“Canada keeps malpractice cost in check”

Susan Taylor Martin in the St. Petersburg Times has some striking numbers:

For neurosurgeons in Miami, the annual cost of medical malpractice insurance is astronomical — $237,000, far more than the median price of a house.

In Toronto, a neurosurgeon pays about $29,200 for coverage. It’s even less in Montreal ($20,600) and Vancouver ($10,650).

Among the reasons why: in 1978 the Canadian Supreme Court imposed (on its own) nationwide limits on pain-and-suffering recoveries, adjusted for inflation and now just over $300,000. A single mutual insurer covers most doctors and takes an aggressive approach to defending claims. Most cases are tried before judges. Billboard and TV advertising by lawyers is much less prevalent in Canada. And so forth — all aside from the loser-pays principle.


  • I’m saving this one when I ask my lawyer friends if they like the Canadian System.

  • Of course, Florida, like Canada, already has non-economic damage caps, as well as limits on attorney’s fees, limits on punitive damages, limits on joint and several liability, and an exemption to the collateral source rule for medmal cases.

    They drank the tort reform kool-aid and got nothing for it, as premiums are still that high. Compounding the injustice, Florida permits doctors to be uninsured, which rewards irresponsible doctors and punishes blameless patients.

  • Max,

    What is your point? Unless you think that medical malpractice insurers are somehow knocking down 90% profit margins in Florida, neurosurgeons in Florida are committing ten times the malpractice of their Canadian peers or else the changes in Florida law that you refer to are minimal in their impact.

    My guess would be that the use of judges to try cases combined with the endless discovery process of American tort cases play much more of a role than loser pays in this difference, but this incredible spread clearly calls out for a serious study by individuals without an ax to grind in this matter.

  • You wrote, “this incredible spread clearly calls out for a serious study by individuals without an ax to grind in this matter.”

    That’s my “point.” As it pertains to all of the typical tort reform suggestions — caps, joint and several, fee limits, punitives, etc — there really isn’t much difference between Canada and Florida, yet the same neurosurgeon in Florida pays ~10x for worse coverage (note that the Canadians have largely unlimited coverage, whereas most American coverage stops around $1-1.5m).

    Why is that? I think one place to start is how Canadian follows the socialist principle of spreading risk as widely as possible, and uses a de facto single-payer system that all physicians join, with minimal disparity between the rates they pay.

    My “point” is that, despite endless promises from insurance companies, drastic tort reform in Florida brought almost no relief to physicians. I suggest that’s because the root cause of these fees is something other than noneconomic damages, or joint and several liability, or punitives, etc. You’re free to argue the opposite, in spite of the Canada/Florida data.

  • I have done plaintiff’s med-mal for almost 30 years and during the years that I raced got to race in Canada twice a year and got to know the then medical director of the Sports Car Club of Canada and discuss the differences in the tort systems and particularly verdict sizes between the two countries. The one thing many people miss when comparing the systems is the fact that medical and rehab special damages basically don’t exist in Canada because of the national healthcare system supplying the services. In America medical specials are the largest part of many verdicts. A catastrophically injured baby or paralyzed adult will have lifetime medical and rehab specials that are astronomical and frankly a jury has to decide whether that burden falls on the physician, if negligent, or burden the taxpayers.
    All the cap stuff and collateral source rule changes (and very few plaintiffs have collateral sources which amount to anything) are not really game changers as long as we have the healthcare reimbursement system we have now.

  • What do the malpractice premium numbers represent as a percentage of income in both places?

  • One big difference between Florida and Canada is that in Florida it is extremely hard to get a bogus suit thrown out so the issue is how much is it going to cost to get the bogus suit to go away. In Canada, the cases are dismissed. The other part of the tort reform in Florida was an interpetation of a issue that was put on the ballot by trial attorneys. This was loosely interpeted that if a physician had three malpractice “judgements” they would lose their liscence. So, what you ended up with is attornyes taking shotty cases and going to the physician and basically shaking them down by saying if you do not pay what we want you will have to take your chances with a jury. The long and short of it is that in Canada, weak cases get thrown out. In Florida, weak cases get settled.

  • According to the article there is no rating for doctor’s skills. That was said to result from the doctors accepting risks as members of a collective, but I suspect that some adjustments would exist if the adverse outcomes were related to anything measurable about doctors. The Canadian system seems to handle adverse outcomes rationally. If patients with adverse outcomes receive adequate care in Canada then the excess premiums in Florida are going into somebody’s gold plated toilet.

    It would be great if someone like Ted Frank wrote a paper reconciling the Canadian and Florida insurance rates.

  • Med Mal claims guy since 1985:

    Just reforms make sense- joint and several usually has the effect of the doc with coverage paying for the one that doesnt. Caps make sense since you are using money, an objective notion to compensate a subjective idea. You just cant weigh pain. The cap is only for this cause of action. The other causes of action can be measured and should be left alone. I like loser pays. If you need insurance to drive a car it should be required for a doc to have hospital priveleges. Makes sense and great for the hospital and vicarious exposure. Change the forum for medmal- this could save 30% of the total medmal cost. Skip the courts, the hollywood potential and arbitrate.
    How about looking up the definition of peer. Docs dont get them by any dictionary. Having skeeter deciding if my insured should have used a Whipple instead of a roux en y nissan fundoplication is not equal nor fair and does not make sense. Who is ok with this other than the plaintiff bar. An expert affidavit makes sense. How about the plaintiff getting more than 40% of the total cost of a case. Arbitration can do this. The arguments re constitutional rights is BS for the start. Start with the peer definition and this leads to an arbitration panel of physicians selected by each side. One expert apiece with x- exam. Maybe structure the result. Come on guys this is simple. The agendas of the plaintiff bar is the thumb in the way of the hammer. Do they look to make their clients whole or pursue lotto numbers at the expense of many.