This report examines recent trends in malpractice claiming—by elderly Medicare beneficiaries and by all claimants—and the available evidence concerning the effects that a range of medical liability reform options might have on Medicare beneficiaries, other patients, and healthcare providers. The first part of the report characterizes patterns in paid lawsuits involving elderly patients during the 2005-2015 period using data from the National Practitioner Data Bank (NPDB) Public Use File. We find that: • For elderly individuals, the number of paid claims reported to the NPDB annually remained fairly stable over the 2005-2015 period. In contrast, for nonelderly individuals, the number declined markedly. • The distribution of paid claims by age is right skewed, with the frequency peaking in age groups 40-49 and 50-59. • Paid claims involving patients aged 70 or above were significantly more likely to involve severe injuries, and nearly twice as likely to involve a death, than claims involving patients under age 60. • Paid claims involving elderly patients were significantly more likely than claims involving younger patients to involve injuries that occurred in the inpatient setting. • Claims involving elderly patients were less likely than claims involving younger patients to be diagnosis related, and more likely to be related to medication, anesthesia, treatment, or monitoring. The second part of the report synthesizes the evidence and theoretical predictions regarding the potential of several leading medical malpractice reform ideas to positively affect the performance of the medical liability system, its impact on healthcare delivery, and the interests of Medicare beneficiaries. For most reforms, the report analyzes evidence from well-designed, controlled studies. Where such studies are unavailable, the analysis encompasses anecdotal reports, case studies, and descriptive findings regarding the operation of proposed systems or close analogues in the U.S. and foreign countries. For reforms that have not yet been tested, the report describes theoretical predictions about the likely effects of the reforms based on relevant scholarship in medicine, law, and economics. The analysis covers eight “traditional” reforms that have been widely implemented by states: caps on noneconomic damages, pretrial screening panels, certificate-of-merit laws, attorney fee limits, jointand-several liability reform, collateral source rule reform, periodic payment, and shortening of statutes of limitation or statutes of repose. It also examines seven “innovative,” less tested reforms: ”health courts,” communication-and-resolution programs, safe harbors for adherence to evidence-based practice guidelines, mandatory pre-suit notification laws, apology laws, state-facilitated alternative dispute resolution, and judge-directed negotiation programs. The reforms are evaluated for their effects on the following outcomes: claims frequency and costs, patient compensation, overhead costs, providers’ liability costs, healthcare spending/defensive medicine, physician supply/access to care, quality of care, unintended consequences, and differential impact on Medicare beneficiaries. 2 We find that the evidence base for evaluating most traditional state tort reforms is substantial and mature. The evidence is sufficient to support the following conclusions: • Noneconomic damage caps are associated with reduced claims frequency, lower compensation award amounts, lower liability insurance premium costs for physicians, reductions in some types of defensive medicine, higher physician supply, and shorter time to settlement—but may have disproportionately large effects on claiming by the elderly. • Pretrial screening panels have no significant effect on claims frequency or compensation amounts. • Attorney fee limits have no significant effect on claims frequency, compensation amounts, liability insurance premiums, or physician supply. • Joint-and-several liability reform has no significant effect on compensation amounts, liability insurance premiums, physician supply, or quality of care. • Collateral-source rule reform has no significant effect on claims frequency, compensation amounts, liability insurance premiums, defensive medicine, physician supply, or health insurance coverage rates. • Periodic payment has no significant effect on claims frequency, compensation amounts, physician supply, or patient care outcomes. • Shorter statutes of limitation/repose have no significant effect on compensation amounts, but are associated with lower liability insurance premiums. The evidence base is too small, or study findings are too mixed, to support inferences regarding the relationship of the traditional reforms to other outcomes. The evidence base for evaluating the innovative tort reforms is very small, as most have not been tested in the U.S. or have been tested so recently that robust outcomes