Journal of General Internal Medicine

, Volume 25, Issue 5, pp 470–473 | Cite as

Defensive Medicine, Cost Containment, and Reform

Perspectives

Abstract

The role of defensive medicine in driving up health care costs is hotly contended. Physicians and health policy experts in particular tend to have sharply divergent views on the subject. Physicians argue that defensive medicine is a significant driver of health care cost inflation. Policy analysts, on the other hand, observe that malpractice reform, by itself, will probably not do much to reduce costs. We argue that both answers are incomplete. Ultimately, malpractice reform is a necessary but insufficient component of medical cost containment. The evidence suggests that defensive medicine accounts for a small but non-negligible fraction of health care costs. Yet the traditional medical malpractice reforms that many physicians desire will not assuage the various pressures that lead providers to overprescribe and overtreat. These reforms may, nevertheless, be necessary to persuade physicians to accept necessary changes in their practice patterns as part of the larger changes to the health care payment and delivery systems that cost containment requires.

KEY WORDS

defensive medicine medical malpractice health care costs health care reform 

Notes

Conflict of Interest

None disclosed.

References

  1. 1.
    Morrisey MA, Kilgore ML, Nelson L. Medical malpractice reform and employer-sponsored health insurance premiums. Health Serv Res. 2008;43(6):2124–42.CrossRefPubMedGoogle Scholar
  2. 2.
    Congressional Budget Office. Medical malpractice tort limits and health care spending. April 2006. Available at http://www.cbo.gov/doc.cfm?index=7174. Accessed January 11, 2010.
  3. 3.
    Jost TS. Health care reform requires law reform. Health Aff. 2009;28(5):w761–9.CrossRefGoogle Scholar
  4. 4.
    McQuade JS. The medical malpractice crisis—reflections on the alleged causes and proposed cures: discussion paper. J R Soc Med. 1991;84:408–11.PubMedGoogle Scholar
  5. 5.
    U.S. Congress, Office of Technology Assessment. Defensive medicine and medical malpractice. Available at http://biotech.law.lsu.edu/policy/9405.pdf. Accessed January 11, 2010; 1994.
  6. 6.
    Passmore K, Leung W-C. Defensive practice among psychiatrists: a questionnaire survey. Postgrad Med J. 2002;78:671–3.CrossRefPubMedGoogle Scholar
  7. 7.
    Summerton N. Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. BMJ. 1995;310:27–9.PubMedGoogle Scholar
  8. 8.
    Chawla A, Gunderman RB. Defensive medicine: prevalence, implications, and recommendations. Acad Radiol. 2008;15:948–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Grepperud S. Medical errors: responsibility and informal penalties. Harvard Health Pol Rev. 2004;5(1):89–95.Google Scholar
  10. 10.
    Dubay L, Kaestner R, Waidmann T. The impact of malpractice fears on cesarean section rates. J Health Econ. 1999;18:491–522.CrossRefPubMedGoogle Scholar
  11. 11.
    Studdert DM, Mello MM, Sage WM, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293(21):2609–17.CrossRefPubMedGoogle Scholar
  12. 12.
    Sloan FA, Shadle JH. Is there empirical evidence for “defensive medicine”? A reassessment. J Health Econ. 2009;28:481–91.CrossRefPubMedGoogle Scholar
  13. 13.
    Massachusetts Medical Society. Investigation of defensive medicine in Massachusetts. Available at: http://www.massmed.org/AM/Template.cfm?Section=News_and_Publications2&CONTENTID=27797&TEMPLATE=/CM/ContentDisplay.cfm. Accessed January 11, 2010; 2008.
  14. 14.
    American Medical Association. Policy H-435.968: enterprise liability; 2009.Google Scholar
  15. 15.
    American Medical Association. Policy H-395.995: expenditure targets for medicare; 2009.Google Scholar
  16. 16.
    Ravich L. Letter to the New York Times. July 7, 2009. Available at http://www.nytimes.com/2009/07/12/opinion/l12health.html?scp=2&sq=ravich&st=cse. Accessed January 11, 2010.
  17. 17.
    Wilson CB. Letter to the Hartford Courant. July 15, 2009. Available at http://www.ama-assn.org/ama/pub/news/letters-editor/hartford-courant-defensive-medicin.shtml. Accessed January 11, 2010.
  18. 18.
    Rohack JJ. Letter to the Washington Post. July 19, 2009. Available at http://www.ama-assn.org/ama/pub/news/letters-editor/washington-post-medical-liability.shtml. Accessed January 11, 2010.
  19. 19.
    Baker T. The medical malpractice myth. Chicago: Univ. of Chicago Press; 2005:45–63.Google Scholar
  20. 20.
    Black BS, Silver C, Hyman DA, Sage WM. Stability not crisis: medical malpractice claim outcomes in Texas: 1988-2002. J Emp L Studies. 2005;2:207–59.CrossRefGoogle Scholar
  21. 21.
    General Accounting Office. Medical malpractice: implications of rising premiums on access to health care. Available at http://www.gao.gov/new.items/d03836.pdf.Accessed January 11, 2010; 2003.
