Defensive Medicine: It Costs, but Does it Work?

In this issue ofThe Journal, Reynolds et al¹take a giant first step in replacing loose conjecture about "defensive medicine" with formal quantitative analysis. From 1983 to 1984, Reynolds et al estimate that the average malpractice insurance premium rose by $1300 to $8400 annually. Concurrently, in response to a perceived increase in malpractice risks, American Medical Association—surveyed physicians reported changes in their medical practices that were worth an additional $4600 per physician per year. The $4600 increase in defensive medicine costs was more than 3.5 times the concomitant $1800 increase in premiums. From such a finding, Reynolds and colleagues posit that each $1 of malpractice risk—as gauged by insurance premiums— induces $3.50 in defensive medicine expenditures. Hence, the average physician who paid $8400 in malpractice premiums for 1984 was responsible for a total annual health care expenditure of $30 000 for defensive medicine. Reynolds et al acknowledge that