PSRO and the dissolution of the malpractice suit

The effect of PSRO on the practice of defensive medicine and the effect of the civil immunity provision on the numbers of malpractice suits may well be substantial. Cost savings in terms of control of overutilization and of the potential for patient injury engendered by that overutilization will ensue. While substantial, those effects will be small compared to the effect of PSRO on the present medical malpractice system. As a social system, malpractice has two positive purposes. It serves as a measure of quality control on outcomes of medical care, and it serves to compensate people for injuries received in medically related situations. How well it serves these purposes is unknown, but what few data exist indicate that it does not significantly enhance the quality of care nor provide an efficient method of compensation. It exists in theory because it is the final check and balance on physician practice--the only existing control on the outcomes of care. Until some system other than malpractice could be conceived which was at least as efficient in outcomes control, malpractice was destined to continue, and no other method of patient compensation could be considered seriously since the compensation and quality control aspects of malpractice were so inextricably bound. With the advent of PSRO, another means of outcomes control came into existence, and as PSRO becomes operational nationwide, that system will prove an efficient and effective system of control over the quality of outcomes of medical care. Within the environment of PSRO, malpractice as a system of outcomes control has little reason to exist, and its worth as a system of patient compensation can be reexamined. It is within the framework of PSRO that other systems of compensation of the injured patient can be considered and developed--systems hopefully more just and more efficient than malpractice. This is the greatest impact PSRO will have on malpractice. It is, of course, a long-term process, and one which will not produce immediate results. In fact, the role of PSRO in effecting a change in patient compensation may never be recognized directly. It is only within the existence of a working system controlling the quality of outcomes of medical care that the injustices of the malpractice system can be righted and alternatives to that system can be considered.