Malpractice liability, along with medical technology and payment system distortions, regularly figures among the most-cited reasons for escalating health-care spending in the United States. On the one hand, Harvard economist Amitabh Chandra conservatively estimates that upwards of $60 billion, or 3 percent of total health care costs ($1.8 trillion), is spent annually as a result of direct litigation and indi­rect defensive medicine costs. On the other hand, tort reform advocates place the figure at $200 billion by extrapolating, to the entire U.S. population, the results of research conducted by Stanford professor Dan Kessler and Mark McClellan. Their 1996 study shows that tort reforms reduced provider liability costs for Medicare heart patients by 5 to 9 percent.

At the heart of these debates is the following question. Does medical malpractice liability achieve its dual goal of compensating victims of medical injuries and deterring medical errors, or does it merely encourage wasteful defensive medicine without improving patient health? Despite considerable empiri­cal research, there is little evidence that malpractice litigation deters medical negligence. The evidence is much stronger—though still hotly debated—that malpractice fears actually encourage physicians to engage in defensive medicine.

The newest release in the Asia health Policy Program working paper series, AHPP working paper #13 by Brian Chen, explores whether malpractice pressures affect physician behavior, patient health, and health care costs in Asia. Studying physicians’ response to legal changes in Taiwan, he finds that greater malpractice liability may, under certain circumstances, prompt physicians to perform more services without necessarily improving patient health.

Dr. Chen investigates how physicians’ test-ordering behavior and propensity to perform cesarean sections were affected first by a series of court rulings in Taiwan that increased physicians’ liability risks, and then by a subsequent amendment to the law that reversed the courts’ rulings. He finds that physicians faced with higher malpractice pressure increased laboratory tests as expected but unexpectedly reduced cesarean sections. The reduction in cesarean deliveries may be due to the fact that liability risks were more closely aligned with physicians’ standard of care after the court rulings. After the law was amended to negate the court decisions, physicians reversed their previous behavior, reducing laboratory tests and increasing cesarean deliveries. This pattern of behavior strongly suggests that physicians in Taiwan practice defensive medicine.

Xueguang Zhou: Details about the school attacks remain to be sorted out — whether they are isolated or copycat acts; whether they are triggered by mental illness or based on some malicious motives. But one thing is clear: these incidents reflect widespread and rapidly rising social anxieties, frustrations and tensions in the Chinese society today.

The New York-based Korea Society and Stanford University's Walter H. Shorenstein Asia-Pacific Research Center launched the nonpartisan "New Beginnings" policy study group on January 10, 2008, to offer recommendations on how U.S. policymakers could expand and strengthen the alliance between the United States and the Republic of Korea (ROK, or South Korea). Composed of former senior U.S. government officials, scholars, and other American experts on U.S.-Korean relations, the New Beginnings project team premised its efforts on the belief that the inauguration of a new South Korean president in February 2008 and a new American president in January 2009 would provide a special opportunity for the two countries to increase mutual understanding and transform the alliance into a global partnership. In a coincidence occurring only once every twenty years, the two new presidents' terms of office would overlap for a full four years. Moreover, the alliance needed renewal and revitalization after years of strain and tension that arose from divergent worldviews of progressive governments in Seoul and a conservative administration in Washington.

Since its establishment, the New Beginnings policy study group has issued a report to the U.S. administration each year. New Beginnings' reports and recommendations reflect insights gained from group conferences as well as individual members' continuing engagement with U.S.-Korean affairs.