There’s an elephant on the table in the planning sessions over how to fix what’s wrong in the delivery of health care in America today.
In the midst of ongoing debate over the scope and
desirability of various health care reform proposals, an obvious and
critical component of cost management is going unnoticed: malpractice
In the case of medical insurance in the United States, there are an
estimated $5.8 billion in medical malpractice claims annually.
While this figure may seem inconsequential when compared with health
care spending expected to reach $2.5 trillion this year, the true
import of these billions is found not merely in the direct cost of
lawsuits. More significant is the number of procedures that are
performed as so-called “defensive medicine,” intended more to mitigate
exposure to litigation than to promote patient welfare. While it is
difficult to estimate the costs of these kinds of practices, a study
published in November of 2008 by Massachusetts Medical Society and
UConn Health Center researcher Robert Aseltine Jr. found that 83
percent of doctors surveyed admitted to “practicing defensive medicine,
with an average of between 18 percent and 28 percent of tests,
procedures, referrals, and consultations and 13 percent of
hospitalizations ordered for defensive reasons.” These are not
insubstantial numbers, especially if you happen to be one of the many
patients directly affected by such defensive medical practice.
The corrosion of the culture of trust necessary to good medical care
resulting from these kinds of practices is perhaps even more worrisome
than the clearly quantifiable economic costs. Patients are less
inclined to trust doctors whom they believe are ordering tests and
procedures out of a desire to protect their own economic interests.
Patients in turn are much more apt to turn to legal remedies when they
feel that doctors have not been forthcoming and trustworthy.
This is a key point I haven’t heard discussed much in the prolific media coverage. Now look at this:
The University of Michigan Health System has implemented
a policy in which doctors help foster a culture of trust by voluntarily
admitting when mistakes have been made and offering compensation before
legal action has been undertaken by the patient. A study by risk
officers and officials at the health system found that malpractice
claims were cut nearly in half after the implementation of this
approach, from 121 in 2001 to 61 in 2006.
Restoring trust in the relationship between patient and doctor is
critical to health care reform that promotes human flourishing and