Greater Use of Resources vs. Defensive Medicine: What’s the Difference?

In the second part of our Healthcare Matters interview with Dr. Anupam Jena, MD, PhD, we discuss the difference between defensive medicine and greater use of resources. Dr. Jena clarifies that, even if a physician is motivated by liability concerns to order more tests or procedures, it does not necessarily mean that the physician is practicing defensive medicine. Instead, it depends on the result of the additional care. If the result is beneficial to the patient, then it is not defensive medicine – even if the physician was motivated by liability concerns. As Dr. Jena explains, “….the intent of the malpractice system (is) to get physicians to practice appropriately…. To the extent that greater use of healthcare services actually improves patient outcomes, we don’t want to call that defensive medicine.” Instead, defensive medicine includes only additional care that provides no benefit to the patient.

Dr. Jena also delves into the results of his study, describing three major findings. First, according to the study data, physicians who spend more are less likely to get sued. Second, when observing the same physician over time, in years when that physician spent more, he or she was less likely to get sued compared with years in which that same physician spent less. Finally, Dr. Jena discusses the example of C-sections, which are widely thought to be defensively motivated in the United States, as U.S. rates are very high. However, the results of Dr. Jena’s study indicate that physicians who ordered more C-sections were less likely to be sued. Though these results are very intriguing, as Dr. Jena explains, he and his fellow researchers did not look at outcomes, so it is difficult to determine whether these increases in spending were defensive in nature, or actual examples of better care leading to better outcomes and, therefore, a lower rate of lawsuits.

A medical doctor and economist, Dr. Jena is Associate Professor of Healthcare Policy and Medicine at Harvard Medical School and an assistant physician at Massachusetts General Hospital. His research areas include medical malpractice, the economics of medical innovation and cost effectiveness, geographic variation in medical care and insurance benefit design.

See Part II of our wide-ranging interview with Dr. Jena below, or watch the entire program here.


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