Hospital administrators estimate more than half of physicians practice defensive medicine and that such unnecessary medical treatment accounts for one-third of all health care costs.
The 2014 analysis by national health care staffing firm Jackson Healthcare corresponds with a 2010 survey by Gallup in which 73% of physicians said they had practiced defensive medicine. In the 2010 survey, physicians estimated 26% of overall health care costs stemmed from defensive medicine.
"We have been studying the reach and impact of defensive medicine for 5 years, and the conclusions are consistent," said Richard L. Jackson, chair and CEO of Jackson Healthcare. "The data show defensive medicine is impacting health care costs and is a uniquely American problem."
Jackson Healthcare examined the responses of 106 hospital executives between February and March for the survey, released April 8. Of participants, 94% said physicians’ fear of lawsuits leads them to practice defensive medicine and in turn elevates health care costs. Hospital administrators estimated an average of 57% of physicians practice defensive medicine. In the 2010 survey, Gallup interviewed 462 physicians across the United States.
Survey participants in the most recent survey were divided on how defensive medicine affects quality of care. Of those surveyed, 32% said defensive medicine has a negative impact, 31% believed it has a positive impact, and 30% said it had no impact.
But "estimates" of defensive medicine may be much different from actual costs, said Dr. Howard Brody, professor and John P. McGovern centennial chair of family medicine at the University of Texas Medical Branch at Galveston (UTMB), and director for UTMB’s Institute for the Medical Humanities.
"I doubt that the [percentage] of defensive medicine can be shown to be as high as they say [nearly one third]," he said. "There’s a difference between surveys of people’s opinions versus actual attempts to measure defensive medicine."
Dr. Brody coauthored a study in the February 2010 Journal of General Internal Medicine about defensive medicine, cost containment, and reform. The study found the subjective aspects of defensive medicine render the practice nearly impossible to quantify.
"I believe that the basic problem is that physicians seldom do anything for one reason only," Dr. Brody said. "Any test or treatment that’s ordered may be ordered for several reasons, one of which might be defensive medicine, but it’s very hard to disentangle how much that contributes among the various other reasons. The best-conducted studies we could find would produce estimates of the actual cost of preventive medicine far below what this recent survey suggests."
Physicians themselves have long reported practicing defensively to diminish litigation risks. A 2005 study in the Journal of the American Medical Association found 93% of high-risk specialists in Pennsylvania reported practicing defensive medicine (JAMA 2005; 293:2609-17). In Massachusetts, 83% of physicians said they have practiced defensive medicine, according to a 2008 report by the Massachusetts Medical Society.
However, Dr. Brody noted the many dynamics play into physicians’ treatment decisions.
"Physicians are, quite understandably, very fearful of lawsuits," he said. "This psychological reaction looms very large in their thinking, and so when asked about defensive medicine, we tend to overestimate its actual scope. I would not boggle at the idea that up to a third of the health care budget is spent on unnecessary things that don’t help patients at all. But I think the main reason physicians order these is because we do what we think we should do, or have been told to do, or feel better if we do more rather than less.