High health care costs may be related to fear of lawsuits
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In essence: Some doctors order hospital admission even for low-risk heart patients in fear of malpractice lawsuits. The large number of low-risk patients admitted to hospitals increase health care costs in the United States.
According to a study led by a University of Iowa researcher, which appears in the 13 July 2005 online issue of the Annals of Emergency Medicine, fear of lawsuits may increase health care costs, because a number of emergency physicians may practice "defensive medicine" when they have to draw a heart care decision. This means that they prefer to recommend admission and order additional pricey tests even for low-risk patients, because if they don't they risk to be involved in medical malpractice lawsuits.
The findings were based on surveys of 33 emergency doctors at two teaching hospitals, covering 1134 patients. The study was limited, mainly because the health professionals did not represent a US national sample and the focus was on heart-related cases. Future studies should strive to collect and analyse more data and suggest cost-cutting options without lowering the health care standards in the United States of America.
The lead investigator in the study was David A. Katz, M.D., associate professor of internal medicine in the UI Roy J. and Lucille A. Carver College of Medicine, and staff physician and researcher at the Department of Veterans Affairs Iowa City Health Care System. The study also involved researchers at University of Wisconsin, Madison; Medical College of Wisconsin; University of Rochester; and Tufts-New England Medical Center. The Agency for Healthcare Research and Quality (AHRQ), a government organisation aiming to improve funded the study, together with a Robert Wood Johnson Foundation Generalist Physician Faculty Scholarship to David Katz, with supplemental support from the University of Wisconsin Department of Medicine.
David Katz said that "Emergency physicians must see all patients, regardless of how risky a patient's case may be" and noted that there are positive aspects in increased care, since physicians who routinely order tests for low-risk patients are "more likely to admit patients who turned out to be intermediate to high risk"". Therefore, he says, "the question becomes: how can we encourage these positive aspects of care without promoting overutilization?".
The study is important because of the large number of people who are found to have no serious heart-related health problems, although they were hospitalised for evaluation. Half of the 7 million US Americans who seek heart-related emergency care every year are admitted into hospitals, but "most of these patients are subsequently shown not to have acute coronary syndromes such as unstable angina or heart attack", according to the public release of the study on the EurekAlert website published on 13 July 2005.
The cost for the admission of a patient in a hospital in the United States of America may be as high as US$1200, while a chest X-ray may cost US$150 and a troponin blood test usually costs US$44. Multiply these costs by 3.5 million and you get an idea of the potential cost savings' magnitude.
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According to an unrelated older study published in a 1998 issue of the American Journal of Cardiology "Heart failure is one of the most common reasons for admission to acute care hospitals. A proportion of these admissions are probably low risk and could be managed in subacute care facilities, resulting in substantial cost savings". That study was conducted by Javed Butler M.D., Sai Hanumanthu M.D., Don Chomsky M.D., and John R. Wilson M.D. The result was that 52% of the admissions in a random sample of 120 (out of a total of 743) admissions for heart failure to Vanderbilt University Medical Center between July 1993 and June 1995 was low-risk and "most of these admissions were for dyspnea without any life-threatening complication". The title of their study was "Frequency of low-risk hospital admissions for heart failure" and its DOI identification code is 10.1016/S0002-9149(97)00851-5.
To end this article with an opinion, NSK would like to say that although reasonable cost-saving measures are usually desirable, health professionals and organisations should not allow even a single life to be lost due to insufficient tests in case a patient was erroneously categorised as "low-risk".
The text of this article is Copyright (C) 2005 by Nikolaos S. Karastathis and is available under the Creative Commons Attribution-ShareAlike 2.0 licence. You are welcome to copy, republish, modify, translate and disseminate the whole text of this article in accordance with the aforementioned licence, but you should always include this copyright notice and refer or link to its original location at http://portal.wikinerds.org/health-lawsuits-fear
About the image: The image shows the Asclepius' stick, the Ancient Greek symbol for medicine, and is in the public domain. It was found here.
More information on the Web:
- The study of David Katz, et al.
- Press release about the study of David Katz, et al. by acep.org
- The study of Javed Butler, et al.
Relevant pages on the Web:
See also on Wikinerds.org:
Wikinerds Portal and Nikolaos S. Karastathis do not offer any kind of medical, legal, and/or financial advice. This article does not contain any medical, legal, and/or financial advice.
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