study medical malpractice reform wont reduce defensive medicine

A new study published in the journal Health Affairs suggests that tort reform efforts such as medical malpractice damage caps that are aimed at reducing doctors’ concerns about being sued are unlikely to be effective at deterring “defensive medicine.”

The study, partially funded by the Robert Wood Johnson Foundation, was performed by researchers from the University of Iowa Health Care, the Center for Studying Health System Change in Washington, D.C., and the Harvard School of Public Health. The team performed a survey of a nationally representative sample of both generalists and specialists about how concerned they were about being sued for medical malpractice.

Regardless of their specialty or geographic location, all physicians expressed high levels of concern about lawsuits, and those fears were often out of proportion to their actual risk of being sued, researchers found.

To determine the actual risk of medical malpractice lawsuits in different states, the study used objective measures such as the cost of premiums for medical malpractice insurance and the number of paid malpractice claims. Doctors in the least-risky states were less than one-third as likely to be sued for malpractice as those in the riskiest states.

The survey showed that physicians in states with the highest risk were only modestly more concerned about being sued than those in the lowest-risk states.

“We found that both generalist and specialist physicians fear being sued for malpractice even in states where their risk of being sued is relatively low,” said Dr. David Katz, the study’s senior author.

“The high levels of malpractice concern, even among physicians in relatively low-risk environments, is striking,” said Katz. “One possible explanation is that most physicians do not have the information to accurately access their actual risk of being sued.”

Medical Malpractice Damage Caps Haven’t Reduced Doctors’ Lawsuit Fears

Many efforts at tort reform assume that fear of medical malpractice lawsuits leads doctors to practice “defensive medicine” — perform unnecessary medical tests and take other steps that provide no patient benefit — on the theory that doing so will insulate them from potential litigation. Performing unnecessary medical procedures could potentially drive up the cost of health care, tort reform proponents say.

Because all medical procedures carry a degree of risk, any doctor who performs them unnecessarily also exposes patients to needless risk, which could be considered medical negligence itself.

Whether or not “defensive medicine” is actually a substantial problem, the study suggests that medical malpractice tort reform is a relatively ineffective way to address it. Several types of medical malpractice reform enacted by states were considered. Some resulted in a significant reduction in individual doctors’ concerns about lawsuits, but the results were mixed.

Specifically, legislation aimed at controlling the cost of a medical malpractice lawsuit did not appear to alleviate doctors’ concerns, and therefore would be ineffective at altering the practice of “defensive medicine.”

Source: Medical News Today, “Doctors Still Fear Malpractice Lawsuits, Despite Tort Reforms,” December 16, 2010

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