It is a common idea: healthcare costs are so high because doctors are forced to order unnecessary tests to protect themselves from liability in medical malpractice lawsuits. Although this notion is widely held in society, a recent study indicates that laws making it harder to sue doctors for medical negligence do not reduce the amount of “defensive medicine” practiced by doctors in states with those medical malpractice reform laws.
The New England Journal of Medicine study found that although “physicians say they order unnecessary tests strictly out of fear of being sued.” In actuality, “the story is more complicated.” The study looked at the practices of emergency room doctors and associated health care costs of emergency room treatment in Texas, Georgia, and South Carolina (three states that passed laws making it harder for injured patients to recover in medical malpractice lawsuits against emergency room doctors). The study considered three factors associated with defensive medicine: 1) ordering of advanced imaging such as CT or MRI scans, 2) whether the patient was admitted to the hospital after an emergency room visit, and 3) the total billed charges for a patient’s emergency room visit. In Texas and South Carolina, the recent medical malpractice reform laws caused no reduction in emergency room charges. In Georgia, average emergency room bills were 3.6% less than before the implementation of the 2005 medical malpractice reform laws.
The author of the study, Daniel Waxman, M.D., Ph.D., indicated that the laws are “legislation looking for a problem that doesn’t exist.” He stressed that most emergency room doctors are not ordering extra tests in an effort to protect themselves from liability but because emergency room doctors have to make decisions with limited information while avoiding causing harm to the patient and not wanting to say “No” to a patient: “In the ER, you have to make snap judgments on incomplete information. Nobody ever faults you for doing another test or admitting a patient to the hospital, but there are lots of ways you can be faulted for not doing those things.”
Whether intentionally or unintentionally, it appears that the legal system and medical negligence lawsuits have become a scapegoat for the costs of modern healthcare. However, in reality, the implementation of medical malpractice reform laws have had little effect on healthcare costs or how emergency room doctors diagnose and treat patients.
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