Offensive medicine

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HALFWAY through the heated battle over health reform last year, Barack Obama delivered an impassioned address to a joint session of Congress. In an effort to win bipartisan support, he raised the prospect of reforming the controversial system of medical tort. Conservatives believe this to be a huge contributor to health costs, but it is a topic Democrats avoid (not least because they receive plenty of cash from trial lawyers).

His olive branch was rejected, and health reform passed Congress in March without a Republican vote. Still, the question of tort reform lingers. Mr Obama accepted in that big speech last September that “defensive medicine may be contributing to unnecessary costs.” And conservatives still argue this is a big reason health care now costs a staggering 17% of GDP.

How much? Not so much, argues a provocative new study published on September 7th in Health Affairs, a policy journal. Michelle Mello of the Harvard School of Public Health and her co-authors first scrutinised data on the direct costs, such as legal damages paid and attorneys’ fees, of the medical liability system. They think these cost less than $10 billion a year.

They also tried to calculate some of the indirect costs, such as the use of “defensive” medicine, and came up with a figure close to $46 billion a year—but Ms Mello is quick to acknowledge the limitations in this area. It is hard enough to work out if doctors are over-utilising tests or services to protect themselves in case they are later sued, but how does one know if fear of litigation is keeping doctors out of certain high-risk fields (say, obstetrics)?

Their overall estimate of $56 billion a year seems like a lot, but it represents a mere 2.4% of total health-care spending. It is also in line with previous estimates made by the Congressional Budget Office. So the wilder claims made by conservatives are therefore suspect.

Even so, reform is still clearly desirable. Happily, Mr Obama is acting, up to a point. In June his administration launched seven demonstration projects, at a cost of $25m, to showcase such reforms as improving safety practices in hospitals, informing patients quickly if they are injured, providing speedy compensation and using expedited means of dispute resolution.

Those small schemes will not satisfy those who want wholesale reform, such as caps on damage awards. But this argument is also exaggerated. Many states, including Texas, have caps (for example, limiting awards for “emotional distress” caused by malpractice), but medical inflation has not slowed down noticeably in those jurisdictions.

The authors of the study point an accusing finger at a different, and more pernicious, factor: the country’s “fee for service” model of medicine. By encouraging overuse of health care, they argue, this costs the country more than does the much-maligned legal system.

http://www.economist.com/blogs/democracyinamerica/2010/09/medical_malpractice?fsrc=scn/fb/wl/bl/offensivemed

[TBoneTX 47,545]

This is an interesting and surprisingly complex topic, si man. This article from 2009 touches on some of the above matters and raises our awareness of others:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676526/

Feedback here is encouraged, si man.

[Heracles 417]

$56 billion a year seems like a lot, but it represents a mere

Yes, what is $56,000,000,000 a year wasted on tort #######. These must be the same people who think the tens of billions spent on illegals are also a drop in the pond.

It's a big deal when your country is bankrupt and starting programs that it cannot afford.

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$56 billion a year seems like a lot, but it represents a mere

Yes, what is $56,000,000,000 a year wasted on tort #######. These must be the same people who think the tens of billions spent on illegals are also a drop in the pond.

It's a big deal when your country is bankrupt and starting programs that it cannot afford.

Do you always carry illegals around everywhere you go, in the hope that you can use them as props at your next comedy show?

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This is an interesting and surprisingly complex topic, si man. This article from 2009 touches on some of the above matters and raises our awareness of others:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676526/

Feedback here is encouraged, si man.

Great article. I'm no doctor but I do think I understand what the author means by vanishing clinical skills. I was fortunate, a few years ago, to happen upon a primary care physician who didn't address every complaint I presented with a battery of tests and/or a prescription. And the track record so far is that he's been right about just about everything. I think I finally understand what "clinical skills" are, if this dude is any indication.

[TBoneTX 47,545]

Great article. I'm no doctor but I do think I understand what the author means by vanishing clinical skills. I was fortunate, a few years ago, to happen upon a primary care physician who didn't address every complaint I presented with a battery of tests and/or a prescription. And the track record so far is that he's been right about just about everything. I think I finally understand what "clinical skills" are, if this dude is any indication.

Exactly the same here, si man.

By the way, for more by this doc (all readable & thought-provoking), go here:

http://www.ncbi.nlm.nih.gov/entrez/query/static/citmatch.html

type "Tex Heart" in the Journal line, & click the one suggested choice; then type "Fred" into the Author line, then hit "search."

Some of these are actual medical articles, but others are like the citation above. I like #9 & #14, personally, si man.

Edited September 9, 2010 by TBoneTX

[ValerieA 350]

Do you think the $10B includes that cost of malpractice insurance, or just the actual costs of getting sued?

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Do you think the $10B includes that cost of malpractice insurance, or just the actual costs of getting sued?

Insurance premiums are a direct cost, so I presume they are counted as such.

Michelle Mello of the Harvard School of Public Health and her co-authors first scrutinised data on the direct costs, such as legal damages paid and attorneys’ fees, of the medical liability system. They think these cost less than $10 billion a year.

They also tried to calculate some of the indirect costs, such as the use of “defensive” medicine, and came up with a figure close to $46 billion a year.

Edited September 9, 2010 by Legacy member

[Heracles 417]

As is the norm for a particular group, they pick and chose aspects of HC abroad and ignore anything that they do not agree with, yet actually makes the system viable [affordable].

No public system abroad allows you to sure frivolously when there is no real or deliberate malpractice. Then again, under the logical English law of tort, I cannot sue anyone unless they were deliberately negligent. A honest mistake is not grounds for $20 million there, nor should it be. It's common sense that a doctor is not some alien able to figure out and screen for all issues, nor are they some machine. People here are not suing for legitimate professional negligence, they are simply suing because they can.

I saw it myself during the two occasions I used a doctor here. They were forced to carry out unnecessary tests so no fuckwit sues them. This is simply not acceptable under public systems and a doctor can get into serious trouble, as it unnecessarily adds to the cost and wait times of others.

Edited September 9, 2010 by Heracles