Thesis (Ph.D.)--Boston UniversityThe number of medical malpractice claims has been increasing in recent years. However, because of the sensitiveness of information and no malpractice insurance coverage, no objective claims-based data has been released in Taiwan to estimate malpractice risk and its economic burden. In a university hospital of Taiwan, after forming a working group for solving malpractice claims in the past 6 years (2005-2010), we have collected 445 cases and examined the clinical, administrative, economic and legal information for these cases. First, after applying the Theory of Planned Behavior as our conceptual framework, we have performed several risk-adjustment models of associated factors on the odds of having legal action. Our main results are that the number of meetings between doctor and patient (OR= 2.478, p less than O.OOO1), along with other factors are significantly associated with the incidence of a malpractice claim developing into a legal action (c-statistics= 0.838). Second, using the amount of compensation as the outcome variable in all settled claims, we have constructed two-part models to describe the relationship between risk factors and outcome. The two-part models contain a logistic regression model as the first part to predict the frequency of paid claims (4.2 times more odds of having paid claims with every meeting between doctor and patient, OR= 4.235, p<0.001; c-statistics= 0.918) and an ordinary linear regression model as the second part to predict the amounts of these payments (every meeting between doctors and patient increasing the payment at 0.18 million NTD [R-square= 0.5521]). Our third study estimates nationwide malpractice costs for Taiwan based on our database, given limitations of extrapolating from a single hospital. We find that the estimated annual cost of medical malpractice for all of Taiwan's doctors is NTD 239.6 million (7.99 million USD) with a range from NTD 168.6 million to 404.3 million (5.62 million to 13.4 million USD). Such a low estimate may be caused by low lawsuit costs (42.7 million NTD, 1.42 million USD) and lower paid claims ratio for settled claims (21%). The results of the legal-economic analysis will contribute to forming a rational basis for policy debate for current malpractice reform in Taiwan
