by montrose on 7/26/18, 10:32 AM with 124 comments
by rayiner on 7/26/18, 5:25 PM
The telling thing about laws to address malpractice liability is that they typically are focused on capping large verdicts. But such laws are illogical: generally, large verdicts will be awarded where a doctor screwed up and caused the most damage. Cases with large verdicts are the most meritorious ones, and the ones where limiting liability is least likely to eliminate over-testing that does not contribute to quality of care.
If states actually wanted to address the costs of defensive medicine, they would do something like create affirmative defenses for doctors who adhered to certain established testing protocols.
by jl2718 on 7/26/18, 5:28 PM
by mattnewton on 7/26/18, 7:14 PM
(I don’t know the market I am talking about at all, but) Maybe they could incentivize cheap tests by capping the cost per test that can be administered without some large red tape process. The market will provide tests under that cap where possible, so they can be administered more frequently & frictionessly. Patients are thoroughly tested, Doctors cover their butts, and test supply companies get to keep selling lots of tests.
by patrickg_zill on 7/26/18, 5:16 PM
by dahdum on 7/26/18, 5:26 PM
Beyond that, once defensive medicine is the status quo, why would they make a choice to not order their usual defensive panels? They aren't paying for them themselves.
by zelon88 on 7/27/18, 2:20 AM
With that error rate, is it fair to say that the extra tests are truly "unnecessary?"
by howard941 on 7/26/18, 5:18 PM
by dhdhshd on 7/27/18, 12:07 AM
by subhobroto on 7/26/18, 7:25 PM
The primary issue here is the resulting cost.
As the article points out: "about 26 percent of every dollar spent."
You probably won't complain paying 26 cents for a $1 popsicle, but if the same popsicle cost you $100, you might be upset paying $26.
But is not the bigger question: Why is the popsicle $100 when it could have cost $1?
Here is a useful chart to show where the money goes: https://qph.fs.quoracdn.net/main-qimg-d68aea3ca1e466f166752e...
Where do you think malpractice costs fit there?
I personally feel sad everytime malpractice fears enter the discussion of costs - its a tiny, ignorable portion right now of total expenses.
However, to a typical layperson, it sounds like a big deal to worry about but actually distracts the attention costs should be getting.
As a result, I have tried to cover it here: https://www.quora.com/Why-does-one-believe-that-malpractice-...
Real input from real practitioners in the industry in the real world.
Sure, Malpractice overhead exists but it's analogous to a drop in the ocean. There is severe waste elsewhere that need to be handled first.
It's a nosebleed in a patient hemorrhaging blood through a punctured artery.
The argument that ordering extra tests offer doctors "additional defense" in case of a lawsuit is absolute hogwash. If anything, the test results put the doctor at a further disadvanatge wrt defense because they had an additional datapoint they should have considered in their diagnoisis but did not.
The primary issue with Healthcare in the U.S. is cost - for those who have the money and the will to spend it, it's one of the best in the world. A lot of the rich visit the US for their Healthcare needs.
Healthcare in the U.S. is optimized for profit: https://www.quora.com/What-makes-the-US-healthcare-system-so...
This is very wrong as it encourages short term profit seeking behavior which is absolutely the opposite of what healthcare should be (eg: C Sections being preferred over natural but long childbirth)
A for-profit system does not help the doctor/provider either (although it gives an illusion of it) - in such a system, the patient's only recourse is to sue the doctor/provider for damages instead of both parties focusing on the root cause which brought the patient to the doctor/provider in the first place.
Extra Medical Tests might be suboptimal but the real pain points are the marginal costs of each test.
Tests in the U.S. are extremely expensive. There is no standardized pricing for any test in the U.S. unlike the rest of the world.
While the rest of the world has pretty much agreed, for example, that a blood group test might be no more than $10 (In India, it costs 20 cents upto 70 cents at current INR-USD exchange rates), in the U.S. depending on which lab you go to, your insurance coverage, your ability to pay and other factors, you might be billed anywhere from $0 - $2000.
That is completely insane.
Also, labs in the U.S are not setup to take requests from customers directly. There are kits you can order and all that
Everytime I try to send a blood sample to a lab on my own, the lab staff seem to be lost - they want my insurance information, my EHR information, my NPI ID and when I explain to them I am not a doctor they ask me to provide my physcian's who ordered the test. (my physcian didn't order the test - I did).
I have had a few labs bill me outrageous out of network fees because the lab tests were not ordered by an in network provider (because I ordered them and I am not a doctor) and the amount of calls and paperpushing I had to do to correct the billing has made me just give up and let a doctors office handle this.
I can read a lipid panel. I don't need to go to a doctor's office to drive in traffic, wait an hour or more just to draw my blood and have it sent to a lab and then have the doctor read the panel to me. I read spreadsheets every hour of the day. I know what mean median and mode is and the lab result often offer these values anyways as part of the report.
I just need the test report.
Now, if my HDLs are too high and I cannot figure out why, sure, I do need to discuss this with a professional.
The solution to this madness?
An "all payer rate set" system. EVERYONE pays the same for the same procedure. Who pays for the care, while important, comes later, not before.
by briandear on 7/26/18, 8:02 PM
https://www.ncbi.nlm.nih.gov/pubmed/19201500/
“The net effects of medical malpractice tort reform on health insurance losses: the Texas experience”
by joshuaheard on 7/26/18, 7:30 PM
by sandworm101 on 7/26/18, 4:41 PM
Damb right. Take away a patient's right to hold doctors accountable and things go south very quickly, at least in a for-profit systems.
>>But American doctors often rail against the country’s medical malpractice system, which they say forces them to order unnecessary tests and procedures to protect themselves if a patient sues them.
The patient can only sue if the patient has been harmed. They aren't performing the extra tests in case just wakes up and decides to sue them. They perform the extra tests so that they don't miss something that could harm the patient so badly that they sue.
Doctors also forget that, again only in the US system, patients often must sue. A harm caused by malpractice isn't always covered by insurance. Patients need to find the money somewhere. Or if an insurance company does cover, the insurance company will then sue the malpracticing doctor (google "subrogation").
A few years ago several states had liability caps ready to become law (iirc $250k). Then a young woman lost both her breasts after a mixup in test results caused her doctor to recommend a double mastectomy. But at least she could still function relatively normally and the injury was not a financial burden. Imagine the costs associated with a 20yo confined to a wheelchair for the next 60+ years. Setting aside medical expenses, 250k buys you maybe four or five converted vans. While some cases are rightly suspect, many of the multi-million dollar settlements really do get spent on legitimate costs.