High physician concern about malpractice risk predicts more aggressive diagnostic testing in office-based practice

Health Affairs

Volumn 32, Issue 8, 2013, Pages 1383-1391

  Carrier, Emily R ^a   Reschovsky, James D ^a   Katz, David A ^b,c   Mello, Michelle M ^d  

^a CENTER FOR STUDYING HEALTH SYSTEM CHANGE   (United States)

^b UNIVERSITY OF IOWA   (United States)

^c Veterans Affairs Iowa City Health Care System   (United States)

^d HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; DEFENSIVE MEDICINE; DIAGNOSTIC TEST; HEADACHE; HEALTH CARE SURVEY; HUMAN; LOW BACK PAIN; MALPRACTICE; MEDICARE; PHYSICIAN; RISK ASSESSMENT; SELF CONCEPT; THORAX PAIN;

COST OF HEALTH CARE; LEGAL/REGULATORY ISSUES;

AGED; ATTITUDE OF HEALTH PERSONNEL; CHEST PAIN; DEFENSIVE MEDICINE; DIAGNOSTIC TESTS, ROUTINE; EMERGENCY SERVICE, HOSPITAL; HEADACHE; HUMANS; LOW BACK PAIN; MALPRACTICE; PATIENT ADMISSION; PHYSICIAN'S PRACTICE PATTERNS; RISK ASSESSMENT; UNITED STATES; UNNECESSARY PROCEDURES; UTILIZATION REVIEW;

EID: 84884222008     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2013.0233     Document Type: Article

References (33)

1. Chandra A, Jena AB, Seabury SA. Defensive medicine may be costlier than it seems. Wall Street Journal. 2013 Feb 7.
2. Mello MM, Chandra A, Gawande AA, Studdert DM. National costs of the medical liability system. Health Aff(Millwood). 2010;29(9):1569-77.
3. Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293(21):2609-17.
4. Office of Technology Assessment. Defensive medicine and medical malpractice [Internet]. Washington (DC): OTA; 1994 Jul [cited 2013 Jun 25]. (Publication No. OTA-H- 602). Available from: http://otacdn.fas.org/reports/9405.pdf
5. Sethi MK, Obremskey WT, Natividad H, Mir HR, Jahangir AA. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. Am J Orthop. 2012;41(2): 69-73.
6. Carrier ER, Reschovsky JD, Mello MM, Mayrell RC, Katz D. Physicians' fears of malpractice lawsuits are not assuaged by tort reforms. Health Aff(Millwood). 2010;29(9):1585-92.
7. Avraham R, Dafny LW, Schanzenbach MM. The impact of tort reform on employer-sponsored health insurance premiums. Austin (TX): University of Texas, Center for Law, Business, Economics; 2009.
8. Congressional Budget Office. Limiting tort liability for medical malpractice. Washington (DC): CBO; 2004 Jan.
9. Baicker K, Chandra A. The effect of malpractice liability on the delivery of health care. Cambridge (MA): National Bureau of Economic Research; 2004 Aug. (NBER Working Paper No. 10709).
10. Kessler DP, McClellan MB. Do doctors practice defensive medicine? Q J Econ. 1996;111(2):353-90.
11. Dubay L, Kaestner R, Waidmann T. The impact of malpractice fears on cesarean section rates. J Health Econ. 1999;18(4):491-522.
12. Center for Studying Health System Change. 2008 health tracking physician survey methodology report [Internet]. Washington (DC): The Center; 2009 Sep [cited 2013 Jun 25]. (Technical Publication No. 77). Available for download from: http://hschange.org/CONTENT/1085/
13. Without those weights, the sample would be biased toward containing sicker patients.
14. Fiscella A, Franks P, Szanziger J, Mooney C, Sorbero M, Williams GC. Risk aversion and costs: a comparison of family physicians and general internists. J Fam Pract. 2000;49(1): 1-12.
15. Katz DA, Williams GC, Brown RL, Aufderheide TP, Bogner M, Rahko PS, et al. Emergency physicians' fear of malpractice in evaluating patients with possible acute cardiac ischemia. Ann Emerg Med. 2005;46(6):525-33.
16. Reed DA, Windish DM, Levine RB, Kravet SJ, Wolfe L, Wright SM. Do fears of malpractice litigation influence teaching behaviors? Teach Learn Med. 2008;20(3):205-11.
17. To access the Appendix, click on the Appendix link in the box to the right of the article online.
18. The risk index used secondary data from the National Practitioner Data Bank, the Medical Liability Monitor, market share reports published by the National Association of Insurance Commissioners, and the American Medical Association's Physician Masterfile. For details, see Note 6.
19. The American Medical Association, for instance, supports national legislation imposing a maximum cap on noneconomic damages of $250,000, as well as other efforts to reform medical malpractice. See American Medical Association. Medical liability reform [Internet]. Chicago: AMA; [cited 2013 Jun 26]. Available from: http://www.amaassn.org/ama/pub/advocacy/topics/medical-liability-reform.page
20. Specifically, age, sex, race, and "snowbird" status (defined as patients with at least 15 percent of their visits in a different census division than that of their main residential location).
21. Klabunde CN, Potosky AL, Legler JM, Warren JL. Development of a comorbidity index using physician claims data. J Clin Epidemiol. 2000;53(12):1258-67.
22. Hermer LD, Brody H. Defensive medicine, cost containment, and reform. J Gen Intern Med. 2010; 25(5):470-3.
23. Mello MM, Kachalia A. Evaluation of options for medical malpractice system reform [Internet]. Washington (DC): Medicare Payment Advisory Commission; 2010 Apr [cited 2013 Jun 5]. Available from: http://www.medpac.gov/documents/Apr10_MedicalMalpractice_CONTRACTOR.pdf
24. Lawthers AG, Localio AR, Laird NM, Lipsitz S, Hebert L, Brennan TA. Physicians' perceptions of the risk of being sued. J Health Polit Policy Law. 1992;17(3):463-82.
25. Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med. 2011;365:629-36.
26. Studdert DM, Thomas EJ, Burstin HR, Zbar BI, Orav EJ, Brennan TA. Negligent care and malpractice claiming behavior in Utah and Colorado. Med Care. 2000;38(3): 250-60.
27. Zeiler K, Silver C, Black BS, Hyman D, Sage WM. Physicians' insurance limits and malpractice payments: evidence from Texas closed claims, 1990-2003. J Legal Stud. 2007;36: S9-45.
28. Studdert DM, Mello MM, Gawande AA, Gandhi TK, Kachalia A, Yoon C, et al. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354(19):2024-33.
29. American College of Obstetricians and Gynecologists. Coping with the stress of medical professional liability litigation [Internet]. Washington (DC): ACOG; c2013 Jan [cited 2013 Jun 26]. Available from: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Professional_Liability/Coping_With_the_Stress_of_Medical_Professional_Liability_Litigation
30. McAninch CB, Chauhan SP, Magann EF, Chauhan VB, Brown JA, Morrison JC. Psychologic effects of poor outcome and professional liability actions on physicians. South Med J. 2008;101(10):1032-4.
31. Martin CA, Wilson JF, Fiebelman ND 3rd, Gurley DN, Miller TW. Physicians' psychologic reactions to malpractice litigation. South Med J. 1991;84(11):1300-4.
32. Seabury SA, Chandra A, Lackdawalla DN, Jena AB. On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim. Health Aff(Millwood). 2013;32(1):111-19.
33. Frakes M. The impact of medical liability standards on regional variations in physician behavior: evidence from the adoption of nationalstandard rules. Am Econ Rev. 2013;103:257-76.