“They did a nice job of finding a population of patients who are being treated by doctors who didn’t have any liability,” said Mark McClellan, the director of the Duke-Margolis Center for Health Policy. Dr. McClellan was a top health official in the George W. Bush administration, which pushed for national liability caps. The paper’s focus on the hospital allowed the researchers to have a lot of precision in their measurements. But it means they didn’t capture all the places where defensive medicine might occur. It’s possible, for example, that liability concerns cause treatment to rise by more than 5 percent for emergency room patients who go home the same day — or not at all in a typical office visit. Mr. Frakes and Mr. Gruber examined a large number of quality indicators to determine whether the doctors who practiced less intense medicine on their military patients were somehow cutting corners. Each measure differed, and there were some places where harm couldn’t be ruled out, but they found no place where the quality of care in the military hospital appeared to clearly be worse. That finding suggests that, when doctors do extra treatment or testing to avoid liability, they are not necessarily taking extra steps that make their patients any healthier. “It suggests that physicians change their behavior in response to liability considerations, but they don’t do it in a very calibrated way,” said Michelle Mello, a professor of law and health policy at Stanford, who has studied medical malpractice. “They tend to make a lot of changes that don’t result in better patient care.” In the federal government and in states, there are frequent proposals to limit medical liability, but there have been no serious efforts to eliminate medical malpractice rights altogether. Mr. Gruber said the paper’s estimates were best viewed as a kind of ceiling for the effects of more realistic reforms. Any law that limits the cases where patients can sue, or the amount of money they can collect, is likely to lower medical use in the hospital by less than the 5 percent they measured in their study. Amitabh Chandra, a health economist at Harvard, said the best policies needed to lower the burden on physicians while still generating “social value.” He said that continued research on the relationship between malpractice pressure and health care quality was important as different approaches were tested.
The medical malpractice system in the US and doctors’ fear of being sued really does add costs, according to a study. US doctors often say that fear of suing forces them to order unnecessary tests and procedures to protect themselves. But some top health economists, including some at Harvard, tend to play down such costs, saying that medical practice is not too affected by fear of liability. Researchers from Duke and MIT have now released what could be the most precise estimate of the costs of “defensive medicine”, at least for hospital care. They found that the likelihood of a lawsuit raised the intensity of health care that people got in hospital by about 5 percent. In addition, the study found that the patients who received extra care were no better off. The researchers examined the health care system for active-duty members of the military, who get access to a government system but are prevented from suing doctors and hospitals for malpractice. They then looked at what happened to the hospital care that these military staff received when a based closed, forcing them to use their benefits in civilian hospitals, where they could sue. The researchers found that spending on health care increased, particularly on extra diagnostic costs. Commenting on the study, Michelle Mello, a professor of law and health policy at Stanford, said that the report showed that physicians changed their behaviour in response to liability considerations, but not in a very calibrated manner. There are frequent proposals, both at federal and state level, to limit medical liability but there have been no serious attempts at eliminating medical malpractice rights altogether. Jonathan Gruber, a health economist at MIT and study author, said the estimates were best seen as a kind of ceiling for the effects of more realistic reforms. Any law limiting the cases where can patients can sue, or the amount of money they receive if successful, is likely to decrease medical use in the hospital by less than the 5 percent they measure in their study. Meanwhile Amitabh Chandra, a health economist at the Congressional Budget Office, said the best policies needed to reduce the burden on doctors while still generating “social value.” The study authors put forward a range of different types of changes that could be made, including one where physicians would be protected from liability if they adhered to common standards of care. The most popular state action has been capping monetary damages, but other approaches have yet to be tried.