Defensive medicine drives up costs
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BOSTON - Dr. James Wang says he tries to tell his patients when extra medical procedures aren't necessary. If they insist, though, he will do it - not so much to protect their health as his own practice.
After being sued for allegedly failing to diagnose a case of appendicitis, Wang says he turned to what's known as "defensive medicine," ordering extra tests, scans, consultations and even hospitalization to protect against malpractice suits.
"You are thinking about what can I do to prevent this from happening again," he said, adding that he did nothing wrong but agreed to a minor settlement to avoid a trial.
The practice is under scrutiny as Congress attempts to get an accurate price tag for the sweeping national health care overhaul. A pivotal floor vote on the Democrats' bill could come as early as Saturday.
Doctors say the hidden costs of the tests along with malpractice insurance and lawsuit awards are major drivers behind the soaring cost of care. Trial attorneys say bad medicine, not lawsuits, is to blame. The debate has split along party lines, with Democrats typically siding with lawyers groups and Republicans agreeing with doctors.
The feuding between doctors' groups like the American Medical Association, who have long battled rising malpractice premiums, and trial attorneys, who say malpractice lawsuits discourage bad medicine, has made it tough to put an accurate price tag on the cost of the issues.
That, in turn, is hampering Congress from getting an accurate tally for any sweeping national health care overhaul as it seeks to balance those costs against expanded coverage.
Doctors say the price of defensive medicine and malpractice insurance accounts for up to 10 percent of health care spending. Lawyers say malpractice settlement costs amount to less than 0.5 percent of the $2.5 trillion spent each year on health care.
The cost of annual malpractice premiums can vary wildly depending on specialty, geographic location and insurance carrier.
A 2009 analysis from the nonpartisan Congressional Budget Office estimates that government health care programs could save $41 billion over 10 years if nationwide limits on jury awards for pain and suffering and other similar curbs were enacted. Those savings are nearly 10 times greater than CBO estimated just last year.
As Congress examines what to do about the issues, some places are examining programs and proposals to limit those costs.
The University of Michigan Health System uses a system that allows doctors to acknowledge mistakes and offer compensation, saving time, money and feelings. As a result, according to the university, malpractice claims fell from 121 in 2001 to 61 in 2006, while the backlog of open claims dropped from 262 in 2001 to 106 in 2006 and 83 in 2007.
The drive for less adversarial approaches has also sparked a "just say sorry" movement, trumpeted in part by the Sorry Works! Coalition, which advocates for disclosure, an apology when appropriate and prompt compensation when necessary.
Not everyone is enamored with the movement.
"An apology just means that the doctor is going to tell the truth," said Chris Milne, president of the Massachusetts Academy of Trial Attorneys.
