Does defensive medicine decrease malpractice claims?

New research published in the British Medical Journal links higher medical spending with decreased malpractice claims. Dr. Anupam B. Jena and her colleagues at Harvard Medical School asked the question: if doctors use more resources, do they suffer fewer malpractice claims? Accessing an enormous database of almost all hospital admissions in Florida from 2000 to 2009, Dr. Jena was able to take a deep look into this question for seven specialties. In their statistical analysis, the researchers were even able to account for multiple potentially confounding characteristics, including patient factors and diseases.

The data set included 24,637 doctors, 18 million hospital admissions, and 4,342 malpractice claims. The researchers found that across six of the seven specialties, more spending was significantly associated with fewer malpractice claims in the next year. For example, internists spent between $19,725 and $39,379 on average for each hospital admission. Internists who spent the least had a malpractice rate of 1.5%, while those who spent the most had a malpractice rate of 0.3%.

Of particular interest to this blog, the study paid special attention to obstetrics. OBGYNs spent between $8,653 and $18,162 on average for each hospital admission.  The researchers pulled out data on 1.5 million deliveries performed by 1,625 OBGYNs. The authors looked at the 496 malpractice claims filed against these obstetricians for deliveries and found that obstetricians with higher c-section rates had fewer law suits. For doctors who performed the most c-sections, the malpractice suit rate was 2.7%, but for those who performed the fewest, the malpractice suit rate was 5.7%. The study looks at correlation, and not causation, so we don’t know if doing more c-sections caused less suits, or if they are just related somehow.

While using this giant data set allowed the researchers to access a tremendous number of admissions, physicians, and claims, it did not allow the researchers to peer inside the motivation behind the spending. At this point, we can only assume that more spending was a result of defensive medicine. Interestingly, if the higher spending is actually resulting in fewer errors, then it may not be wasteful. Unfortunately, malpractice claims do not always match up with actual errors, and it’s entirely possible that spending more led to more errors, not fewer, but people sued less for another reason. For instance, some research suggests that more spending leads to higher patient satisfaction, but worse healthcare. So, while it’s certainly exciting to think spending more is an easy way to decrease law suits, the opposite may be true in the long term.