Physicians’ claims that defensive medicine resulting from their fear of being sued is driving up health-care spending, is unfounded, according to study conducted by a researcher in Clemson University’s College of Business.

Barkowski, research, defensive, health care

Scott Barkowski, left, accepts an award for his research from the Southern Economic Association.
Image Credit: Submitted

Scott Barkowski, assistant professor in the John E. Walker Department of Economics, examined 16 years of medical spending in the U.S. to determine whether physicians’ defensive treatment practices were driving up health-care spending.

The study tapped several data sources, including the National Practitioner Data Bank, that identified adverse actions and malpractice payments for all 50 states from 1992-2008.

His research concluded there is no evidence that higher medical costs resulted from doctors ordering more tests and procedures to insulate themselves from malpractice actions.

A survey of physicians published in 2010 in the Archives of Internal Medicine found 91 percent of doctors who responded believed “physicians order more tests and procedures than needed to protect themselves from malpractice suits.” The survey also found 91 percent also agreed “protections against unwarranted malpractice suits are needed to decrease the unnecessary use of diagnostic tests.”

Physicians contend they will error on the side of over treating a patient out of fear that something might be missed, resulting in them being sued. So, they end up doing more than what may be necessary to mitigate those risks. The physicians’ concerns over litigation has gotten some traction in legislatures as more than half of the states have laws limiting malpractice damages.

Barkowski’s research introduces a second source of risk physicians face beyond those that may result from a missed diagnosis. He said adverse actions from regulators and medical boards pose more serious implications to physicians’ livelihoods.

“Sanctions from a regulatory authority are risks physicians aren’t insured for that can ultimately lead to having a license suspended or revoked,” Barkowski said. “It seems regulations that can affect your ability to practice medicine are as much or more of a risk than being sued.”

Though Barkowski’s research found no evidence of defensive medicine affecting health-care spending, it did find a hint of increase from regulatory authorities.

“My estimates would suggest that if the total amount of regulatory risk was cut in half, we would see health-care spending increase by almost half a percent. The effect is quite small, given that the average level of spending on hospital care averaged about $11.5 billion in each state,” he said. “So, it might serve us better to invest less time on tort reform and pursue other avenues to cut the fat out of our spending habits on health care.”

Barkowski’s research on health-care spending was the winner of the Southern Economic Association’s 2017 Georgescu-Roegen Prize. The prize is presented annually for the best academic article published in the Southern Economic Journal.

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