Medical errors remain a leading cause of harm in healthcare, yet the effectiveness of malpractice insurance structures—specifically experience-rating, where premiums adjust based on a provider's claim history—in reducing these errors is unclear. If experience-rating does not meaningfully improve safety, it could represent a misallocation of resources or even unintended consequences. Conversely, if it works, refining its use could save lives. This calls for a systematic investigation into how insurance models impact medical errors.

How the Investigation Could Work

The core approach would involve analyzing the connection between malpractice insurance structures and error rates through:

• Data collection: Gathering regional or institutional data on insurance pricing models and medical errors, supplemented by case studies of policy changes.
• Causal analysis: Employing statistical methods (e.g., difference-in-differences) to isolate the effect of experience-rating while accounting for factors like hospital size or patient demographics.
• Stakeholder engagement: Partnering with insurers or providers to access proprietary data, framing the study as mutually beneficial for cost reduction and quality improvement.

Key beneficiaries include providers (lower premiums), insurers (fewer payouts), and patients (safer care), though incentives may conflict—e.g., providers might resist transparency that exposes weaknesses.

Potential Execution and Challenges

A minimal viable product could start with publicly available data (e.g., state malpractice records or National Practitioner Data Bank claims), later expanding to partnerships for deeper insights. Challenges like data accuracy or stakeholder reluctance could be addressed by:

• Validating error reports against multiple sources (claims, audits).
• Offering anonymized analyses to incentivize participation.

Unlike existing efforts like the Leapfrog Group’s safety ratings—which don’t examine insurance designs—this would directly link experience-rating to outcomes, filling a critical gap.

By clarifying whether insurance models drive safety improvements, this research could inform policies that better align financial incentives with patient well-being.