Kavanagh Kevin T, Calderon Lindsay E, Saman Daniel M
From *Health Watch USA, Somerset, Kentucky; †Eastern Kentucky University, Richmond, Kentucky; and ‡Essentia Institute of Rural Health, Duluth, Minnesota.
J Patient Saf. 2014 Dec;10(4):222-30. doi: 10.1097/PTS.0b013e3182a7e992.
The hidden cost of defensive medicine has been cited by policymakers as a significant driving force in the increase of our nation's health-care costs. If this hypothesis is correct, one would expect that states with higher levels of tort reform will have a decrease in Medicare utilization and that medical utilization will decrease after tort reform is enacted.
State-level reimbursement data for years 1999 to 2010 (the last year available) was obtained from the Dartmouth Atlas of Health Care. Medical tort rankings for the 50 states were obtained from the Pacific Research Institute (PRI) and correlated with state medical utilization for the year 2010. In 3 states, Mississippi, Nevada, and Texas, data were available to make pretort and posttort reform comparisons.
Data analysis between total state Medicare Reimbursements and the PRI's tort rankings showed no significant observed correlation. In 6 Medicare utilization categories (total Medicare, hospital and skilled nursing facility, physician, home health agency, hospice, and durable medical equipment), a negative trend was observed when correlated with PRI tort rankings. This trend does not support the hypothesis that defensive medicine is a major driver of health-care expenditures. Tracking expenditures in the states of Texas, Nevada, and Mississippi, before and after passage of comprehensive medical tort reform gave inconsistent results and did not demonstrate substantial or meaningful total Medicare savings. In Mississippi, there was a trend of decreased expenditures after medical tort reform was passed. However, in Texas, where 80% of the analyzed enrollees resided, there was a trend of progressive increasing expenditures after tort reform was passed.
The comparison of the Dartmouth Atlas Medicare Reimbursement Data with Malpractice Reform State Rankings, which are used by the PRI, did not support the hypothesis that defensive medicine is a driver of rising health-care costs. Additionally, comparing Medicare reimbursements, premedical and postmedical tort reform, we found no consistent effect on health-care expenditures. Together, these data indicate that medical tort reform seems to have little to no effect on overall Medicare cost savings.
政策制定者认为，防御性医疗的隐性成本是我国医疗保健成本增加的一个重要驱动因素。如果这一假设正确，那么人们会预期侵权改革程度较高的州医疗保险利用率会下降，并且在实施侵权改革后医疗利用率也会降低。
1999年至2010年（可获取数据的最后一年）的州级报销数据来自《达特茅斯医疗保健地图集》。50个州的医疗侵权排名来自太平洋研究所（PRI），并与2010年的州医疗利用率相关联。在密西西比州、内华达州和得克萨斯州这3个州，可以获取数据进行侵权改革前后的比较。
对州医疗保险总报销额与PRI侵权排名之间的数据分析显示，未观察到显著相关性。在6个医疗保险利用类别（医疗保险总额、医院和专业护理机构、医生、家庭保健机构、临终关怀和耐用医疗设备）中，与PRI侵权排名相关联时观察到了负向趋势。这一趋势并不支持防御性医疗是医疗保健支出主要驱动因素的假设。追踪得克萨斯州、内华达州和密西西比州在全面医疗侵权改革通过前后的支出情况，结果并不一致，也未显示出医疗保险总体上有实质性或有意义的节省。在密西西比州，医疗侵权改革通过后有支出下降的趋势。然而，在80%的分析参保者所在的得克萨斯州，侵权改革通过后支出呈逐步上升趋势。
将《达特茅斯医疗保健地图集》的医疗保险报销数据与PRI使用的医疗事故改革州排名进行比较，并不支持防御性医疗是医疗保健成本上升驱动因素的假设。此外，比较医疗保险报销情况，在医疗侵权改革前后，我们发现对医疗保健支出没有一致的影响。综合来看，这些数据表明医疗侵权改革似乎对医疗保险总体成本节省几乎没有影响。
