Abstract Our Nation is currently engaged in a debate about the future of health care in America. Health care reform has several platforms to be addressed in order for it to be successfully implemented. Tort reform, being one of those platforms, is proposed as one solution to the rapidly increasing health care cost in the United States. Careful reform of medical malpractice laws can lower administrative costs and health spending. This will also lead to improved patient safety and steer physicians away from the costly practice of defensive medicine. Defensive Medicine.
Is It Costing Our Health Care System? As the debate continues on national health care reform, both Republicans and Democrats agree that bipartisan cooperation and compromise are necessary to solve America’s health care problem. Rising cost, unequal access, and average outcome describes some of the issues that are currently on the reform agenda for these political parties. As this debate continues, one of the topics that are being discussed is tort reform. Tort reform refers to proposed changes in the civil justice system that would reduce tort litigation or damages.
In the United States tort reform is a contentious political issue. US tort reform advocates propose, among other things, procedural limits on the ability to file claims, and capping the awards of damages. Democrat Senate Finance Chairman Max Baucus wrote in a health care reform paper, “Careful reforms of medical malpractice laws can lower administrative cost and health spending…. A serious effort at comprehensive health care reform then should address medical malpractice. ” Baucus argues tort reform would lead to “improved patient safety” and move physicians.
“away from the costly practice of defensive medicine and toward the best quality of care. ”(Baucus, 2009) A Harvard School of Public Health study indicated 40 percent of malpractice lawsuits are “without merit. ” Professional services firm Towers Perrin estimates the burdensome cost of medical lawsuits at $30 billion a year nationally, directly impacting American health care cost. (2006) The growth in medical malpractice awards has played a significant role in the way physicians feel they have to practice medicine.
Many now adopt an attitude that “views every patient as a potential lawsuit. ” This protective fear-of –lawsuit attitudes result in physicians adopting behaviors that increase healthcare cost through the practice of defensive medicine. (Weinstein, 2008) Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily not to ensure the health of the patient, but as a safeguard against possible malpractice liability. Fear of litigation has been cited as the driving force behind defensive medicine.
(Weinstein, 2008) Defensive medicine is a consequence of malpractice lawsuits that contribute to the increase of healthcare nationwide. The current medical liability crisis has had many unintended consequences, most notably a decrease in the access to care in a growing number of states and an increase in healthcare costs. (Weinstein, 2008) A study in the Journal of American Medical Association says defensive medicine is more that wasteful it “may reduce access to care and even pose risk of physical harm.
”(2005) Access is affected as physicians move their practices to states with lower liability rates and change their practice patterns to reduce or eliminate high risk services. This leads to another unintended consequence, a change in doctor-patient relationships. (Weinstein, 2008)” The fear of being sued that is driving physicians to defensive medicine is dramatically increasing healthcare cost and threatens the success of health reform efforts,” says Dr. Manish Sethi, a researcher with the Department of Orthopedic Surgery at Massachusetts General Hospital.
(Goodnough, 2009) Defensive medicine takes two main forms: assurance behavior and avoidance behavior. Assurance behavior involves the charging of additional, unnecessary services in order to a)reduce adverse outcomes, b)deter patients from filing medical malpractice claims, or c)provide documented evidence that the practitioner is practicing according to the standard of care, so that if, in the future, legal action is initiated liability can be pre-empted. (David M. Studdert, et al. , 2005) Diagnostic defensive medicine practices have a much greater impact on costs that do therapeutic defensive practices.
One study conducted by American Academy of Orthopedic Surgeons, showed assurance behavior reported by 92 percent of physician respondents involves ordering test (particularly radiological imaging) performing diagnostic procedures through CT scans, x-rays, MRI studies, ultrasound studies, laboratory testing and referring patients for consultation. The ordering of unnecessary tests can lead to diminishing quality of care and produce emotional distress and necessitate additional invasive or hazardous procedures.
Reported in this same study, avoidance behavior was reported by 42 percent of physician respondents. Avoidance behavior occurs when providers restrict their practice eliminating high-risk procedures and procedures prone to complications, and avoiding patients with complex problems or patients perceived as litigious. On the therapeutic side, defensive therapeutic measures such as Caesarean sections or invasive procedures such as breast lump biopsies are accompanied by significant risks to patients and increased healthcare expenditures not to mention the issues of patient safety.
Physicians practice patterns have clearly changed in response to the liability crisis. With no relief in sight, these defensive behaviors will become engrained in a new standard of care, and healthcare costs will continue to rise unnecessarily. Our only hope is that federal and state legislators will take this key issue into consideration when developing a comprehensive approach to America’s healthcare crisis. (Weinstein, 2008) Civil litigation reform can improve the climate of health care practice in America. Doctors practice less defensive medicine thus lowering overall industry cost.
Patients and doctors have improved relationships. Lawsuit abuse no longer pushes doctors into early retirement removing valuable experience and expertise from the medical field. More doctors mean greater choice, opportunity and patient access. Medical malpractice reform opens the door to more doctors. Without tort reform, we are sure to see patient lines getting longer. Defensive medicine is definitely a threat to the success of the healthcare reform efforts and is a big burden nationally to the healthcare system.
(Perry Beider, 2004) If we want a change in our country’s health care that will make a positive difference we need to start with tort reform. Tort reform’s impact is significant. It may be small but it can be measured. President Barack Obama advocates a healthcare reform to lower cost, reduce waste, enhance quality of care, and improve patient access, and increase choice and competition. He states “It will provide more security and stability to those who have health insurance. It will provide insurance to those who don’t.
It will lower the cost for our families, our businesses, and our government. ” To have the reform that impacts cost, such reform must include medical malpractice reform. (Obama, 2009) The findings show that defensive medicine is a definite practice which many physicians have been persuaded to follow. With experience in direct patient care, this is not a surprising fact. As an experienced radiology technologist this type of care is very common to see, physicians ordering test after test, “in our eyes” for no apparent reason. Now the reason is clearer to understand.
Having researched tort reform and medical malpractice, I now have a more broad understanding of how the “tort” system works in relation to physicians and medical malpractice. R References David M. Studdert, L. S. , Michelle M. Mello, J. P. , William M. Sage, M. J. , Catherine M. DesRoches, D. , Jordon Peugh, M. , Kinga Zapert, P. , et al. (2005). Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment. Journal of American Medical Association , 293:2609-2617. Glass. (n. d. ). The High Cost of Defensive Medicine.
Ezine Articles . Goodnough, K. (2009). Study Shows Defensive Medicine Widespread. UCON Advance . Kessler, S. B. (2005). Impact of Malpractice Reforms on the Supply of Physicians Services. Journal of American Medical Association , 293:2618-2625. Obama, B. (2009). The Obama Plan: Stability and Security For All Americans. Perry Beider, S. H. (2004). Limiting Tort Liability For Medical Malpractice. Taylor, L. (2009). Tort Reform Critical To Health Reform Success. New Albanynew-Exchange , 4. Weinstein. (2008). The Cost of Defensive Medicine. Rosemont.