Correlation Between Malpractice Litigation and Legislation Reform in Taiwan Over a 30-Year Period

Hsieh, Ming-Ta; Lu, Li-Hui; Lin, Chi-Wei; Chen, Yun-Wen

BACKGROUND: The annual medical litigation rate has increased yearly since 1987 in Taiwan. Policy makers keep going medical legislation reforms. The effectiveness of legislation reforms to reduce malpractice litigation risk is uncertain. OBJECTIVE: To determine whether medical legislation reform helps reduce the risk of medical litigation. DESIGN, SETTING, AND PARTICIPANTS: This retrospective study used national data obtained from Ministry of Health and Welfare in Taiwan. The period analyzed was from 1987 to 2018. The annual medical litigation rate was determined, types of medical negligence litigation were compared, medical appraisal results were summarized, and the importance of medical legislation was identified. INTERVENTIONS: After legislation reform vs before legislation reform. MEASUREMENTS: The main outcome showed trends in medical dispute assessments over time by adjusting for the general population (per 1, 000, 000 people). We established 2004 and 2012 as the 2 cut-points for further analysis of medical appraisal results due to legislation reform. RESULTS: With legislation reforms, the annual medical litigation rate decreased from 26.68 cases per million people in 2012 to 16.41 cases per million people in 2018. The annual medical litigation rate declined by approximately 38% from 2012 to 2018. Medical appraisal results were malpractice cases in 22.1% before Medical Care Act (2004 Reform) compared with 18.8% from 2004 to 2012 (odds ratio [OR], 0.82; 95% CI, 0.727–0.924; p=0.001), and 6.4% after mediation system introduced in 2012 (odds ratio [OR], 0.243; 95% CI, 0.205–0.288; p<0.001). CONCLUSION: Medical legislation reform has reduced the risk of malpractice litigation over time.