient for health reform and policy makers should evaluate and incorporate newer approaches.