In part 3 of our 5 part series where we explore what influences healthcare costs, we dive into Defensive Medicine. If you haven’t yet, take a look at the previous two posts in the series: “Why is Healthcare So Expensive?” and “How Administrative Costs Increase the Cost of Healthcare“.
Studies have shown that up to 92% of physicians partake in a practice called defensive medicine. Defensive medicine is when doctors move outside of what would be considered normal medical practices in order to prevent a potential lawsuit. How does this practice impact healthcare spending? In devastating fashion. Defensive medicine is estimated to cost the U.S. healthcare system billions annually.
A 2011 study in the New England Journal of Medicine found that roughly 1 in 14 U.S. doctors face a malpractice suit every year. These lawsuits averaged a settlement of over $270,000. There was significant variation between different medical specialties regarding the risk of medical malpractice. Although most claims do not lead to payments for the party bringing the charge, the process is time-consuming and costly for both sides. It is estimated that physicians spend an average of 11% of their careers with an unresolved malpractice claim, and claims that did not result in payments account for more than 70% of this time. There are a few underlying factors that influence defensive medicine.
A Difficult Situation: Patient-Physician Relationships
We all know the healthcare system is complex. To further complicate the situation, new research confirms a physician shortage over the next decade. That coupled with the Affordable Care Act creating an influx of 30 million people into the healthcare system creates an unfavorable environment for physicians.
Patients can often be demanding and even threatening towards physicians and healthcare organizations. Difficult patients can influence physicians for testing and procedures that might not be medically necessary by pressuring them or threatening to sue them. These types of pressures create the environment where the defensive medicine thrives. This is when we see the care that is driven by patient fear and anxiety rather than scientific evidence and physician expertise.
Often when patients come to respected healthcare facilities they might have unrealistic expectations as to what can be done medically for them or their loved one. When patients don’t get “fixed” or find a miracle treatment they often leave frustrated and upset. Or when patients feel like they aren’t being heard or that the facility isn’t “doing enough” they could threaten to sue or pressure physicians to do something that wouldn’t be wise or needed.
The internet and social media have hindered physician care as well. Patients can find all sorts of information that may or may not be true. This can lead them astray from good medical practice or what might be relevant to their specific situation.
Also, popular news sources can cover new studies that are misleading and create speculation for patients. For instance, in recent years a study found a relationship between PPI medications (used to treat heartburn and other gastric acid problems) and kidney disease and dementia. This was a major scare for some people that turned out to be based on poor research and careless reporting techniques. The patient would then call or visit their doctor and want to be put on a different medication due to fear of what they saw in the news. This could lead to the physician prescribing an alternative medication that would not be necessary for fears that are not correct. This is yet another situation where patients can influence or dictate their care against the quality medical practice.
The Broken Malpractice System
Unfortunately, the malpractice system is complicated and unhelpful for both patients and physicians. Many are calling for a new medical malpractice system to be implemented that would help protect physicians who are using evidence-based practices. Some states are considering implementing a “no blame” system that would have cases reviewed by a panel of medical experts. This would help patient claims be heard more quickly and they would be paid in a way like our current legal system.
Defensive medicine is influenced by situational pressures, patient demands, and is further complicated by the inefficient and outdated medical malpractice system. New measures need to be implemented to help eliminate these issues and stop the use of defensive medicine. This could help cut healthcare spending drastically.
Stay tuned for our upcoming posts where we explain the other costs of healthcare: Pharmaceutical Companies and Third Party Payer.
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