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Higher-Cost Care Reduces Malpractice Claims Against Physicians

BOSTON – Money might not be able to buy happiness, but it does appear to help protect physicians against having malpractice claims filed against them.

That’s according to a recent report, published in BMJ, the British Medical Journal, which finds that higher-spending physicians face fewer malpractice claims.

The study led by Harvard Medical School researchers notes that nearly three-quarters of physicians report practicing defensive medicine, at a cost of as much as $50 billion annually in the United States.

Despite the widespread use of defensive medicine, little research exists on its effectiveness in protecting against malpractice claims.

The research combined data on 18,352,391 hospital admissions in Florida during 2000-09 with data on the malpractice histories of the 24,637 physicians who treated the patients. With 4,342 malpractice claims filed against physicians, 2.8% per physician-year, rates of malpractice claims ranged from 1.6% per physician-year in pediatrics to 4.1% per physician-year in general surgery and obstetrics and gynecology.

Yet, in six out of seven specialties, higher-spending physicians faced fewer legal actions. Among internal medicine physicians, for example, those in the bottom 20% of hospital spending –about $19,000 per hospitalization –faced a 1.5% probability of being accused of malpractice compared to 0.3% in the top spending quintile – about $39,000 per hospital admission.

In another example, obstetricians who performed more C-sections, often used in defensive practice, were less likely to face a malpractice claim.

"It has remarkably been unknown whether defensive medicine 'works' or whether the majority of U.S. physicians could be incorrect in believing that greater spending is associated with reducing malpractice liability," said lead author Anupam Jena, associate professor of health care policy at Harvard Medical School.

"The threat of malpractice is a very salient risk for most practicing physicians, particularly in high-risk specialties," added co-author Seth Seabury of the University of Southern California. "If physicians perceive that higher spending can protect them from malpractice claims, then they are likely to practice defensively even if they feel that the additional spending is unnecessary or offers no clinical benefits to patients."

Previous research by Jena and Seabury found that the typical physician spends nearly 11% of his or her career with an open malpractice claim and that, in some high-risk specialties, the lifetime risk of being sued is nearly 100%.

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