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Defensive Medicine

The document examines the impact of malpractice liability on defensive medicine practices among healthcare providers, highlighting that fear of lawsuits can lead to unnecessary treatments. An analysis of reforms indicates that reducing liability pressure can decrease medical expenditures by 5-9% without negatively affecting patient outcomes. The study concludes that implementing such reforms could save over $50 billion annually while maintaining health quality for elderly patients with heart disease.

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13 views21 pages

Defensive Medicine

The document examines the impact of malpractice liability on defensive medicine practices among healthcare providers, highlighting that fear of lawsuits can lead to unnecessary treatments. An analysis of reforms indicates that reducing liability pressure can decrease medical expenditures by 5-9% without negatively affecting patient outcomes. The study concludes that implementing such reforms could save over $50 billion annually while maintaining health quality for elderly patients with heart disease.

Uploaded by

lachanhday
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Do Doctors

Practice
Defensive
Medicine?
DANIEL KESSLER AND MARK MCCLELLAN

Presenter: Thy Tran


Daniel P. Kessler, whose work focuses Mark Barr McClellan is the director of the
on health policy and health care Center for Health Policy and the Margolis
finance. He is currently a professor in Professor of Business, Medicine and Health
management at the Stanford Graduate Policy at Duke University. Former
School of Business and a professor of Commissioner of Food and Drugs
law at Stanford Law School
Summary
"Defensive medicine" is a significant social problem.”
Fear of liability can lead healthcare providers to administer unnecessary
treatments, resulting in inefficiencies greater than the costs of
compensating malpractice claimants.

Malpractice liability reforms were analyzed using data on elderly Medicare


beneficiaries treated for serious heart disease in 1984, 1987, and 1990.
Reforms that directly reduce provider liability pressure led to:
- Reductions of 5 to 9 percent in medical expenditures.
- Minimal effects on mortality or medical complications.

Conclusion: Liability reforms have the potential to reduce defensive


medical practices.
Introduction
The medical malpractice liability system serves two main purposes:
● providing compensation for patients injured due to negligence
● encouraging doctors to provide careful treatment.

The study aims to provide empirical evidence on defensive medicine by


analyzing the relationship between medical malpractice tort law,
treatment intensity, and patient outcomes.

Longitudinal data on elderly Medicare recipients hospitalized for heart


disease from 1984 to 1990, matched with information on tort laws, is used
to study the effects of tort law reforms.
01
MALPRACTICE LIABILITY
AND EFFICIENT
PRECAUTION IN
HEALTH CARE
● Three elements for a successful claim: proof of adverse event,
causation by the provider, and provider negligence.

● The principal role of the malpractice liability system is to


induce doctors to take the optimal level of precaution
against patient injury.

● Malpractice pressure, influenced by legal environment and


externalized costs, can lead to either suboptimal or defensive
medical practices.

● Incentives to practice defensively may be intensified by judges


and juries imposing liability with error, encouraging excessive
care.
Literature Review

Previous studies do not directly answer whether


intensive treatment due to fear of malpractice claims
affects patient outcomes, relying on assumptions about
the relationship between survey responses and actual
treatment behavior.

→ Past analyses lack direct empirical evidence on how


malpractice reforms would actually affect physician
behavior, medical costs, and health outcomes.
02
ECONOMETRIC MODEL

Describe en qué consiste esta


sección si lo necesitas
The econometric models compare time trends across
states with and without tort law reforms over a seven-
year period
→ Measure the effects of changes in malpractice
pressure on medical decision-making.

The models test for defensive medicine by examining


the relationship between the effects of law changes
on medical expenditures and health outcomes.

Specification tests are conducted to ensure that


reform adoption is not correlated with unobserved
trends or patient characteristics
03
DATA & METHODS
The data used in our analysis come from two principal
sources

Comprehensive longitudinal
claims data: elderly Medicare
beneficiaries admitted for AMI
or IHD 1984,1987, 1990

State Malpractice Laws and


Reforms Database: liability
laws and malpractice-control
policies from 1969 to 1992
04
EMPIRICAL RESULTS
● Impact of Tort Reforms on Expenditures: Direct reforms led to
reductions of more than 5 percent for AMI and 9 percent for IHD by
five years after reform adoption.

● Effects on Mortality and Health Outcomes: The impact of


reforms on health outcomes was minimal.

● Long-Term Effects of Reforms: The effects of reforms over were


larger in long term compared to short term.

● Robustness of Results: Alternative specifications and inclusion


of controls did not change the estimated effects of tort reforms on
expenditures, mortality, or health outcomes.
Doctors do indeed practice defensive medicine, and the study
points out the importance of understanding how liability rules
have effects on
physician decisions and healthcare expenditures
05
POLICY IMPLICATIONS
Direct reforms lead to substantial
reductions in hospital expenditures (5-9%
within 3-5 years) without adverse health
outcomes.

Estimated potential savings from


nationwide adoption of direct reforms have
an amount of over $50 billion per year
without adverse health consequences.

Future research should focus on directly


assessing the impact of liability reforms on
physician decisions and patient outcomes
Conclusio
n
Implementing malpractice liability reforms, such as those
that limit the amount of money awarded in lawsuits, can
significantly reduce the growth of medical expenses in
treating elderly patients with heart disease. These reforms
have no appreciable consequences on important health
outcomes like mortality or common complications.

→ Treatment of elderly patients with heart disease does


involve "defensive" medical practices, driven by fear of
lawsuits.
→ Even small reductions in liability can help lessen
these costly defensive practices.
How can we
reduce
unnecessary
care?
How can we
reduce
unnecessary
The best way to reduce unnecessary
care may be the promotion of a

care?
medical culture that is not only
patient-focused, but also enables
physicians and medical staff to work
together as a team.

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