Saturday, June 15

Study Suggests Patient Demands, Medical Malpractice Not to Blame for Ballooning Health Spending

Physicians often believe that patient requests for inappropriate care are responsible for a major portion of rapidly rising healthcare costs, but that perception isn’t borne out by the latest research.

In a study published Feb. 12 in the journal JAMA Oncology, Ezekiel Emanuel and colleagues found that the rate at which such requests are fulfilled, at least in the field of oncology, is quite low, and therefore patient requests “are unlikely to add significantly to health care costs.”

The researchers used data from 5,050 patient-clinician encounters occurring in three outpatient oncology centers between October of 2013 and June of 2014. Of those, only 8.7% included a patient demand for any specific medical intervention. Most of the time, physicians judged those requests to be clinically appropriate and complied.

Inappropriate clinical requests are even rarer, according to the group’s data, and oncology clinicians fulfill them only 0.14% of the time.

Patient Demands and Clinician Relationship

While the researchers’ data cannot directly address the question of why physicians overestimate the number of patient demands they receive, they suggest that “one possibility is that patients’ demands or requests, while infrequent, are emotionally salient.”

That is, because patient demands can make a clinician feel that he or she is not being trusted as an expert, the therapeutic relationship may suffer.

The study’s discussion also notes that a lack of trust may be cyclical; patient demands may harm the therapeutic relationship, but once that trust barrier is broken, patients may be even more likely to feel that they need to be their own advocates rather than relying on their doctors.

The Impact of Medical Malpractice Suits

The other commonly cited reason that doctors order unnecessary tests and procedures is that they feel the need to protect themselves from the specter of medical malpractice lawsuits.

But the study’s authors note that “malpractice and defensive medicine account for very little of health care costs and cost growth.”

The Congressional Budget Office has previously found that reforming malpractice guidelines would result in only a 0.5% decrease in health spending, and only 0.3% of that would come from eliminating so-called defensive medicine.

“The perception by the medical community and others that patient requests and the practice of defensive medicine to avoid malpractice claims are the main sources of higher medical costs is not supported by this recent research,” says Corey L. Stull of Perry Law Firm. “Interestingly, medical professionals and not patients are the final decision makers in terms of medical testing and procedures performed.”

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