The average payments in medical malpractice disputes cases jumped 52% between 1991 and 2003, according to a recently released study.

Malpractice payments to patients grew an average of 4% a year during the same period, according to researchers from Dartmouth College, The Johns Hopkins University, and the RAND Corp.

The study revealed that 96% of medical malpractice cases are settled before going to trial. The average payment for a malpractice case — including court judgments and cases settled out of court — jumped from about $173,000 in 1991 to about $261,000 in 2003, according to “The Growth of Physician Medical Malpractice Payments: Evidence from the National Practitioner Data Bank.”

The average payment for the highest 10% of all payments increased from about $868,000 in 1991 to about $1.16 million in 2003. Court judgments were between 1.7 and 2.4 times as large as out-of-court settlements, according to the study published online Tuesday by the journal Health Affairs.