Abstract
Introduction. Professional liability insurance is a main regulatory instrument used to ensure financial compensation for patients and protect physicians from the economic consequences of medical errors. However, beside its financial and legislative aspects, malpractice cases and liability exposure are significant psychological stress factors for the medical professionals. Previous literature on the question have provided an evidence of increased levels of emotional exhaustion, anxiety, depressive symptoms, and defensive medical practices. Physicians frequently report persistent psychological distress during and after legal proceedings, even when financial damages are covered by insurance. Studies conducted in the United States, Europe, Asia, and Australia demonstrate that litigation-related stress may alter clinical decision-making, reduce job satisfaction, and contribute to workforce attrition. In healthcare systems with compulsory professional liability insurance, financial protection may decrease the economic insecurity. Even so, the psychological burden caused by the legal scrutiny, reputational risk, and institutional investigation often remains significant. In transitional health systems, including countries of Central Asia, insufficient clarity of legal standards and the risk of criminal prosecution may intensify professional stress and feelings of vulnerability. This review aims to provide a synthesis of international literature from 2015 to 2025 on the relationship between professional liability insurance, the risks of malpractice, burnout among physicians, defensive medicine, and the stability of the workforce. Special emphasis is made on the comparison between the experiences of different countries regarding the mandatory and voluntary nature of insurance and its possible implications for mental well-being. The findings suggest that although insurance offers structural economic solutions, it does not necessarily reduce the mental pressure of malpractice risks. It is necessary to integrate various strategies to reduce the mental pressure of litigation risks among healthcare professionals. It is also necessary to assess the recent insurance system reforms in Kazakhstan from the perspective of international literature and conduct more studies on the long-term impact of the reforms on the mental safety of physicians. Keywords: professional liability insurance, medical malpractice, physicians, burnout, professional, stress, psychological, mental health, health policy, occupational stress.