Roosevelt Institute | Cornell University

Bleeding the SystemHow defensive medicine is costing the taxpayer big time

By Karim FarhatPublished December 8, 2019

Cornell Roosevelt
Defensive medicine is a practice within the medical community that is costing taxpayers billions of dollars. The public should be made aware of the ramifications and origins of this practice as well as possible solutions. With nationalized healthcare, becoming more and more likely with every election, this issue is pertinent as to whether or not the nation will be able to afford it.

Defensive medicine is costing the U.S. healthcare system, and by extension taxpayers, billions of dollars. US Medical practitioners live in fear of malpractice lawsuits, so they have resorted to overprescribing tests and procedures just for the sake of not getting sued. The origins of this practice have roots in the mythical compensation culture of the U.S. In addition to driving up the cost of healthcare, this practice damages the patient-doctor relationship and further decreases the standard of care.

The most worrying aspect of this problem is its prevalence. If only a handful of anxious doctors were prescribing tests for assurances, then the added cost would be negligible; however, this is not the case. According to surveys conducted by Jackson Healthcare, the nation’s third largest healthcare staffing agency, 73 percent of doctors have admitted to practicing defensive medicine. Due to the nature of health insurance in America and the prevalence of government-subsidized healthcare, the majority of these costs fall under the government budget. Defensive medicine was estimated to cost the taxpayer anywhere from 210 billion to 850 billion with no signs of decreasing any time soon.

This practice has arisen from a deep-rooted fear within the medical community. Instead of trusting their years of medical training, doctors are finding it easier to simply test for every possible malady on the spectrum in order to clear their name should the worst come to bear. In other words, doctors are running scared, and for good reason. A study conducted by the American Medical Association finds that over a third of U.S. doctors have had a medical liability lawsuit filed against them. Moreover, this number climbs to nearly half for doctors over the age of 55. This very real threat of costly malpractice penalties, not to mention the average $30,000 in defence costs, is reason enough for any doctor to prescribe numerous tests. . These economic costs of a malpractice suit do not even begin to touch on the opportunity cost of a destroyed reputation. No sick person wants to be treated by a doctor under investigation for medical malpractice. A reputation that took decades to build can crumble in the face of one frivolous lawsuit. So,when it comes to  holding off on costly tests and procedures, doctors have nothing to gain and everything to lose.

High profile lawsuits where companies are sued for seemingly banal reasons, like the McDonald’s Hot Coffee Case, have birthed a perceived culture where the average joe can sue and win big. Despite being thoroughly debunked, this idea of a compensation culture where people are compensated for every misstep against them, real or imagined, has instilled a sense of paranoia within the medical community. This brings in the other aspect of defensive medicine. In a study of 800 physicians conducted by the Harvard School of Public Health, 42% of them were found to be eliminating procedures prone to complications and avoiding patients whose conditions could be described as litigious. Not only are doctors overprescribing and overtreating, they are also shying away from more invasive/risky procedures that might actually be more effective in the long run.  

Despite years of training and study, doctors’ expertise is often overridden in favor of self-treatment derived from hours of internet searching. It is not uncommon for patients to approach doctor’s and ask for a prescription to certain medications they would not have prescribed themselves. With a few concerned determined looks and the ever-looming threat of a lawsuit, doctors end up feeling pressured to prescribe a medicine they may not have prescribed otherwise. In a study of 192 physicians from six different states, it was found that knee osteoarthritis patients who requested Celebrex were more than twice as likely to receive the prescription when compared to patients who made no specific request. Moreover, patients who requested oxycodone were more likely to receive a prescription for a strong narcotic over a weak one. This anti-professional mindset can be more broadly seen in terms of the anti-vaccination movement in which a mistrust of medical professionals has lead to a drop in  vaccination rates as well as corresponding outbreaks of diseases long thought to be a thing of the past.

A less noticeable, but perhaps more important aspect of this argument is the effect defensive medicine has on the number of practicing doctors. Projections from the Association of American Medical Colleges foresee a shortage of up to 121,900 physicians by 2032 in primary and specialty care. The toxic client-patient culture that has brought upon the practice of defensive medicine both encourages older doctors to retire earlier and discourages younger students from entering the field.

One possible solution to this epidemic is currently being proposed by Florida and Georgia lawmakers is the Patient Compensation System. Under this new system, patients would no longer directly sue physicians or hospitals but rather request an investigation into their behavior by a panel of healthcare experts. If the panel ruled in the patient’s favor then he/she would be compensated in a matter of months rather than several years, as is the norm. This would solve the current problem doctors have with the system: their lack of confidence in the average juror’s ability to understand the intricacies of medical cases. Without the ever-looming threat of lawsuits dangling over their heads, doctors would be able to issue a diagnosis without a costly plethora of unnecessary tests. Moreover, these same doctors would be able to comfortably move forward with more invasive but worthwhile procedures. As the practice of defensive medicine disappears, so too will the exorbitant costs that come with it. 

On the flip side, a panel of experts would do little to assuage the concerns of those who already doubt the system. While the overall effectiveness of this system might change a few opinions, its popularity with the average person will ultimately lie in its objectivity. To remedy this, these policies should include a tenant which states that the panel experts should have no relation to the defendant i.e. not work at the same facilities/no fiscal partnerships.

The problem of defensive medicine is both widespread and costly. Its practice is ballooning the healthcare budget to unsustainable levels, and bringing an end to it should be a focal point for healthcare policymakers. With presidential candidates clamoring for reform in this sector of government, a proposal that includes lowering costs would win over people on both sides of the political spectrum. In a time of ballooning national debt, it pays to be fiscally conservative. 

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