Florida physicians reportedly continued to decrease or eliminate important health services in 2004 in response to difficulties in finding or paying for professional liability insurance, according to a study in the October 10 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Despite growing concern about possible effects of instability in the professional liability insurance (PLI) market on patient access to health care, there has been little formal, systematic assessment of how physicians may be changing their services to adapt, according to background information in the article. Understanding the impact of professional liability insurance market instability on health service delivery is important to clinicians and policymakers concerned with patients' access to needed medical care, the authors suggest.
Robert G. Brooks, M.D., of Florida State University, Tallahassee, and colleagues surveyed rural and urban/suburban physicians in Florida in 2004 to determine recent changes in services offered, professional liability insurance premium changes, satisfaction with practice and future practice plans.
Overall, 727 (54.4 percent) of the 1,346 responding physicians (380/685 rural and 347/661 urban/suburban physicians) stated that they had decreased or eliminated the delivery of patient services in the previous year, the researchers report. "The most common services eliminated were nursing home coverage (42.1 percent), vaginal deliveries (29.1 percent) cesarean deliveries (26.0 percent), emergency department coverage (22.8 percent) and mental health services (21.2 percent). In addition to outright elimination, a number of physicians responded that they had decreased services in these areas as well. . Surgical specialists (70.2 percent) and general surgeons (68.5 percent) respectively, had the highest number of decreased or eliminated services. Obstetricians/gynecologists (63.6 percent) and family medicine physicians (60.2 percent) were also commonly represented in this group."
"Changes in health care services seemed to be related to changes in PLI premiums," the authors write. "Overall, physicians who had premium changes in the highest quartile (increase > 50 percent) (61.1 percent) were more likely to indicate that they had decreased or eliminated services compared with those in the lowest quartile (increase < 15 percent) (51.4 percent). . Similarly, we noted statistically significant relationships between increases in PLI premiums and decrease in or elimination of services for rural physicians (66.2 percent vs. 48.1 percent) and for actual premiums for urban/suburban physicians (64.7 percent vs. 43.0 percent.)"
The authors conclude that the findings presented in the study "strongly suggest that physicians across Florida have continued to decrease or eliminate important health care services. This trend seems to be affecting a broad array of services and types of physicians, both generalists and specialists. Given the importance of access to health care for vulnerable populations, these statewide trends suggest the need for additional attention by physician leaders and policy-makers to the ongoing effects of the PLI market."