There has been a lot of controversy about the role medical malpractice plays in health care spending. Whether and the extent to which physicians practice defensive medicine, and what that approach might cost, are uncertain. Many doctors certainly say they regularly practice defensively to avoid malpractice suits. Research in the British Medical Journal takes a new approach to the topic. (BMJ Article) The study was carried out by looking at total spending relating to admissions at acute hospitals in Florida from 2000 to 2009. The primary association studied was between average spending in a year by a physician responsible for admissions and allegations of malpractice in the subsequent year. The study was across seven specialties but also looked specifically at whether obstetricians who did more caesarean deliveries had fewer malpractice claims.
There was a clear association between a doctor having high spending and less malpractice claims. Spending ranged from an average of $19,725 for the bottom 20% of physicians to $39,379 for the top 20%. And the bottom 20% had a 1.5% malpractice rate while the top 20% had only a .3% rate, five times lower. In addition, obstetricians who performed more caesarean deliveries had much lower rates of malpractice claims. There are limits to the study–we don’t know for sure why the higher-cost physicians ordered more services, maybe there were reasons other than malpractice concerns. But the association has a logic. Nobody likes to be accused of negligence and doctors are no exception. And malpractice claims can be expensive and time-consuming to defend, even with insurance. So it would be sensible for physicians to practice defensively if it results in fewer malpractice suits. If it works, why wouldn’t they do that? And this may be a gross measure of quality–it suggests, as other studies have, that spending more per patient may actually result in better outcomes.