Institute for the Medical Humanities, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1311, USA.
J Gen Intern Med. 2010 May;25(5):470-3. doi: 10.1007/s11606-010-1259-3. Epub 2010 Feb 9.
The role of defensive medicine in driving up health care costs is hotly contended. Physicians and health policy experts in particular tend to have sharply divergent views on the subject. Physicians argue that defensive medicine is a significant driver of health care cost inflation. Policy analysts, on the other hand, observe that malpractice reform, by itself, will probably not do much to reduce costs. We argue that both answers are incomplete. Ultimately, malpractice reform is a necessary but insufficient component of medical cost containment. The evidence suggests that defensive medicine accounts for a small but non-negligible fraction of health care costs. Yet the traditional medical malpractice reforms that many physicians desire will not assuage the various pressures that lead providers to overprescribe and overtreat. These reforms may, nevertheless, be necessary to persuade physicians to accept necessary changes in their practice patterns as part of the larger changes to the health care payment and delivery systems that cost containment requires.
防御性医疗在推高医疗保健成本方面的作用存在激烈争议。医生和医疗政策专家在这个问题上往往存在明显的分歧。医生认为，防御性医疗是医疗成本通胀的一个重要驱动因素。另一方面，政策分析人士观察到，医疗事故改革本身可能不会对降低成本有太大作用。我们认为，这两种答案都不完整。最终，医疗事故改革只是医疗成本控制的必要但不充分的组成部分。有证据表明，防御性医疗仅占医疗成本的一小部分，但并非微不足道。然而，许多医生所期望的传统医疗事故改革并不能缓解导致提供者过度开药和过度治疗的各种压力。尽管如此，这些改革可能还是有必要的，以说服医生接受其行医模式的必要改变，作为成本控制所要求的医疗支付和提供系统的更大变革的一部分。
