One point of contention in the current debate over reforming our expensive health insurance system concerns the practice of so-called “defensive medicine.” Defensive medicine has been defined in the medical literature as “a deviation from sound medical practice that is induced primarily by a threat of liability.” In practice, defensive medicine includes additional testing or treatments, avoidance of risky procedures, referral to specialists or even the refusal to take care of certain patients. Defensive medicine is considered by many as costly as well as unnecessary for proper medical care while adding a dimension of mistrust between doctor and patient. Defensive medicine has been used as an argument for medical malpractice tort reform.
The fact is that any time this issue has been studied — and it’s been studied numerous times over the last 25 years — no significant relationship has been demonstrated between the risk of being sued and increased costs due to “defensive medicine.” As early as 1994, a study by Congress’ Office of Technology and Assessment concluded that the effects on defensive medicine of tort reforms “are likely to be small.” More recently, the General Accounting Office in a 2003 study rejected the medical profession’s claims that the practice of defensive medicine was widespread and costly. The GAO criticized the medical profession’s self-serving studies as unreliable and based on inadequate response rates. These studies consisted of little more than sending doctors questionnaires asking if they practiced defensive medicine and then receiving, quite predictably, the desired response.
The GAO noted that “officials from AMA and several medical, hospital and nursing home associations in the nine states we reviewed “¦ cited surveys and published research but could not provide additional data demonstrating the extent and costs associated with defensive medicine.” The GAO report concluded that while “defensive medicine may be practiced in specific clinical situations, the findings are limited and cannot be generalized to estimate the prevalence and costs of defensive medicine nationwide.” Similarly, the insurance industry’s use of bogus statistics and arguments that medical malpractice limits would save health care costs based on considerations like defensive medicine was rejected in 2005 by the Annenberg Center’s reputable Factcheck.org. A 2004 CBO report concluded that “defensive medicine may be motivated less by liability concerns than by the income it generates for physicians or by the positive (albeit small) benefits to patients. On the basis of existing studies and its own research, CBO believes that savings from reducing defensive medicine would be very small.” Limiting tort liability would have no significant impact on health care spending, according to the CBO. View more