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Articles by Donald E. L. Johnson

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Today is Friday, October 28, 2016

What does defensive medicine cost? It depends on your agenda

Democrats who depend on malpractice lawyers for huge campaign contributions do everything they can to down play the cost of defensive medicine. Republicans who don’t get money from trial lawyers do everything they can to show that the threats of malpractice suits cause physicians to increase the cost of health care by 30% to 50% by practicing defensive medicine. When physicians practice defensive medicine, they order more tests and procedures and drugs than they should in an effort to reduce their risks of being sued. Trial lawyers win. Medical supply companies and medical device companies win. Physicians and hospitals win. Patients and taxpayers lose.

A new Gallup poll of physician finds that 25% of procedures ordered by physicians are unnecessary. Jackson Healthcare uses that number to estimate that $650 billion of the $2.5 trillion spent on health services is spent on unnecessary tests and treatments. Click on the hed of this story to see links to several relevant articles.

The American Tort Reform Assn

Tangible and Unseen Health-Care Costs; Spending by Doctors Extends Beyond Insurance as Many Take Steps to Protect Themselves; Patients’ Wishes Push Up Bills, Too. By DIONNE SEARCEY and JACOB GOLDSTEIN.

Impact graphs from

Calculating how much defensive medicine actually costs is extremely difficult, because medical professionals often have many motivations for ordering tests and other procedures. The U.S. spends a higher percentage of its gross domestic product on health care than any other nation in the industrialized world. Legal expenses contribute to the bill.

Even so, health-care experts say the direct costs of medical malpractice—the insurance premiums, claims paid and legal fees—amount to a very small portion of overall health-care spending.

Total spending on medical malpractice, including legal-defense costs and claims payments, was $30.41 billion in 2007, according to an estimate from consulting firm Towers Perrin. That is a significant figure, but it still amounts to a little more than 1% of total U.S. health-care spending, which the federal government estimates at $2.241 trillion for 2007.

Indirect costs that stem in part from medical professionals looking for legal protection play a far larger role in health-care spending, doctors and some analysts say. And they are one reason medical liability is bubbling as an issue as Congress reviews whether to pass a health-care overhaul. Sen. John Kerry, a Democrat, and Sen. Orrin Hatch, a Republican, both said earlier this week that Congress needs to find a way to eliminate frivolous malpractice cases.

“There are significant savings that can be achieved in our health-care systems if we have prudent medical malpractice reform in place,” said Sen. Hatch in a statement.

Art Ushijima, president and chief executive of the Queen’s Medical Center, based in Honolulu, says legal concerns have become a bigger burden. He recalls that when he first came to the hospital—Hawaii’s largest—about 20 years ago, there was one staff attorney. Now there are six. Salaries for staff, with the costs to support them, are “well into the seven figures,” he says.

At the University of Miami School of Medicine’s patient practice, 14 cents out of every dollar collected in fees for services to patients goes toward buying medical malpractice insurance, says William Donelan, the university’s vice president for medical administration. That figure doesn’t include costs of defensive medicine, which are difficult to quantify, he says. “Our system is really irrational and out of control,” he says.

Study shows defensive medicine widespread. By Kristina Goodnough.

Impact graphs from U. of Connecticut study:

The study is based on a survey – believed to be the first of its kind – that was completed by more than 900 physicians in Massachusetts. It asked about their use of seven tests and procedures: plain film X-rays, CT scans, magnetic resonance imaging, ultrasounds, laboratory testing, specialty referrals and consultations, and hospital admissions.

About 83 percent reported practicing defensive medicine, with an average of between 18 percent and 28 percent of tests, procedures, referrals, and consultations and 13 percent of hospitalizations ordered for defensive reasons.

Such practices were estimated to cost a minimum of $1.4 billion per year in Massachusetts.

The study, “Investigation of Defensive Medicine in Massachusetts,” is the first to specifically quantify defensive practices across a wide spectrum and among a number of specialties.

It also is the first to link defensive practices across a number of medical specialties – anesthesiology, emergency medicine, family medicine, internal medicine, general surgery, neurosurgery, orthopedics, and obstetrics/gynecology – directly with Medicare cost data.

Poll: One of Four Healthcare Dollars Spent on Unnecessary Medical Care

Impact graphs from FierceHealthcare:

February 23, 2010. WASHINGTON (February 22, 2010) - One in four dollars spent on health care in America now pays for unnecessary tests and treatments that physicians order to keep from being sued, according to a new Gallup poll of the nation’s doctors released today by Jackson Healthcare and the Center for Health Transformation.

The poll, conducted by the Gallup organization for Jackson Healthcare, showed that of physicians surveyed nationwide, 73 percent said they practiced some form of “defensive medicine” in the past 12 months to protect themselves from frivolous lawsuits. . .Based on Gallup’s survey, Jackson Healthcare officials estimate that $650 billion of the $2.5 trillion spent on healthcare annually is spent on unnecessary tests and treatments.

Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment

David M. Studdert, LLB, ScD, MPH; Michelle M. Mello, JD, PhD, MPhil; William M. Sage, MD, JD; Catherine M. DesRoches, DrPH; Jordon Peugh, MA; Kinga Zapert, PhD; Troyen A. Brennan, MD, JD, MPH

JAMA. 2005;293:2609-2617.


Context How often physicians alter their clinical behavior because of the threat of malpractice liability, termed defensive medicine, and the consequences of those changes, are central questions in the ongoing medical malpractice reform debate.

Objective To study the prevalence and characteristics of defensive medicine among physicians practicing in high-liability specialties during a period of substantial instability in the malpractice environment.

Design, Setting, and Participants Mail survey of physicians in 6 specialties at high risk of litigation (emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) in Pennsylvania in May 2003.

Main Outcome Measures Number of physicians in each specialty reporting defensive medicine or changes in scope of practice and characteristics of defensive medicine (assurance and avoidance behavior).

Results A total of 824 physicians (65%) completed the survey. Nearly all (93%) reported practicing defensive medicine. “Assurance behavior” such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%). Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. Avoidance of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents’ lack of confidence in their liability insurance and perceived burden of insurance premiums.

Conclusion Defensive medicine is highly prevalent among physicians in Pennsylvania who pay the most for liability insurance, with potentially serious implications for cost, access, and both technical and interpersonal quality of care.


Posted by Donald E. L. Johnson on 02/28/10 at 01:23 PM
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