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Docs on defense add costs to healthcare

by Alan Markow, published

Although individual physicians practice all forms of specialized medicine, they have all learned the skills of defensive medicine to one degree or another. 

     “Defensive medicine can be simply defined as medical responses undertaken to avoid liability rather than to benefit the patient,” wrote Richard E. Andersen, M.D. in the Journal of Internal Medicine in 1999.

Dr. Andersen goes on to argue that this risk-averse behavior could be said to “violate the Hippocratic Oath, violence to the doctor-patient relationship, and is manifestly self-serving for the physician.” But he then points out that standards of service have been adjusted to permit levels of tests and procedures that were once viewed as unnecessary.  The resultant increase in such procedures as caesarian deliveries and use of fetal heart monitors, Dr. Andersen argues, adds costs to the healthcare system, while providing very little additional protection to the patient.

According to some experts, costs associated with defensive medicine far exceed losses from malpractice cases, which tend to be a tiny part of overall health care expenses.  It is the threat of malpractice litigation that some believe has raised American health care costs to amounts that far exceed the rest of the world.

The conservative-leaning Washington Times reported back in 2009 that Harvard researcher Amitabh Chandra estimated the cost of defensive medicine at $60 billion annually.  “Other research places the yearly cost at roughly $200 billion,” the article stated without attribution.

According to a 2010 article by liberal-leaning NPR, Rep. Tom Price (R-GA) – a doctor himself – claimed on the Republican website America Speaks Out that the cost of defensive medicine runs $650 billion annually – nearly 25 percent of the nation’s entire healthcare bill.  But the NPR article then brings out its own Harvard health care cost expert who argues that most of the current cost estimates for defensive medicine are – in her words – “quite imaginative.”

She’s Michelle Mello of the Harvard School of Public Health, who performed a study for the scholarly publication Health Affairs in 2010.  She and her colleagues found that the total cost of medical malpractice-related expenses in the health care system, including defensive medicine, is about $55.6 billion per year, or about 2.4 percent of annual health care spending. Defensive medicine is about 80 percent of that total.

With numbers that swing from one extreme to the other, it's wise for the average voter to consider the source of the information we try to grapple with as it pertains to an issue as complex as healthcare cost.  A friend of mine, who is a physician, got me started thinking beyond the limited cost of litigation and into the broader area of defensive medicine.  It made sense to me that there’s a lot more expense that goes into preventing litigation than there is in actual court cases, but the extreme high and low end claims in some of the source material seems politically motivated.  Amazingly, the two Harvard studies mentioned in separate articles from left and right-leaning publications reach nearly identical and relatively unsurprising conclusions. 

I also hear the echo of ambulance chasers whenever one of those BAD DRUG ads comes on the radio or television.  They make me believe that there are law firms out there trying to stir the pot just to make a profit for themselves, and I have to believe those firms are adding unnecessary costs to the healthcare system as well.

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