Despite tort reform efforts aimed at reducing malpractice risk, a recent study indicates physicians are still worried about lawsuits, leading them to practice defensive medicine and driving up healthcare costs.
Many tort reform efforts are driven by the idea that fear of being sued leads physicians to practice defensively – for example, ordering unnecessary lab tests for a patient. But researchers at the University of Iowa say reform isn't alleviating doctors' concerns, so they're still practicing defensive medicine.
"We found that both generalist and specialist physicians fear being sued for malpractice even in states where their risk of being sued is relatively low," said senior study author David Katz, MD, an associate professor of medicine with University of Iowa Health Care. "One likely explanation is that physicians' concerns about malpractice are driven more by their perception that the malpractice tort process is unfair and arbitrary and less by their actual risk of getting sued."
Katz, who is also a research investigator at the Center for Research in the Implementation of Innovative Strategies in Practice at the Iowa City Veterans Affairs Medical Center, conducted the study with colleagues from the Center for Studying Health System Change in Washington, D.C., and the Harvard School of Public Health. The findings were published in the journal Health Affairs.
According to the research team, a national survey found high levels of concern about being sued for malpractice among all physicians, regardless of specialty or geographic location.
Physicians in the highest-risk states, however, expressed only modestly higher levels of concern than those in low-risk states (4.3 points on a 100-point scale). This small difference was particularly surprising given that physicians in the least risky states have less than one-third of the malpractice risk as those in the most risky states. The researchers used objective measures of risk, such as malpractice premium rates and risk of incurring a paid malpractice claim, to calculate physicians' actual malpractice risk.
"The high levels of malpractice concern, even among physicians in relatively low-risk environments, is striking," Katz said. "One possible explanation is that most physicians do not have the information to accurately access their actual risk of being sued."
The study indicates several types of state tort reforms, such as caps on total damages, are individually associated with significantly reduced malpractice concerns, but the results were mixed.
In addition to Katz, the study team included Emily Carrier, James Reschovsky, Michelle Mello and Ralph Mayrell. The study was funded in part by the Robert Wood Johnson Foundation.