  22. 22.
    Gingrich N, Oliver W. Selling out doctors to pay off trial lawyers. Politico. Available at http://www.politico.com/news/stories/0909/26707.html. Accessed January 11, 2010; 2009.
  23. 23.
    Pacific Research Institute. Sally Pipes on health care. Available at http://liberty.pacificresearch.org/press/sally-pipes-on-health-care. Accessed January 11, 2010.
  24. 24.
    PriceWaterhouseCoopers. The factors fueling rising healthcare costs 2006. Available at http://www.ahip.org/redirect/PwCCostOfHC2006.pdf. Accessed January 11, 2010; 2006.
  25. 25.
    Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. Addressing the new health care crisis. Available at http://aspe.hhs.gov/daltcp/reports/medliab.pdf. Accessed January 11, 2010; 2003.
  26. 26.
    Kessler D, McClellan M. Do doctors practice defensive medicine? Q J Econ. 1996;111:353–90.CrossRefGoogle Scholar
  27. 27.
    Kessler D, McClellan M. Malpractice law and health care reform: optimal liability policy in an era of managed care. J Pub Econ. 2002;84:175–97.CrossRefGoogle Scholar
  28. 28.
    Avraham R, Dafny LS, Schanzenbach MM. The impact of tort reform on employer-sponsored health insurance premiums. Northwestern Univ. Working Paper. Available at http://www.kellogg.northwestern.edu/∼/media/Files/Faculty/Research/ArticlesBookChaptersWorkingPapers/The%20Impact%20of%20Tort%20Reform%20on%20Employer-Sponsored%20Health%20Insurance%20Premiums.ashx. Accessed January 11, 2010; 2009.
  29. 29.
    Congressional Budget Office. Letter from Douglas W. Elmendorf, Director, to Rep. Bruce L. Braley. December 29, 2009. Available at http://www.cbo.gov/ftpdocs/108xx/doc10872/12-29-Tort_Reform-Braley.pdf. Accessed on January 11, 2010.
  30. 30.
    Orszag PR. Opportunities to increase efficiency in health care: statement at the Health Reform Summit of the Committee on Finance, United States Senate, June 16, 2008. Washington, DC: Congressional Budget Office; 2008.Google Scholar
  31. 31.
    Towers Perrin. 2008 Update on U.S. Tort Cost Trends. Available at http://www.towersperrin.com/tp/getwebcachedoc?webc=USA/2008/200811/2008_tort_costs_trends.pdf. Accessed on January 11, 2010; 2008.
  32. 32.
    Chandra A, Shantanu N, Seabury SA. The growth of physician medical malpractice payments: evidence from the National Practitioner Data Bank. Health Affairs Web Exclusive. May 31, 2005.Google Scholar
  33. 33.
    Leonhardt D. A system breeding more waste. New York Times. September 23, 2009.Google Scholar
  34. 34.
    Eisenbrey R. Tort costs and the economy: Myths, exaggerations, and propaganda. Economic Policy Institute. November 20, 2006. Available at http://www.epi.org/publications/entry/bp174/. Accessed January 11, 2010.
  35. 35.
    Siegel R. Examining numbers in Bradley op-ed. National Public Radio. August 31, 2009.Google Scholar
  36. 36.
    Aaron HJ, Ginsburg PB. Is health care spending excessive? If so, what can we do about it? Health Affairs. 2009;28(5):1260–75.CrossRefPubMedGoogle Scholar
  37. 37.
    Gawande A. The cost conundrum. New Yorker. June 1, 2009. Available at http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande. Accessed January 11, 2010.
  38. 38.
    Charles SC, Wilbert JR, Franke KJ. Sued and nonsued physicians’ self reported reactions to malpractice litigation. Am J Psychiatry. 1985;142:437–40.PubMedGoogle Scholar
  39. 39.
    Martin CA, Wilson JF, Fiebelman ND, Gurley DN, Miller TW. Physicians’ psychologic reactions to malpractice litigation. South Med J. 1991;84:1300–4.PubMedGoogle Scholar
  40. 40.
    Localio AR, Lawthers AG, Brennan TA, et al. Relation between malpractice claims and adverse events due to negligence: results of the Harvard Medical Practice Study III. N Engl J Med. 1991;325:245–51.PubMedCrossRefGoogle Scholar
  41. 41.
    Studdert DM, Brennan, TA, Thomas EJ. Beyond dead reckoning: measures of medical injury burden, malpractice litigation, and alternative compensation models from Utah and Colorado. In L Rev 2000;33(4):1643-86.Google Scholar
  42. 42.
    Studdert DM, Mello MM, Gawande A, et al. Claims, errors, and compensation payments in medical malpractice litigation. N Eng J Med. 2006;354(19):2024–33.CrossRefGoogle Scholar
  43. 43.
    Kohn KT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999.Google Scholar
  44. 44.
    Leape LL, Berwick DM. Five years after To Err Is Human: what have we learned? JAMA. 2005;293(19):2384–90.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  1. 1.Institute for the Medical HumanitiesUniversity of Texas Medical BranchGalvestonUSA
  2. 2.Institute for the Medical Humanities, and Family Medicine, John P. McGovern Centennial ChairUniversity of Texas Medical BranchGalvestonUSA

Personalised recommendations