Fix this and the rest is do-able

There’s an elephant on the table in the planning sessions over how to fix what’s wrong in the delivery of health care in America today.

In the midst of ongoing debate over the scope and desirability of various health care reform proposals, an obvious and critical component of cost management is going unnoticed: malpractice litigation…

In the case of medical insurance in the United States, there are an estimated $5.8 billion in medical malpractice claims annually.

While this figure may seem inconsequential when compared with health care spending expected to reach $2.5 trillion this year, the true import of these billions is found not merely in the direct cost of lawsuits. More significant is the number of procedures that are performed as so-called “defensive medicine,” intended more to mitigate exposure to litigation than to promote patient welfare. While it is difficult to estimate the costs of these kinds of practices, a study published in November of 2008 by Massachusetts Medical Society and UConn Health Center researcher Robert Aseltine Jr. found that 83 percent of doctors surveyed admitted to “practicing defensive medicine, with an average of between 18 percent and 28 percent of tests, procedures, referrals, and consultations and 13 percent of hospitalizations ordered for defensive reasons.” These are not insubstantial numbers, especially if you happen to be one of the many patients directly affected by such defensive medical practice.

The corrosion of the culture of trust necessary to good medical care resulting from these kinds of practices is perhaps even more worrisome than the clearly quantifiable economic costs. Patients are less inclined to trust doctors whom they believe are ordering tests and procedures out of a desire to protect their own economic interests. Patients in turn are much more apt to turn to legal remedies when they feel that doctors have not been forthcoming and trustworthy.

This is a key point I haven’t heard discussed much in the prolific media coverage. Now look at this:

The University of Michigan Health System has implemented a policy in which doctors help foster a culture of trust by voluntarily admitting when mistakes have been made and offering compensation before legal action has been undertaken by the patient. A study by risk officers and officials at the health system found that malpractice claims were cut nearly in half after the implementation of this approach, from 121 in 2001 to 61 in 2006.

Restoring trust in the relationship between patient and doctor is critical to health care reform that promotes human flourishing and societal well-being.

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