Muskie School of Public Service

The USM Muskie School recently prepared two research and policy briefs for the Health Care Forum of the Policy Leaders Academy, a nonpartisan educational program for Maine Legislators.

Federal Health Care Reform: An Overview, authored by Andrew Coburn, Muskie Professor and Program Director of Population Health and Health Policy at the Cutler Institute. States will have significant choices and responsibilities in implementing the Patient Protection and Affordable Care Act. This policy brief summarizes the major components of the Act—health insurance coverage, delivery system improvements, and cost containment—and offers a concise description of other important provisions related to prevention and public health, workforce, and long term care.

Medicaid Managed Care: Background, Issues, and Options, authored by Julie Fralich, Program Director of Disability & Aging at the Cutler Institute. Medicaid managed care has become a leading model for the delivery and payment of health care services in state Medicaid programs across the U.S. Implementation of such programs requires thoughtful planning, active stakeholder engagement, and an effective administrative infrastructure to manage and operate in a value based purchasing environment. This policy brief provides an overview of the issues that states must consider in developing and implementing a Medicaid managed care program.

The Health Care Forum is sponsored in partnership with the USM Muskie School and the Margaret Chase Smith Policy Center at the University of Maine. The Policy Leaders Academy is a program of the Maine Development Foundation and is sponsored by the Maine Health Access Foundation.

Study author Dr. Bill Thomas (photo credit: Tim Greenway)

Muskie researchers have published a revealing study in the September issue of Health Affairs, the nation’s leading health policy journal, that provides first-time comprehensive data on the effects defensive medicine–the practice by doctors and other health professionals to prescribe unnecessary tests and procedures to to reduce perceived threats of lawsuits. They found that national tort reform would likely lead to less than 1% decline in medical costs.

National tort reform and a resulting decline in malpractice insurance premiums would probably have little impact on costs in terms of reductions in defensive medicine, according to J. William Thomas, visiting professor at the USM Muskie School and his co-authors Erika Ziller and Deborah Thayer, also at the Muskie School.

“The practice is commonly assumed to increase health care costs,” said Thomas. “But, until now, we didn’t have consistent enough data to support that idea.” Their analysis shows that estimated savings from a 10 percent decline in malpractice premiums would translate into reductions in defensive medicine equal to less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.

In their published results, the authors wrote: “We conclude that defensive medicine practices exist and are widespread, but their impact on medical care costs is small.”

The USM team’s findings were published at the same time as a study by researchers at the Harvard School of Public Health, which pegged the total cost of malpractice at approximately $55.6 billion a year, or 2.4 percent of annual health care spending.

An interview with Dr. Thomas was published in Mainebiz on October 4, 2010.

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