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At conference on avoidable care, experts say malpractice lawsuits not the central issue

At a conference attended by dozens of doctors, the message of one panel discussion might have seemed out of place: Medical malpractice is not a primary culprit in the rising cost of medical care.

The speakers and most audience members who approached the microphones during a panel near the start of the two-day Avoiding Avoidable Care conference, hosted in Cambridge by the Lown Cardiovascular Research Foundation and the New America Foundation, seemed to agree.

Malpractice is “such an unimportant element of what is going on,” said Dr. Jerome Hoffman, professor of emergency medicine at the University California, Los Angeles, and the University of Southern California, after a panel of experts spoke about what drove doctors to provide unnecessary care.

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Amitabh Chandra, an economist and professor of public policy at the Harvard Kennedy School, argued that the practice of defensive medicine -- ordering tests and procedures to avoid lawsuits -- was not a significant driver.

Each year, the United States spends about $56 billion on medical liability, he said, including a total of $10 billion on payments to injured patients and administrative costs. The rest, about $46 billion, is attributable to “doing more than we should because we want to reduce the threat of litigation,” Chandra said.

That’s a lot of money. But, think about it in the context of the $2.5 trillion that the United States spends on health care each year, Chandra said. Then, medical liability accounts for a fraction of the total yearly costs, about eight days of annual spending.

How much can overhauling the malpractice system save money or change doctors’ behavior?

“It’s not clear to me that this is really going to be the thing that changes the cost curve,” Chandra said.

Hoffman said the threat of a malpractice case was much smaller when he started practicing medicine, but physician behaviors were similar. He attributed the practice of defensive medicine to a cultural fear of uncertainty and anxiety about getting something wrong and being blamed for it, rather than the fear of being sued.

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Dr. Rita Redberg, chief editor of the Archives of Internal Medicine and a professor and cardiologist at the University of California, San Francisco Medial Center, said the malpractice issue is a “smoke screen.”

Doctors must tackle culture norms that hold that it is better for someone to die as a result of a doctor doing something than to die from not doing something, she said.

Cost aside, Chandra said, there may be a better reason for overhauling the malpractice system.

“The emotional cost born by physicians in terms of time, stress, reputational damage, or having their name dragged through the local newspaper are colossal,” he said.

And that burden does not improve the quality of health care, he said.


Chelsea Conaboy can be reached at cconaboy@boston.com. Follow her on Twitter @cconaboy.