Adjusting Risk
By: Dr. Anthony J. Lombardi
Many pundits write extensively about risk of chiropractic treatments and specifically neck manipulation. All science aside I like to look to insurance companies who use actuarial sciences to determine risk and the price of insurance premiums based on that risk. For example in Ontario, Canada I pay about $1700 CDN per year for malpractice insurance and my neighbour who is an MD pays $8400 CDN.
My stance is that if neck manipulation or any realm of chiropractic was unsafe or controversial:
1. Why isn’t it being reflected in the price of our malpractice insurance?
2. If under-reporting of adverse effects is the culprit then can we not assume that under-reporting in the medical profession (or any other profession) happens just the same?
I asked these questions to longtime chiropractic critic Dr. Edzard Ernst. This was his response:
I PRESUME YOUR MD-NEIGHBOUR TREATS PATIENTS WITH DIFFERENT CONDITIONS AND SERIOUS DISEASES. THIS IS WHERE THINGS CAN GO WRONG MORE EASILY. THAT ALONE COULD EXPLAIN THE DIFFERENCE. BUT THERE ARE MANY OTHER FACTORS AS WELL. THE INSURANCE PREMIUM CAN BE AN INTERESTING RESEARCH SUBJECT, BUT THE DATA YOU JUST MENTIONED DOES PROVE ABSOLUTELY NOTHING.
However, one could make the argument that DC’s who treat MSK issues also regularly see people with many other co-morbitities – some that they are never even told about. And under-reporting can happen in any profession at anytime – conversely, there are many cases of over-reporting which occur each year in the form of frivolous claims across all professions.
Influences Behind Premiums
In fact, I researched why chiropractic malpractice insurance premiums are among the lowest in healthcare.
There are 3 things that influence the cost of health care premiums:
1. The average size of malpractice payment awarded.
2. The performance of the stock market.
3. Laws in place which limit malpractice awards.
The factors 2 and 3 are self explanatory and are independent of health professions altogether. If the stock market performs poorly then the invested malpractice insurance premiums likely did not perform well – this makes an increase at some point to be likely in order for insurance companies to recoup the losses. Lastly, laws in place which limit awards will keep insurance premiums down. This allows insurance companies to limit the amount of payout monies – so they can conserve their funds and budget their expenditures.
The first factor however, is the most influencial and the most dependent on the type of health profession.
Size of award is determined by this:
>The award the > the damages >the damages the > the premiums.
The greater the malpractice award- greater the damages to the patient. The greater the damages – the higher the premiums.
NPDB
The National Practitioner Data Bank (NPDB) is a government run data bank which contains information on medical malpractice payments related to health care practitioners, entities, providers, and suppliers. Federal law specifies the types of actions reported to the NPDB and who submits the reports.
President Ronald Reagan passed a law through Congress in 1986 which makes it obligatory for medical malpractice payers (malpractice insurance companies) to report to the NPDB when they make a payment for the benefit of a health care practitioner resulting from a written claim or judgment.
According to the NPDB, from 2004-2014 chiropractors had 2,051 malpractice claims paid and during that time the amount of the average number of chiropractors in the US was 61,000. In that same time period there were an average of 800,000 practicing MD physicians in the US and malpractice insurance companies paid out 111,756 malpractice claims. The percentage of malpractice claims and the percentage of occurances was significantly higher in the MD cohort (13.69%) vs the DC cohort (3.36%). Further, the NPDB lists the highest 25 malpractice insurance premiums among health professionals in the US – chiropractic did not make the list.
So, regardless of what the different research may or may not say – we can use actuarial sciences to explain why chiropractors pay significantly less malpractice insurance premiums. This is because patients make considerably less claims against chiropractors than other practitioners. And secondly, when adverse reactions to treatment happens, the damages chiropractors cause appear to be dramatically less than their MD counterparts.
Whether you are paying car insurance, health insurance, home insurance, or malpractice insurance; the concept remains the same. The greater the risk, the greater the cost – and the greater the (malpractice) reward.
Please forward your questions to exstore@usa.com
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