Malpractice insurance costs increased over recent decades because of higher claim frequency, larger payouts, and legal expenses. Surgical and obstetric specialties often have the highest premiums, though variation is large by state and insurer. While tort reform remains contentious, clinical safety measures - standardized processes, error reduction, and better communication - can reduce adverse events and the conditions that generate claims, helping protect patients and lower liability exposure for clinicians.
What happened to malpractice insurance costs?
Over the past two decades many physicians have seen malpractice insurance premiums climb. Insurers point to higher claim frequency and larger payouts as the primary drivers. At the same time, high-profile jury awards and growing legal costs have influenced pricing and underwriting in the market.
Which doctors are most affected?
Surgical specialties and obstetrics have commonly faced the highest premiums because their practice carries a greater risk of serious, costly patient harm. However, premium levels vary widely by state, insurer, and individual claims history.
Why some people blame the legal system
Patients and trial lawyers say litigation is essential to hold providers accountable. Some physicians and insurers argue parts of the tort system allow weak or opportunistic claims that inflate insurer losses and premiums. The result has been sustained debate over policy changes such as caps on non-economic damages and limits on attorney fees.
Where tort reform has been enacted, insurers and policy advocates often point to stabilizing effects on premiums; opponents argue caps can restrict compensation for legitimately harmed patients. Specific effects depend on local law, court decisions, and insurer behavior. 1
Prevention and quality as an alternative strategy
Beyond legal reform, clinicians and health systems can reduce malpractice risk by improving care processes. Evidence from patient safety and quality-improvement programs shows that reducing errors, improving handoffs, and enhancing informed consent and communication lowers the likelihood of adverse events - and reduces the conditions that lead to claims. Hospitals that adopt standardized safety practices, checklists, and robust incident review systems can cut both harms and reputational risk. 2
Communication matters
Many claims stem from failed communication rather than clear-cut negligence. Prompt disclosure, apology where appropriate, and transparent follow-up can defuse patient anger and reduce litigation. Training clinicians in these skills is a low-cost, high-impact tool.
What this means for doctors and patients
Improving clinical processes and patient-centered communication does not remove legal accountability. But it can reduce preventable harm, protect patients, and help stabilize malpractice exposure and insurance costs for providers. Policymakers and health systems should pair targeted legal reforms with investments in quality improvement to balance patient rights with a sustainable liability environment. 3
- Confirm current specialty-level premium rankings and which specialties have the highest median malpractice premiums in 2024-2025.
- Verify the number of U.S. states with tort reform measures (e.g., caps on non-economic damages) and recent legislative changes through 2024-2025.
- Review recent systematic reviews or large studies that quantify the effect of patient safety/intervention programs and open disclosure on malpractice claim frequency and insurer payouts.