Defensive Medicine Driving Up Healthcare Costs

Posted on: November 16, 2009  |   Author: Jamie
Filed Under: Access to Care, Fraud & Abuse, Health Information, Liability & Litigation, Other   |   Leave a Comment

There is a heated debate currently ensuing between doctors and lawyers about defensive medicine and its effect on the rising costs of healthcare in the U.S.  Doctors attribute the high costs of healthcare to the payments of malpractice insurance and malpractice lawsuit awards.  Trial attorneys, however, are blaming the rising costs on the practice of “bad medicine.”

Of the $2.5 trillion dollars spent each year on healthcare, doctors say that 10 percent of this amount is attributable to practicing defensive medicine and paying for malpractice insurance, while lawyers attribute less than .5 percent of this spending on payments for medical malpractice settlement costs.  Around 720 doctors who responded to a 2008 survey by the Massachusetts Medical Society reported practicing defensive medicine in fear of facing a malpractice lawsuit, estimating the cost of extra tests to be around $281 million and unnecessary hospital admissions around $1.1 billion.  A study by researchers at the Harvard School of Public Health and Columbia Law School performed in 2005 found 93 percent of the 824 doctors who participated reported practicing defensive medicine. Lawyers attribute the rising costs of healthcare to “bad medicine,” insisting that medical malpractice suits protect patients from the devastating effects of medical errors. Lawyers also feel that the extra tests involved in the so-called practice of defensive medicine are really fueled by the self-interest of the doctor, arguing that many doctors have a financial interest in laboratories that conduct extra tests or procedures creating a conflict of interest which could add to the level of unnecessary tests.

Congress is currently deciding how to curb the rising costs of healthcare. A 2009 Congressional Budget Office analysis estimates that government health care programs could save $41 billion over 10 years if national limits on jury awards for pain and suffering in malpractice suits were enacted, along with similar restraints.  Along with this approach, there has also been a drive for less adversarial approaches to limiting rising malpractice costs. The University of Michigan Health System uses a system in which doctors acknowledge mistakes and then offer compensation, causing malpractice claims to fall from 121 in 2001 to 61 in 2006.  Another movement, which has found less support with lawyers, is a campaign enacted in part by the Sorry Works! Coalition urging doctors to apologize for their wrongdoing and provide prompt compensation when appropriate.

Commentary: In the article, Dr. James Wang points out that he makes an effort to tell his patients when the treatments they may be considering are not necessary in order to keep the cost of providing care to a minimum. If the patients insist that they have the unnecessary test done though, Wang admits to ordering or performing the procedure in order to protect himself from a medical malpractice lawsuit later. Wang is among many doctors who admittedly perform defensive medicine in order to protect themselves from suits of medical malpractice. The catch here is that in many cases, doctors are not practicing “bad medicine” and are actually attempting to inform patients that the treatments they seek are not required for their health. In these, the majority of situations, if the choice comes down to protecting themselves from a lawsuit even though they practiced sound medical judgment or ordering tests even though they incur further unnecessary costs, how can society fault doctors for choosing to protect themselves?

msnbc.com, Nov. 4, 2009.

Calorie Counting in NYC

Posted on: November 5, 2009  |   Author: Karla
Filed Under: Legislation, Public Health Policy   |   Leave a Comment

New York City was the first city in the United States to legally require caloric content to be posted clearly next to menu item prices in chain restaurants.  Since this “ground-breaking calorie labeling law” was passed, 16 states and localities have passed similar laws.  Two recent studies reported findings that contradict one another.  However, the discrepancies are due to variations in study focus and size.

The first study focused on low-income, minority neighborhoods.  Researchers assessed the effect of calorie labeling on individuals purchasing chain food within these neighborhoods.  The results of the low-income neighborhood study show that the calorie labeling law had no effect on the meals purchased at chain restaurants.  “We looked at a population that’s much more price sensitive, so calorie information could have taken a backseat to pricing in our group,” said Brian Elbel, assistant professor of medicine and health policy at New York University School of Medicine and author of the study.  Elbel also noted that he would have liked to have seen a larger impact on this population because obesity rates tend to be higher within the low-income, minority neighborhoods.

The health department’s study assessed the effect of the calorie labeling law on a citywide level.  The results of this study showed little change in the amount of calories purchased at 8 of 13 chain restaurants surveyed.  People purchased fewer calories at Au Bon Pain, Kentucky Fried Chicken, McDonald’s and Starbucks. Despite the lack of change among the majority of chain restaurants, there were two interesting findings.  First, the amount of calories purchased at Subway has increased significantly.  Researchers attributed the increase to the ongoing “$5 footlong” sandwich promotion. Secondly, the number of calories purchased at coffee shops decreased by nearly 10 percent.  In 2007, the average amount of calories purchased at coffee shops was 260.  Now, the calorie average is down to 237 calories.

Among chain restaurant customers, only 56% said they noticed the calorie information posted with the prices.  An even smaller number, 15%, used the calorie information when deciding what to order.  On average, the 15% of individuals that take the calorie information into account purchased 106 fewer calories than consumers who did not notice or use the calorie information.  “Dietary changes come slowly,” said Dr. Lynn Silver, an assistant commissioner in the city’s Department of Health and Mental Hygiene, while explaining the results.

Commentary: Although New York City’s calorie labeling law has not achieved significant results in reducing caloric consumption throughout the city and within low-income, minority neighborhoods, the law has made an impact in a short amount of time.  This law was the first of its kind, and it is promising to see that 16 other states and localities have followed in New York City’s footsteps.  Further, the 10 percent decrease in the amount of calories ordered at coffee shops is a step in the right direction.  Many of the calories that people overlook are liquid calories, such as those found in flavored lattes and blended coffee drinks.  Unfortunately, the results from the low-income neighborhood study show that caloric content is less influential than lower prices.  In order to decrease caloric intake in low-income neighborhoods, healthy foods need to be more affordable and available.  Despite these challenges, the law is still young and could make a larger impact in the years to come.

The New York Times, November 2, 2009