Legal, Regulatory, and Claims-Related Factors Associated With U.S. General Surgery Malpractice Premiums, 2013-2023
Andrew Saleeb, Natasha A. Sioda, Emily Thompson, Dillon Cheung, Megan Nelson, Justin T. Brady, Zhi Ven Fong, Irving A. JorgeBackground
General surgery malpractice premiums vary across states. We examined whether legal, regulatory, and payment measures were associated with premium levels and annual changes.
Methods
We analyzed 50 states during 2013-2023, expressing monetary measures in 2023 dollars. Between-state regressions evaluated mean premiums; annual models included state- and year-fixed effects. Generalized caps included restrictions on noneconomic recovery in at least one ordinary medical-liability claim category. Policy-change analyses were exploratory.
Results
Among 550 state-years, each additional mean annual payment report per million residents was associated with 2.32% higher mean premiums across states (95% CI, 1.20%-3.44%;
Discussion
Higher payment frequency was associated with higher average premiums across states, but year-to-year changes in payment frequency within a given state were not detectably associated with that state’s own premium changes. Cap estimates varied depending on how caps were defined and remained statistically uncertain. These ecological findings do not establish causal effects or support specific policy prescriptions.