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80 Tex. L. Rev. 1595 (2001-2002)
Deterrence of Medical Errors: Theory and Evidence for Malpractice Reform

handle is hein.journals/tlr80 and id is 1609 raw text is: Deterrence of Medical Errors: Theory and Evidence
for Malpractice Reform
Michelle M. Mello* and Troyen A. Brennan
I.   Introduction
After a decade and a half of quiet slumber, medical malpractice
litigation is once again becoming an area of significant interest in health
policy. This is a result of two larger themes in health care policy-the
medical market and the patient safety movement-intersecting at a
somewhat curious location. The perceived need to provide care that is both
cost-effective and safe has health care managers and policymakers grappling
with how to build a business case for quality.' This struggle, in turn, has
generated interest in the possible role of medical malpractice litigation in
deterring costly medical errors.
The theme of the medical market is not a new one in health care. Many
observers of health policy, led (somewhat surprisingly) by legal academics,2
have long argued that the only way to counter professional control over
supply and demand in health care is to institute market incentives. These
commentators believe that professional dominance has minimized the role of
educated consumers and competitive market choices.3      This control has
allowed physicians and hospitals to thrive while insulated from efficiency
demands.
In the vanguard of the marketplace movement has been managed care,
with its integration of market themes into the doctor-patient relationship.
Unlike traditional fee-for-service providers, capitated providers do not have a
financial incentive to supply health services of marginal necessity or benefit.
Managed care, unfortunately, has foundered due to consumer dissatisfaction
and, in particular, the ongoing litigation brought by patients who have been
denied care.4
Assistant Professor of Health Policy and Law, Harvard School of Public Health.
Professor of Law and Public Health, Harvard School of Public Health; Professor of
Medicine, Harvard Medical School; and Department of Medicine, Brigham and Women's Hospital,
Boston.
1. See Molly Joel Coye, No To3tas in Health Care: Why Medical Care Has Not Evolved to
Meet Patients' Needs, 20 HEALTH AFF. 44, 45 (2001); Robert S. Galvin, Te Business Case for
Quality, 20 HEALTH AFF. 57,57-58 (2001).
2. See generally CLARK C. HAVIGHURST, HEALTH CARE CHOICES: PRIVATE CON'RACrs AS
INSTRUMENTS OF HEALTH CARE REFORM (1985) (arguing for increased use of contracts that
specify patients' legal rights).
3. See idU at 2 (contending that the current market fails to offer sufficient health care options).
4. See Alice A. Noble & Troyen A. Brennan, Managed Care in the Newv Era of Systems-
Think: The Implications for Managed Care Organizational Liability and Patient Safety. 29 J.L

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