the PIAA Data Sharing Project and The National Practitioner Data Bank: Policy, Purpose, and Application. Law and Contemporary Problems 1997 Vol. 60, No.1:59–79. 24 Critics of the NPDB data note that multiple reports for the same claims payment are possible and that some data elements are inconsistently coded (see, for example, U.S. General Accounting Office: National Practitioner Data Bank: Major Improvements Needed to Enhance Data Bank’s Reliability. Washington, DC: GAO Report GAO-01-130, Nov 2000). Other data support the quality of NPDB data. See, for example, Waters TM, Parsons J, Warnecke R, Almagor O, Budetti PP, “Usefulness of Information Provided by the National Practitioner Data Bank,” The Joint Commission Journal on Quality Improvement, 2003, 29(8): 416-424. The limitations of the PIAA data stem primarily from its less than national coverage. 17 Total Dollars in Paid Claims Figure 1 shows the total medical malpractice payments for physicians for the years 1991 through 2003 (the PIAA data begins in 1994 and ends in 2002). Total payments on medical malpractice claims rose substantially during the 1990s and early 2000s. According to the NPDB, total payments for physician medical malpractice claims in the U.S. more than doubled between 1991 and 2003, rising from $2.12 billion in 1991 to $4.45 billion in 2003. Extrapolating from PIAA data,25 a second set of estimates was created for the years 1994– 2002. While these estimates are somewhat lower than those derived from NPDB data, they generally parallel the NPDB trend. Together, these data highlight the increase in total claims payment over the last decade. Sources: Author calculations using data from the National Practitioner Data Bank (NPDB), Public Use Data File NPBD0412, accessed May 2005, http://www.npdb-hipdb.com/PUBLICDATA.HTML; the Physician Insurers Association of America (PIAA), Data Sharing Project, personal communication, 2004; American Medical Association (AMA), Physician Characteristics and Dist ibu ion in the US, 2003-04 Edition (1991-2000 physician data); and AMA data from the Kaiser Family Foundation, State Health Facts Online, at www.statehealthfacts.org (2001-2003 physician data). r t 25 Extrapolation made by multiplying the ratio of all active US physicians (AMA data) to the number of physicians covered by the PIAA data (PIAA Data Sharing Project). 18 Average Claims Payments Figure 2 shows the average payment for a physician medical malpractice claim for the years 1991 through 2003 (1988-2002 for PIAA). The average claim rose significantly over the period: between 88% (NPDB estimate, 1991- 2003) and 131% (PIAA estimate, 1991-2002). Sources: Author calculations using data from the National Practitioner Data Bank (NPDB), Public Use Data File NPDB0412, accessed May 2005, http://www.npdb-hipdb.com/PUBLICDATA.HTML, and from the Physician Insurers Association of America (PIAA), Data Sharing Project, personal communication, 2004. Number of Paid Claims Figure 3 presents the number of paid medical malpractice claims each year from 1991 to 2003 (1994-2002 for PIAA). Both the NPDB data and the PIAA suggest that there has been at most a modest increase in the number of paid claims over the last decade. Considering just the start and end points of the data, NPDB data would indicate a 12% increase in the number of claims, 19 rising from an estimated 13,687 paid physician claims in 1991 to 15,287 in 2003 (see Figure 3), while the PIAA data also show a modest increase, from 10,882 in 1994 to 11,590 in 2002, a 7% increase. Looking at the trend lines over the entire period, however, there does not appear to be consistent growth in the number of paid claims. Sources: Author calculations using data from the National Practitioner Data Bank (NPDB), Public Use Data File NPDB0412, accessed May 2005, http://www.npdb-hipdb.com/PUBLICDATA.HTML, and from the Physician Insurers Association of America (PIAA), Data Sharing Project, personal communication, 2004. Average Defense Costs Per Claim Every medical malpractice claim levied against a physician--including those that result in no payment--results in sizeable “defense costs” on the part of the malpractice insurer or defendant (legal fees, expert witness costs, other handling fees). Figure 4 shows PIAA data on the average defense costs per medical malpractice claim for the period 1991 to 2001. These costs parallel the pattern for total and average claim payments, rising rapidly since 1991 (see Figure 4). In 1991, defense costs were approximately $15,000 per physician claim. In 2001, these costs had risen to approximately $29,500. Defense costs 20 for paid claims more than doubled from $21,000 in 1991 to almost $44,000 in 2001, while defense costs for claims with no payment (61% of all claims) almost doubled from $12,000 to $23,500. Source: Patient Access C isis: The Role of Medical Litigation, Statement of the Physician Insurers Association of America before a joint hearing of the United States Senate Committee on the Judiciary, and the Committee on Health, Education, Labor and Pensions, February 11, 2003. r Variation Across States While the general trend in the U.S. has been increasing medical malpractice costs, it is important to note that there is considerable variation across states in the severity of the trend. Figure 5 illustrates the magnitude of the