Professional lability insurance: I. A historical perspective.

Medical professional liability insurance (also known as malpractice insurance) is designed specifically to protect physicians, clinics, hospitals and health care facilities, and other health personnel in the event that a patient files a claim against them, alleging negligence, with resulting injury or harm. It is one of the largest expenses for any medical practice and is a high priority concern of every physician. The market for this insurance, the approach to evaluating it, and the cost of it have changed dramatically in the last 20 years.

Roots of the NCMIC: Loran M. Rogers and the National Chiropractic Association, 1930-1946.

Today's National Chiropractic Mutual Insurance Company (NCMIC) evolved from the legal protective services offered initially by the Universal Chiropractors' Association, and subsequently, by the National Chiropractic Association (NCA). At first these services focused on the criminal defence of chiropractors charged with unlicensed practice. However, as an increasing number of jurisdictions enacted chiropractic statutes, the NCA's legal program became ever more involved in civil litigation: suits for malpractice and negligence. Steering the NCA throughout its tumultuous voyage was its longtime secretary-treasurer, Loran M. Rogers, D.C. When the NCA spun off its legal services division in 1946, forming the National Chiropractic Insurance Company (predecessor of the NCMIC), Rogers continued his work as executive secretary-treasurer of the malpractice insurer.

MIIX reinvents itself, again.

The Medical Inter-Insurance Exchange (MIIX) converted from a reciprocal exchange to a stock company, on August 4, 1999. At the same time, MIIX completed an initial public offering of stock and is now listed on the New York Stock Exchange as The MIIX Group, Inc., under the symbol "MHU." In order to understand the necessity and process of this transformation, a review of the history and operation of MIIX is helpful.

A brief history of health care quality assessment and improvement in the United States.

We review the history and current efforts to assess and improve health care in the United States. This process has involved a host of government agencies and commissions, professional organizations, insurance underwriters, corporations, and more recently, market forces. Traditional approaches to quality control have stressed case-by-case analysis and identifying outliers. Newer approaches include creating practice guidelines and profiles of hospitals and physicians. The joint goals of quality improvement and cost control can best be realized if institutions and practitioners embrace these new approaches and use them to enhance their performances.

The medical liability insurance crisis: how it began.

Economic pressures, awareness that physicians can be sued, improved medical care, and increased patient expectations have led to the skyrocketing liability insurance costs physicians face today. In the early days when the doctor could offer hope but little medicine, patients were not inclined to sue for medical "failures." But with the Great Depression, World War II, more recent medical advances changed the patient-physician relationship. Patients had gained the expertise of specialists, but often lost the personal relationship they once shared with their primary physician. Thus, when treatments were unsuccessful, the patient often-times blamed the physician. Insurance premiums (and patient costs) increased, while patients became even more aware that physicians were covered by insurance. This article reviews key economic, medical, and social events that led to the present medical liability insurance crisis.