The Truth About Defensive Medicine

Defensive medicine is the idea that a doctor will preform the unnecessary test or medical procedures in order to avoid being sued in a medical negligence claim. While people who favor tort reforms say defensive medicine drives up the cost of health care, government researchers question whether defensive medicine actually exists. In fact the congressional budget office has called the evidence of defensive medicine " not conclusive" and has indicated that, "on the basis of existing studies and its own research, CBO believes that savings from reducing defensive medicine would be very small." College research echos the same the same sentiment. Researchers at Dartmouth College said "the fact that we see very little evidence of wide spread physician exodus or dramatic increases in the use of defensive medicine in response to increases in state malpractice premiums places the more dire predictions of malpractice alarm in doubt." The government accountability office (GAO) has put out similar statements questioning whether defensive medicine occurs saying, " The overall prevalence and cost of [defensive medicine] have not been reliably measured." And " study results can not be generalized to estimate the extended cost of defensive medicine practices across the healthcare system." The GAO also reported " officials from AMA [American Medical Association] and several medical hospital and nursing home associations told us that defensive medicine exists to some degree, but that it is difficult to measure"

 

Is it defensive medicine or defending the pocketbook?

 

To the extent that defensive medicine does exist the research that has been done has shown that the true motivation behind it is not liability but rather a desire to simply help a patient or in some cases boost physician income. One government agency found that doctors chose not to order tests or diagnostic procedures 95% of the time. When doctors do order tests, those who do almost always do so because of medical indications. But only one half of one percent of all cases involved doctors who were ordered tests solely due to medical negligence concerns. General Accounting office has also determined that doctors may actually practice defensively because it generates more income. Defensive medicine is considered a revenue enhancing motive and one of the real reasons behind the utilization of extra diagnostic tests and procedures. In Florida health authorities determined that laboratories that do x-rays, MRI's or CT scans, known as diagnostic imaging and clinical labs were ordering additional tests because the majority were owned by doctors and the tests provided a lucrative stream of income on the side. Although federal law prohibits the referral of Medicare patients to certain physician owned facilities. Private pay insurance cannot prevent this. One researcher has even commented, "when medicine is a business, defensive medicine is understood and may even be profitable" the Congressional budget office recognizes that there was a financial incentive for defensive medicine but also identified there are potential health benefits to the patient "so called defensive medicine may be motivated less by liability concerns than by the income it generates for physicians or by the positive benefits to patients". Researchers at Tulane University found that defensive medicine actually has a positive effect on patients outcome. Contrary to popular belief defensive medicine is not driving up healthcare costs. One would think that states that have already limited liability for doctors through tort reform would have experienced significantly lower health care costs than states that do not limit liability. Kansas has some of the strictest caps in the county, which should eliminate any need to practice defensively thereby lowering healthcare costs in the state. Yet research shows that Kansas healthcare costs are in line with the rest of the nation. An article published in the New Yorker found healthcare cost will ultimately arise from the accumulation of individual decisions doctors make about what service and treatment to try. The most expensive piece of medical equipment as the saying goes is a doctors pen. One doctor recently admitted to CNN that more tests are ordered to generate additional income. He explained as follows, "Doctors are able to profit not just from being physicians like we have traditionally but by ordering tests on equipment that they own or sending patients to facilities that they own or have a financial interest in." Physicians own the majority of diagnostic imaging centers and clinical labs in Florida research has shown. Health officials in the state found owning the facilities and ordering additional tests provides a lucrative stream of income to physicians. Again all the federal laws prohibit the referral of Medicare patients to physician owned facilities. Private pay insurance may be referred without violation of any law. The American Hospital Association recently debated a policy that would ban doctors from referring patients to hospitals when they have a financial stake in the hospital. Many researchers believe that physicians will cherry pick patients and self refer profitable procedures and insured patients that are in hospitals. By doing this they take much of the needed income away from the community hospitals. This type of self referral behavior may damage the healthcare system at large by adding costs and weakening the healthcare safety net as community hospitals see their mix of patients becoming more complex and less well financed.

 

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