Theoretically, the malpractice system is supposed to penalize substandard care. However, if the majority of claims brought against providers are filed for care that is not negligent, then the credibility of this system may be reduced. To address this issue, the Harvard Medical Practice Study examined the relationship between malpractice claims and true adverse events in patient care. The investigators linked clinical reviews of more than 30,000 inpatient records with statewide records of malpractice claims to determine the frequency with which negligent and nonnegligent medical care, as evaluated by physician reviewers, led to malpractice claims. They found that 1.53% of patients who had adverse events filed malpractice claims. The ratio of adverse events caused by negligence to malpractice claims was 7.6:1. The authors conclude that the malpractice system infrequently compensates patients injured by medical negligence and rarely holds providers accountable for substandard care.