Health affairs
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The first decade of the patient safety movement achieved some real gains, focused as it was on adverse events amenable to systemwide solutions, such as infections associated with health care and medication errors. However, diagnostic errors, although common and often serious, have not received comparable attention. ⋯ Health information technology, better training, and increasing acknowledgment of the problem hold some promise. As approaches to measuring, preventing, and mitigating harm from diagnostic errors are proven to work, it will be important to integrate these approaches into policy initiatives to improve patient safety.
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Eager to reduce unnecessary use of hospital emergency departments by Medicaid enrollees, states are increasingly implementing cost sharing for nonemergency visits. This paper uses monthly data from the 2001-2006 Medical Expenditure Panel Surveys (MEPS) to examine how changes in nine states' copayment policies influence enrollees' use of emergency departments. The results suggest that requiring copayments for nonemergency visits did not decrease emergency department use by Medicaid enrollees. Future research should examine more closely the effects at the state level and investigate whether these copayments affected the use of other services, such as hospitalizations or visits to physicians by Medicaid enrollees.
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Physicians contend that the threat of malpractice lawsuits forces them to practice defensive medicine, which in turn raises the cost of health care. This argument underlies efforts to change malpractice laws through legislative tort reform. ⋯ We also found relatively modest differences in physicians' concerns across states with and without common tort reforms. These results suggest that many policies aimed at controlling malpractice costs may have a limited effect on physicians' malpractice concerns.