In October 2009, Jackson Healthcare conducted a national survey
of physicians to qualify their attitudes regarding the practice of
medicine in light of the healthcare reform environment. In
their open-ended responses, defensive medicine was an issue
consistently offered by physicians as the primary problem driving
healthcare costs. Survey participants reported that medically
unnecessary diagnostic and treatment services were being ordered in
an effort to avoid lawsuits.
Jackson Healthcare believed this issue merited further
exploration and quantification. Our secondary research found
no publicly reported research that quantified the extent and
economic impact of defensive medical practices among U.S.
physicians.
In December 2009, Jackson Healthcare polled physicians again to
quantify the scope and impact of defensive medicine
practices. Jackson believed physicians were the most reliable
source to quantify unnecessary medical activities, since physicians
drive all healthcare expenses through their orders. Survey
participants estimated that 34 percent of overall healthcare costs
is attributable to defensive medicine. Nine out of 10
physicians reported practicing defensive medicine. In Texas,
where tort reform legislation was passed in 2001, physicians
reported defensive medicine practices no less than the overall
participant average.
Based upon these findings, and in an effort to validate the
scope and impact of defensive medicine, Jackson Healthcare retained
Gallup to conduct an independent national physician poll using
their world-renowned methodology. Gallup's findings, though
more conservative than Jackson's, found that physicians attribute
26 percent of overall healthcare costs to the practice of defensive
medicine. Of the physicians surveyed, 73 percent agreed that
they had practiced some form of defensive medicine in the past 12
months.
Bottom Line
A report from The Centers for Medicare and Medicaid Services
recently estimated overall U.S. healthcare spending in 2009 to be
$2.5 trillion. If physician estimates are accurate, according
to Gallup and Jackson surveys, between $650 billion and $850
billion are being spent each year due to defensive, or
lawsuit-driven, medicine.
Jackson Healthcare's online survey also found that the impact of
defensive medicine practices extends beyond inflating costs.
Its consequences are 1) limiting access to care for high-risk
patients, 2) over- and under-treating patients with
life-threatening illnesses, and 3) fostering distrust among
patients and their physicians, which has resulted in lowered
physician morale and manpower.
As long as physicians are personally financially liable for
medical errors or omissions, they will continue to practice
defensive medicine, because they have to put their careers,
reputations and personal net worth at risk every day. This is
placing an unnecessary burden on patients by subjecting them to
unnecessary tests and treatments, while inflating their
out-of-pocket expenditures.
Key Findings from Gallup Survey
- Physicians attribute 26 percent of overall healthcare costs to
the practice of defensive medicine
- Of the physicians surveyed, 73 percent agreed that they had
practiced some form of defensive medicine in the past 12
months
- Physicians indicating they had practiced a form of defensive
medicine in the last twelve months attribute 21 percent of their
practice to be defensive in nature
Key Findings from Jackson Healthcare Survey
- Physicians attributed 34 percent of overall healthcare costs to
defensive medicine
- Nine out of 10 physicians (92 percent) reported practicing
defensive medicine
- In cases of true negligence, nine out of 10 (89 percent)
physicians agree that patients receiving negligent treatment should
be compensated
- Emergency room, primary care and OB/GYN physicians are most
likely to practice defensive medicine
- Younger physicians and female physicians reported less
tolerance for risk and are more likely to practice defensive
medicine
- Physicians who reported practicing defensive medicine,
estimated the following:
- 35 percent of diagnostic tests were ordered to avoid
lawsuits
- 29 percent of lab tests were ordered to avoid lawsuits
- 19 percent of hospitalizations were ordered to avoid
lawsuits
- 14 percent of prescriptions were ordered to avoid lawsuits
- 8 percent of surgeries were performed to avoid lawsuits
Consequences reported to exist beyond the threat of the
courtroom, included:
- Practicing "rule-out medicine" vs. "diagnostic medicine"
- Physicians appear afraid to trust their own clinical judgment
and trust first-round tests, resulting in tests to confirm the
results of tests
- Physicians expressed concern over not only missing a diagnosis,
but being charged with delay in diagnosis
- Patients are viewed as plaintiffs, not partners
- Patient access to medical information and self-diagnoses via
the web has increased physician compliance with patient demands in
an effort to avoid lawsuits
- Physicians avoid high risk patients, because a bad outcome
increases chances of litigation
- Physicians avoid procedures and practices that would increase
medical malpractice insurance premiums, thereby limiting patient
access to treatment
- Physicians are considering leaving the profession
Conclusions
An opportunity exists to save $6.5 trillion over the next 10
years. However, traditional tort reform will not solve this
problem. It may reduce malpractice costs, but until
physicians are protected from being personally financially liable
for unintended mistakes and omissions, they will continue ordering
unnecessary test and treatments to avoid lawsuits.
Gallup Survey Metholodology
Between December 2009 and January 2010, Gallup conducted
telephone interviews with 462 randomly selected practicing
physicians from across the U.S.
Jackson Healthcare Survey Metholodology
In December 2009, Jackson Healthcare invited 138,686 physicians
to participate in a confidential online survey in an effort to
quantify the costs and impact of defensive medicine. Over
3,000 physicians spanning all states and medical specialties
completed the survey, a 2.21 percent response rate. The
survey error range is at the 95% confidence level: +/-1.15
percent.
The following definition was cited in the survey: "Defensive
medicine is the practice of diagnostic or therapeutic measures
conducted primarily not to ensure the health of the patient, but as
a safeguard against possible malpractice liability. Fear of
litigation has been cited as the driving force behind defensive
medicine. Defensive medicine is especially common in the United
States of America, with rates as high as 79% to 93%, particularly
in emergency medicine, obstetrics, and other high-risk
specialties.
Defensive medicine takes two main forms: assurance behavior and
avoidance behavior. Assurance behavior involves the charging of
additional, unnecessary services in order to a) reduce adverse
outcomes, b) deter patients from filing medical malpractice claims,
or c) provide documented evidence that the practitioner is
practicing according to the standard of care, so that if, in the
future, legal action is initiated, liability can be pre-empted.
Avoidance behavior occurs when providers refuse to participate in
high risk procedures or circumstances.
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