A review of the global feasibility of medical malpractice insurance: Legal frameworks, economic viability, implementation challenges, and impact on patient safety

Medical malpractice insurance (MMI) is a critical determinant of healthcare quality, health partitioners' behavior, and health system sustainability in many countries. Despite decades of global efforts to reform MMI, evidence of the structure, awareness, implementation, and the impact of its framework remains fragmented. The aim of this review was to synthesize the global literature to map current evidence on the MMI legal framework, its economic viability, barriers to its implementation, and the implications for healthcare delivery and patient safety. A narrative review, informed by a systematic search, was conducted according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) 2020 guidelines. Fourteen studies published between 2004 and 2022 were identified from multiple countries, including the United States, Spain, Switzerland, Georgia, Nigeria, and Turkey. Eligible studies included published reviews, empirical studies, and modeling studies related to MMI and its framework. Data were extracted on study characteristics, legal contexts, economic viability assessment, implementation challenges, and patient safety implications. The included studies address a broad range of malpractice-related issues. The evidence revealed substantial variability in how countries regulate and implement MMI, with notable gaps in practitioner knowledge, legal coherence, and affordability. A lack of awareness of health practitioners, regulatory fragmentation, and economically regressive insurance models continue to shape health practitioners' behavior that could indirectly affect safety and access. The literature lacks robust empirical evaluations that quantify how specific liability reforms translate into improved patient-level outcomes. Future research can prioritize comparative analysis to evaluate policy reforms to create balanced protection for both health practitioners and patients.