Abstract
Purpose
Defensive medicine, broadly defined as medical practices that protect physicians from
malpractice lawsuits without providing benefits to patients, can lead to wasteful
use of health care resources and higher cost. Although physicians cite malpractice
liability as an important factor driving their decisions to order imaging tests, little
research has been done to examine the systematic impact of liability pressure on overall
imaging. The authors examined the extent to which radiography use is influenced by
malpractice liability pressure among office-based physicians.
Methods
Using National Ambulatory Medical Care Survey data from 1999 to 2010, the authors
used multivariate difference-in-difference logistic regression to examine the effects
of different types of state tort reforms on the probability of radiography orders
by primary care physicians (PCPs) and specialists.
Results
The probability that a PCP ordered radiography decreased when states enacted permanent
caps on noneconomic damages (−1.0%,
P < .01), periodic payment reforms (−1.6%,
P < .05), and the total number of tort reforms (−0.5%,
P < .05). Specialist physicians were responsive to two reforms: caps on punitive damages
(−6.1%,
P < .01) and the total number of medical tort laws (−1.2%,
P < .01). The passage of new indirect reforms was found to reduce radiography orders
for PCPs (−1.8%,
P < .05), and the repeal of indirect reforms was found to increase radiography orders
for specialists (+3.4%,
P < .01).
Conclusions
State tort reform seems to reduce physicians’ ordering of radiography. This analysis
also suggests that reforms that make it harder to sue physicians have a stronger impact
than reforms that directly reduce physicians’ malpractice claim payments.
Key Words
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Article Info
Publication History
Published online: December 21, 2016
Footnotes
This work was supported by a research grant from the Harvey L. Neiman Health Policy Institute. The authors have no conflicts of interest related to the material discussed in this article.
Identification
Copyright
© 2016 American College of Radiology
