Gross Clinic (1875) by Thomas Eakins.
Blawgletter doesn't know where to come out on the pending health care debate. We hear about single payer, universal coverage, Harry & Louise, lobbyists, the AMA, Big Pharma, socialized medicine, taxing of benefits, cost controls, and lots of other buzzwords. Who can tell what to do?
One thing stands out for us — the notion of defensive medicine, an idea that says doctors order tests and avoid practice areas because they fear malpractice lawsuits. The impulse drives up costs. It may explain why Americans pay the most for health care but get less benefit than people who live in lower-cost countries.
Call us skeptical. A doctor may believe he requires unnecessary tests to protect himself, but you also need to know if the extra work — for him and others — also raises his pay and status.
[Has anyone studied the relative importance of the desire for self-protection versus the incentive for more money and professional standing? Can anyone separate out the effects of each?]
A group at Dartmouth said in February:
Recent research points to the critical role of "discretionary" decision-making by physicians, such as whether to admit a patient to the hospital, refer to a specialist, order diagnostic tests or see the patient more frequently. Local hospital and other provider decisions also matter, such as whether to make new investments in clinical services that have higher "profit" margins. Some data point to for-profit hospital ownership as contributing to more rapid growth.
Even if we abolish liability for malpractice, doctors would still struggle with the profit motive. We hope somebody figures out how to get incentives right.