During the health-care debate, the impact of medical malpractice suits was controversial, with the Republicans saying it was a key part of the escalating cost issue and the Democrats saying, not so much. For its part, the CBO estimated tort-law changes would cut only about 0.5% from U.S. health-care spending.
A study now reinforces the long-held belief of many doctors that malpractice -– or fear of same — is really pretty important on the cost front after all. Researchers wanted to know if physicians' behavior and attitudes explain some of the regional variations in the number of intensive procedures. (Citing the Dartmouth Atlas of Health Care, they said the rate of a given cardiac procedure might be three to eight times higher in one area of the country than another, depending on the procedure.) The researchers surveyed 598 cardiologists across the U.S. about what non-clinical reasons might lead them to recommend cardiac catheterization. They also calculated a doctor's "cardiac intensity score" — a quantitative measure of his or her propensity to test and treat, based on his or her response to hypothetical patient scenarios.
The study, published online in Circulation: Cardiovascular Quality and Outcomes, found that nearly 24% of those surveyed reported that fear of malpractice was a non-clinical factor in their decision to recommend catheterization; docs with high intensity scores were more likely to say that legal fears influenced their recommendation. And 27% said if they thought their colleagues were likely to order the procedure, they would too. Researchers also asked doctors if they'd recommend the test because "the patient expects it," "to satisfy the expectations of the referring physician," or to enhance "the financial stability" of a medical practice. (Surprisingly, five doctors actually admitted they frequently or sometimes recommended catheterization for that last reason.)
Only the fear of malpractice, however, was significantly associated with regional differences in the level of health-care services used. "I think this study provides enough evidence to think it's maybe a target for intervention," says F. Lee Lucas, lead author of the study and associate director of the Center for Outcomes Research and Evaluation at Maine Medical Center, who found the malpractice findings surprising. "It seemed to be, for a fair number of physicians, to be a clear motivation for doing something potentially unnecessary."
Even for doctors who aren't directly affected by malpractice suits, the fear of being sued may lead them to order more tests than they otherwise might have – that's so-called defensive medicine.
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