Yesterday we touched on the myth of defensive medicine’s connection to medical malpractice. It does not make sense logically, and there is no credible evidence that medical professionals order more tests than necessary as a result of fear of lawsuits. Instead, these misleading arguments are advanced in order to unfairly influence public opinion to take away the rights of community members. This is certainly the case in Chicago and throughout Illinois, as lawmakers have passed tort reform laws in our state in the past. Fortunately, most of those efforts have been struck down by the state Supreme Court as violations of our our state constitutional dictates.
The Real Cause of “Defensive” Medicine Importantly, rejecting the myth that defensive medicine is caused by med mal fears is not the same as suggesting that there is not a problem with the ordering of unnecessary tests or procedures. In fact, there very well may be too many tests ordered by doctors that drive up the costs of healthcare. But the real culprit behind those tests is simple: profit for medical providers. The Center for Justice & Democracy’s briefing book touches on this subject and summarizes various studies and stories which seek to show how extra medical care is caused by the age-old motivator–money.
For example, this is illustrated most vividly in cases involving unnecessary cardiac work. Just last month the New York Times published a story indicated how “unnecessary and dangerous [heart] procedures were taking place at some HCA hospitals, driving up costs and increasing profits.” Sadly, evidence was uncovered showing that many cardiologists were recommending costly procedures without proper justification for ordering the tests. In fact, sometimes misleading statements were made to make it seem as if the tests were necessary.
This situation illustrates an often overlooked, but obvious fact–as “defensive” medicine goes up, medial profits go up. In that light, it’s clear that there isn’t anything much “defensive” about these extra procedures.
The Real Evidence
The briefing book points to a helpful analysis from the Washington Post to indicate how doctors are the true beneficiaries of claimed “defensive” medicine. The story shares the example of a medical clinic on the Illinois and Iowa border that usually ordered eight or nine CT scans a month. However, protocol changes took place where doctors began bringing their own CT scanner into the clinic. That means that instead of sending out the tests to others, doctors could order the tests in-house–and keep the profits.
Did the altered profit-motive change the ordering of CT scans? Absolutely.
It wasn’t long before the tests were ordered seven times more than in the past–from seven or eight to forty-nine to fifty-six tests per month.
Similar problems were found at other medical clinics. One study found that, on average, ordering of expensive tests tripled once the doctors did their own tests (and reaped the profit-benefit).
A health economist and public policy professor from the University of Georgetown noted that if we eliminate this sort of profit-motive it “could reduce the nation’s health care bill by as much as a quarter.”
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