The European countries, Canada, and the United Kingdom allow only limited contingent fees. They have little medical malpractice litigation as compared with the United States, and little personal injury litigation of any type. It is assumed that the limitation on contingent fees is responsible for the dearth of litigation. This underlies the call by many physicians and others to limit or abolish contingent fees in the United States. Although it is true that contingent fees are necessary to ensure that most individual plaintiffs have access to the courts, the important question is why other counties have not adopted contingent fees. The answer is that there is a quid pro quo for this lawsuit- free climate.

In the medical context, other developed countries are less dependent on litigation because their citizens have some level of guaranteed access to medical care and rehabilitation services. In the United Kingdom, for example, the National Health Service provides medical services without regard to the cause of the injuries or the patient’s personal financial status. Other social welfare agencies help with disability relief. Therefore, there is no need for patients to sue to force negligent third parties to pay for the cost of their injuries. The disciplining of physicians is separate from compensating the plaintiff. A physician found to be incompetent is struck off the register rather than incurring a large litigation loss that will ultimately be paid by the other physicians in the same insurance pool.

In the United States, patients are responsible for their own medical bills and rehabilitation services. Many persons have medical insurance through their employers, but a substantial number do not. Moreover, this employment-based insurance is lost if the patient’s injuries interfere with his or her ability to do the job. Politically, it is easier to leave compensation to an entrepreneurial law system rather than to address the problems of an incomplete medical care delivery system.