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Defensive Medicine: It Costs, but Does it Work?

Jeffrey E. Harris, MD, PhD
JAMA. 1987;257(20):2801-2802. doi:10.1001/jama.1987.03390200141032.
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In this issue of The Journal, Reynolds et al1 take 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


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