Defensive medicine: from courts to medical practice – analyzing causes, costs, and solutions
DOI:
https://doi.org/10.11606/issn.2317-2770.v29i2e-236841Keywords:
Defensive Medicine, Health's Judicialization, Health Care Quality, Access, and EvaluationAbstract
Introduction: Defensive medicine refers to practices adopted to minimize the legal risks faced by physicians, which can negatively impact both patients and healthcare services. It is associated with the increasing judicialization of medicine and the structure of healthcare systems, leading to high costs, inefficiency, reduced productivity, resource waste, and limited access to care. Examining its causes has led to actionable solutions, including legal adjustments, reorganization of physicians’ workload, and improvements in medical education and ongoing training. The topic is closely connected to legal medicine, health economics, and preventive medicine. Objective: To analyze the determinants of defensive medicine in different healthcare systems, highlighting its financial and non-financial impacts, mitigation strategies, and the controversies documented in the scientific literature. Method: A search was conducted in the PubMed database using the Advanced Search Builder, including the following MeSH Terms in an additive manner: malpractice[MeSH Terms], AND, defensive medicine[MeSH Terms], AND, health care costs[MeSH Terms]. The search was filtered to include articles between 2016 and 2023, followed by a structured review of the selected articles. Results: Only original articles written in English were included. The six selected articles addressed the central theme of the present study. None of the articles were published in Latin America or referred to countries in this region. Conclusion: Defensive medical practices have expanded in tandem with the increasing judicialization of healthcare, affecting the quality of care and access to services and generating significant repercussions on the structure of healthcare systems, including substantial financial costs. The topic is especially relevant for legal medicine practitioners, jurists, healthcare managers, and policymakers, given its potential to modify structural variables and impact the long-term viability of healthcare systems.
Downloads
References
Kapp MB. Defensive medicine: No wonder policymakers are confused. Int J Risk Saf Med. 2017;28(4):213–9. DOI: https://doi.org/10.3233/JRS-170733
Panella M, Rinaldi C, Leigheb F, Knesse S, Donnarumma C, Kul S, et al. Prevalence and costs of defensive medicine: a national survey of Italian physicians. Journal of Health Services Research & Policy. 2017;22(4):211-7. DOI: https://doi.org/10.1177/1355819617707224
Montanera D. The importance of negative defensive medicine in the effects of malpractice reform. European Journal of Health Economics. 2016;17(3):355–69. DOI: https://doi.org/10.1007/s10198-015-0687-8
Tuers DM. Defensive medicine in the emergency department: increasing health care costs without increasing quality? Nurs Adm Q. 2013;37(2):160–4. DOI: https://doi.org/10.1097/NAQ.0b013e318286de06
Panella M, Rinaldi C, Leigheb F, Donnarumma C, Kul S, Vanhaecht K, et al. Los determinantes de la medicina defensiva en hospitales italianos: el efecto de ser una segunda víctima. Revista de Calidad Asistencial. 2016;31:20–5. DOI: https://doi.org/10.1016/j.cali.2016.04.010
Osti M, Steyrer J. A perspective on the health care expenditures for defensive medicine. European Journal of Health Economics. 2017;18:399–404. DOI: https://doi.org/10.1007/s10198-016-0848-4
Gerlach J, Abodunde B, Sollosy M, Coustasse A. Rethinking the obvious: time for new ideas on medical malpractice tort reform. Health Care Manager. 2019;38(2):109–15. DOI: https://doi.org/10.1097/HCM.0000000000000260
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Thiago dos Santos Oliveira, Henrique Barretti Geaquinto, Emilio Zuolo Ferro
This work is licensed under a Creative Commons Attribution 4.0 International License.
Autores que publicam nesta revista concordam com os seguintes termos:
- Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.
- Autores têm autorização para assumir contratos adicionais separadamente, para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.
