Do Medicaid and Medicare Patients Sue Physicians More Often than Other Patients?

SUMMARY Fear of being sued for malpractice is often cited as one reason for the distressing trend of reduced physician participation in Medicaid and other publicly funded programs (8). Physicians in many specialties report practice changes in response to the threat of malpractice liability, including dropping services to medically " high-risk " patients. But the problem is particularly acute in the practice of obstetrics (32). As of 1990, 24 percent of obstetricians reported they limited their high-risk obstetric care and 12 percent stopped practicing obstetrics altogether (21). Over one-third of practicing obstetricians responding to a 1987 survey did not provide services to Medicaid patients (5). The American Academy of Family Physicians reports a continuing trend among its membership to drop obstetrics services; by 1990, only 28 percent of family practitioners continued to provide obstetric services (8,1). Although concern about malpractice is not the only reason for obstetric providers' changing practice patterns, these surveys indicate that access to care for poor patients has suffered. But do Medicaid patients sue doctors more often than other patients? Anecdotal information suggests that a significant proportion of physicians believe that poor patients sue more often (8). Some lawyers maintain that the doctors should expect the poor to sue less frequently because it is difficult for poor people to obtain legal representation for malpractice claims (13). Malpractice suits are typically brought on a contingent fee basis and awards are based on future earnings as well as pain and suffering. Thus, representing the poor and the elderly may not be as economically profitable for private bar lawyers as representing those with substantial potential future earnings. On the other hand, the courts do not assume that the