The impact of tort reform on defensive medicine, quality of care, and physician supply: A systematic review

Abstract

Objective To evaluate the impact of tort reform on defensive medicine, quality of care, and physician supply. Data Sources Empirical, peer‐reviewed English‐language studies in the MEDLINE and HeinOnline databases that evaluated the association between tort reform and our study outcomes. Study Design We performed a systematic review in accordance with the PRISMA guidelines. Data Collection/Extraction Methods Title and abstract screening was followed by full‐text screening of relevant citations. We created evidence tables, grouped studies by outcome, and qualitatively compared the findings of included studies. We assigned a higher rating to study designs that controlled for unobservable sources of confounding. Principal Findings Thirty‐seven studies met screening criteria. Caps on damages, collateral‐source rule reform, and joint‐and‐several liability reform were the most common types of tort reform evaluated in the included studies. We found that caps on noneconomic damages were associated with a decrease in defensive medicine, increase in physician supply, and decrease in health care spending, but had no effect on quality of care. Other reform approaches did not have a clear or consistent impact on study outcomes. Conclusions We conclude that traditional tort reform methods may not be sufficient for health reform and policy makers should evaluate and incorporate newer approaches.

Defensive medicine in Europe: a ‘full circle’?

“…Probably not by chance was DM born in the USA, where negligence lawsuits and tort actions are very frequent [29], although unevenly distributed among the States depending on their different legislations [4]. In general, DM practices are likely to be more common in nations with a higher density of lawyers and recourse to tort lawsuits [2], e.g.…”

“…Basically, DM refers to all medical care by physicians, aimed primarily at preventing the risk of litigation [2][3][4]. Interest in DM as a strategy for deterring patients' lawsuits for medical negligence and malpractice has increased in recent decades because of the growing number of litigations in many countries [5][6][7].…”

Defensive medicine in Europe: a ‘full circle’?

“…Probably not by chance was DM born in the USA, where negligence lawsuits and tort actions are very frequent [29]-although unevenly distributed among the States depending on their different legislations [4]. In general, DM practices are likely to be more common in nations with a higher density of lawyers and recourse to tort lawsuits [2]-e.g., Italy has by far the highest proportion of malpractice lawsuits settled in courts among the largest mainland European countries (90% in 2014 compared to 60% in France and 40% in Germany) [15].…”

Matching Imaging Services to Clinical Context: Why Less May Be More

“…Advancements in imaging technologies often result in higher radiologist workloads by increasing the total number of images included in each study, thereby adding to the total volume of work in which hundreds or thousands of images are included in studies that in years past would have included only dozens of images [9]. Fear of medicolegal consequences adds to radiologists' workload because of defensive imaging ordering practices [10]. Radiologists spend additional time to reach referring providers to avoid gaps in communication of critical and actionable incidental findings.…”