A study published on October 5, 2015 in BMJ that sought to investigate whether a higher use of resources by physicians is associated with a reduced risk of medical malpractice claims concluded that “[o]ur findings suggest that greater resource use, whether it reflects defensive medicine or not, is associated with fewer malpractice claims.”
The study used data involving nearly all admissions to acute care hospitals in Florida for the period from 2000 to 2009 linked to the medical malpractice history of the attending physician involved. The study’s authors examined the association between a physician’s average hospital costs in a given year and the probability of a medical malpractice claim arising from an incident occurring the following year, by investigating whether physicians in seven medical specialties with higher average hospital charges in a year were less likely to face an allegation of medical malpractice in the following year. The study adjusted for patient characteristics, co-morbidities, and diagnosis.
The data included 18,352,391 hospital admissions involving 24,637 physicians and 154,725 physician years, and involved 4,342 medical malpractice claims against physicians (medical malpractice rates ranged from 1.6% per physician year in pediatrics to 4.1% per physician year in general surgery and in obstetrics and gynecology).
The study found that average spending by physicians was associated with reduced risk of incurring a medical malpractice claim (in six medical specialties, a greater use of resources was associated with statistically significantly lower subsequent rates of alleged medical malpractice incidents).
The study’s authors caution that “It is … uncertain whether higher spending is defensively motivated.”
Supporters of medical malpractice reforms, which typically make it more expensive and more difficult for victims of medical negligence to seek compensatory damages for the injuries and harm they suffered as a result of alleged medical malpractice (and often set limits on the amount of compensatory damages that they may receive no matter how painful or permanent their injuries may be), cite the costs of “defensive medicine” as a basis for the need for “reforms.”
Defensive medicine is defined as medical care provided to patients solely to reduce the threat of medical malpractice liability rather than to further diagnosis or treatment. Most physicians in the United States report that they practice defensive medicine in order to reduce their perceived risk of medical malpractice liability.
The study’s authors found that obstetricians with higher risk adjusted Cesarean delivery rates in a year had fewer alleged medical malpractice incidents the following year (Cesarean deliveries are often cited as being influenced by defensive medicine). Specifically, the average adjusted Cesarean delivery rate for each obstetrician increased from 5.1% in the bottom fifth of obstetrician years to 31.6% in the top fifth, whereas the probability an obstetrician experienced an alleged medical malpractice incident in the subsequent year decreased from 5.7% in the bottom fifth to 2.7% in the top fifth.
The study cautioned, “to the extent that our findings indicate a causal relation – meaning that higher resource use directly lowers the risk of malpractice – we do not know whether that is because patients receiving more resource use experience better outcomes and have less cause to sue, or whether outcomes are the same and the additional care simply wards off lawsuits.”
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