DO THE POOR SUE MORE - A CASE-CONTROL STUDY OF MALPRACTICE CLAIMS ANDSOCIOECONOMIC-STATUS

Objective.-To evaluate whether socioeconomic status is associated with risk of malpractice claims, particularly among those who have suffere d medical injury. Design.-Case-control study. Setting.-Fifty-one hospi tals in New York State. Methods.-The presence and severity of medical injury, defined as disability at the time of discharge or prolongation of the hospitalization caused by medical treatment as opposed to the disease process, were assessed through review of approximately 31 000 hospital records in New York in 1984. These sampled records were then linked to formal malpractice claims. To estimate the risk of malpracti ce claims by age, gender, race, insurance status, and income, we condu cted a case-control study of claimant cases matched with nonclaimant c ontrols. The cases were all those patients who filed malpractice claim s referring to alleged malpractice during a sampled hospitalization. P hysician reviewers had previously judged the level of disability that resulted from the medical injury. Claimants (n=51) were each matched w ith five nonclaimant controls on the basis of injury. Noninjured cases were matched with noninjured controls and injured cases were matched with injured controls. Results.-We found that poor patients (odds rati o [OR], 0.2; 95% confidence interval [CI], 0.03 to 0.8) and uninsured patients (OR, 0.1; 95% CI, 0.005 to 0.9) were significantly less likel y to file malpractice claims, after controlling for the severity of me dical injury. Among patients who suffered medical injury, the elderly (OR, 0.2; 95% CI, 0.03. to 0.9) were also less likely to file claims. Gender and race were not independently associated with risk of malprac tice claims. Conclusions.-Poor and uninsured patients are significantl y less likely to sue for malpractice, even after controlling for the p resence of medical injury. Fear of malpractice risk should not be a si gnificant factor in the decision to serve the poor. Tort reforms that would protect physicians who serve the medically indigent from malprac tice suits may not be warranted.