Study: ‘Defensive medicine’ represents small portion of medical costs

Defensive medicine, which is care delivered in response to a fear of malpractice lawsuits, accounted for about 28 percent of tests, procedures and hospitalizations at three hospitals, according to a study published in JAMA Internal Medicine.

Defensive medicine has been estimated to cost $46 billion annually in the U.S., although those costs have been measured directly, according to the study.

Cleveland Clinic researchers assessed the cost of defense medicine for these services by asking physicians to estimate the defensiveness of their own orders. For the study, the 36 hospitalist physicians rated 4,215 orders for 769 patients.

Of the orders, 28 percent were rated as at least partially defensive and the mean cost was $1,695 per patient, of which $226 was defensive. Completely defensive orders represented about 2.9 percent of costs, mostly because of additional hospital days, the researchers found.

“[A]lthough a large portion of hospital orders had some defensive component, our study found that few orders were completely defensive and that physicians’ attitudes about defensive medicine did not correlate with cost. Our findings suggest that only a small portion of medical costs might be reduced by tort reform,” wrote lead author Michael B. Rothberg, MD, MPH, Cleveland Clinic, et al.