Defensive medicine's cost

There's reason to question whether capping medical malpractice awards would help keep insurance costs in check. But that doesn't mean tort reform doesn't matter as we talk about driving down the cost of health care.

The American Association

for Justice's recent study crunched the data and found that state caps on medical malpractice awards don't reduce insurance costs for doctors or patients.

The group's analysis also shows that the malpractice insurers in states with caps in place had 24 percent higher profits than similar insurers in states that do not cap damages.

The non-profit trial lawyer group said it found no correlation between the cost of malpractice premiums and health insurance premiums. They say Maine, for example, has the country's ninth-lowest malpractice premiums but the fourth-highest health insurance premiums. Nevada, which has capped malpractice awards for years, has the third-lowest health insurance premiums but ninth-highest malpractice premiums.

Still, the question remains: How much does the threat of litigation play into the practice of “defensive medicine” - when medical professionals order tests and procedures not necessarily because they help the patient, but because they might protect against costly potential lawsuits.

Jim Levett, a cardiothoracic surgeon and chief medical officer for Physicians' Clinic of Iowa, told us this week he's seen that hard-to-quantify cost estimated as being around $200 billion a year in this country. No small change.

Then Brad Lint, Executive Director Iowa Association for Justice, reminded us that the fee-for-service structure of our health delivery system offers doctors financial motivations to over test, too.

“It would be a much stronger argument for them to make if their incomes weren't based on the very tests and procedures they order,” he said.

The same can be said for attorneys who earn fees of up to 40 percent of the settlement if they win a malpractice case.

Medical providers must be held accountable for medical negligence. Patients who suffer lost wages or are stuck with expensive medical bills and other costs because of a provider's error should be compensated.

Some kind of limits on pain and suffering - the quality of life damages - might help keep those settlements from getting out of control and create a system that's fairer and consistent.

Like seemingly every facet of our health care conundrum, there is no easy answer. But it's an issue that deserves careful consideration.

So do proposals to replace fee-based medical services with an outcomes-focused system that better coordinates patient care and builds patient-physician relationships. Such an approach could reduce litigation in the first place.