Does Defensive Medicine Exist?

By Jim Barfield

The thought that many physicians practice defensive medicine is one of the reasons bantered around for the high and continually growing costs of health care.

Defensive medicine is the idea that when you, the patient, visit your doctor, the doctor performs tests that are over and above what is necessary and are for the sole purpose of preventing you from suing.

Does defensive medicine exist and is it a reason for high health care costs? There have been many surveys and studies both from independent organizations and those with vested interests that attempt to answer this question.

MAJOR DIFFERENCES IN THE ESTIMATES

An article published in the September 2010 issue of Health Affairs puts the costs at 2.4 percent of total health care spending. “Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008, or 2.4 percent of total health care spending,” the journal reports. In 2004, the Congressional Budget Office (CBO) estimated that the entire cost of the malpractice system accounted for only about 2 percent of the overall costs of health care. However, in October 2009, the CBO released a report that found that malpractice reforms would reduce health care spending by 0.1 percent ($40 billion) over the next 10 years.

A 2010 Gallup national physician survey, commissioned by Jackson Healthcare, states that physicians attribute 26 percent of overall health care costs to defensive medicine. In addition, 73 percent of the physicians agreed that they had practiced some form of defensive medicine in the past 12 months. The survey results showed that “$1 in every $4 spent on health care each year is spent on unnecessary tests and treatments ordered by physicians solely to protect themselves against lawsuits.”

The range of estimates from – 0.1 percent to 26 percent of overall health care costs – is attributable to defensive medicine, and there are many other studies with even higher estimates. The CBO even reports that the evidence for defensive medicine is “not conclusive.” Furthermore, the CBO reports, “On the basis of existing studies and its own research, CBO believes that savings from reducing defensive medicine would be very small.”

STATES WITH LIABILITY CAPS

Another important point is that some states have already limited doctors’ liability with tort reform. If defensive medicine is a major issue, states with tort reform should have lower health care costs. But that is not the case. A good example is Texas which has very high health care costs while having very stringent laws limiting awards in malpractice lawsuits. Awards for non-economic damage (pain and suffering) are limited to no more than $250,000. For wrongful death, damages (both economic and non-economic) are adjusted annually for inflation and are currently capped at $1.65 million plus the cost of any necessary medical or custodial care.

The fact also remains that ordering tests and procedures generates income. Physicians affiliated or employed by health care systems order tests and procedures that, in most cases, are performed by the same health care system. “So-called 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,” the CBO points out.

So, does defensive medicine exist? Depending on what you read, it is or is not a factor in health care costs. However, we are bombarded with lawsuit-induced warnings on so many other issues. I believe defensive medicine exists and it increases the cost of health care … But the jury is still out on how much.


Jim Barfield is the president, CEO and co-owner of Luke & Associates, Inc. on Merritt Island. His company, founded in 2004, is a major provider of medical and clinical support services for the military. In addition, Luke provides advisory and assistance services in the fields of engineering, research, information systems and medical systems.


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