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The determinants of defensive medicine practices in Belgium

Published online by Cambridge University Press:  22 November 2016

Tom Vandersteegen ,
Wim Marneffe ,
Irina Cleemput ,
Dominique Vandijck  and
Lode Vereeck
Tom Vandersteegen*
Affiliation:
Faculty of Applied Economics, Hasselt University, Hasselt, Belgium
Wim Marneffe
Affiliation:
Faculty of Applied Economics, Hasselt University, Hasselt, Belgium
Irina Cleemput
Affiliation:
Faculty of Applied Economics, Hasselt University, Hasselt, Belgium
Dominique Vandijck
Affiliation:
Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
Lode Vereeck
Affiliation:
Faculty of Applied Economics, Hasselt University, Hasselt, Belgium
*
*Correspondence to: Tom Vandersteegen, Faculty of Applied Economics, Hasselt University, Martelarenlaan 42, BE-3500 Hasselt, Belgium. Email: tom.vandersteegen@uhasselt.be
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Abstract

In 2010 the Belgian government introduced a low cost administrative procedure for compensating medical injuries to overcome the major shortcomings of the existing tort system. This paper examines, for the first time, to what extent this reform had an impact on physician specialists’ defensive practices and what are the relevant determinants affecting physicians’ clinical decision making. Based on a survey of 508 physicians, we find evidence of a relatively modest increase in defensive practices among physicians in various specialties. In general, 14% of the respondents, who were aware of the reform, reported to have increased their overall defensive behaviour, while respectively 18 and 13% altered their assurance and avoidance behaviour. Commonly used physician characteristics, such as claims experience and gender, have a similar impact on defensive medicine as documented in existing literature. Furthermore, the determinant physician’s access to an incident reporting system is found to have a significant impact on most of the defensive medicine measures. Health care institutions may therefore play an important role in controlling and reducing physicians’ defensive practices.

Type
Articles
Information
Health Economics, Policy and Law , Volume 12 , Issue 3 , July 2017 , pp. 363 - 386
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Copyright
© Cambridge University Press 2016 

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References

Allen, I. E. and Seaman, C. A. (2007), ‘Likert scales and data analyses’, Quality Progress, 40(7): 64.Google Scholar
Asher, E., Greenberg-Dotan, S., Halevy, J., Glick, S. and Reuveni, H. (2012), ‘Defensive medicine in Israel – a nationwide survey’, PLoS One, 7(8): e42613.CrossRefGoogle ScholarPubMed
Asher, E., Parag, Y., Zeller, L., Yerushalmi, R. and Reuveni, H. (2007), ‘Unconscious defensive medicine: the case of erythrocyte sedimentation rate’, European Journal of Internal Medicine, 18(1): 35–38.CrossRefGoogle ScholarPubMed
Baldwin, L. -M., Hart, L. G., Lloyd, M., Fordyce, M. and Rosenblatt, R. A. (1995), ‘Defensive medicine and obstetrics’, Journal of the American Medical Association, 274(20): 1606–1610.CrossRefGoogle ScholarPubMed
Beckman, H. B., Markakis, K. M., Suchman, A. L. and Frankel, R. M. (1994), ‘The doctor-patient relationship and malpractice: lessons from plaintiff depositions’, Archives of Internal Medicine, 154(12): 1365–1370.CrossRefGoogle ScholarPubMed
Bergs, J., Lambrechts, F., Simons, P., Vlayen, A., Marneffe, W., Hellings, J., Cleemput, I. and Vandijck, D. (2015), ‘Barriers and facilitators related to the implementation of surgical safety checklists: a systematic review of the qualitative evidence.’ BMJ Quality & Safety 24(12): 776–786.CrossRefGoogle Scholar
Bertram, D. (2006), ‘Likert Scales are the meaning of life’, CPSC 681 - Topic Report, pp. 1–10. Available at http://poincare.matf.bg.ac.rs/~kristina//topic-dane-likert.pdf.Google Scholar
Black, N. (1990), ‘Medical litigation and the quality of care’, The Lancet, 335(8680): 35–37.CrossRefGoogle ScholarPubMed
Bradley, C. P. (1992), ‘Factors which influence the decision whether or not to prescribe: the dilemma facing general practitioners’, British Journal of General Practice, 42(364): 454–458.Google ScholarPubMed
Carrier, E. R., Reschovsky, J. D., Mello, M. M., Mayrell, R. C. and Katz, D. (2010), ‘Physicians’ fears of malpractice lawsuits are not assuaged by tort reforms’, Health Affairs, 29(9): 1585–1592.CrossRefGoogle Scholar
Currie, J. and MacLeod, W. B. (2008), ‘First Do No Harm? Tort Reform and Birth Outcomes’, Quarterly Journal of Economics, 123(2): 795–830.Google Scholar
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A. and Lowery, J. C. (2009), ‘Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science’, Implementation Science, 4(1): 50.CrossRefGoogle Scholar
Dick III, J. F., Gallagher, T. H., Brenner, R. J., Yi, J. P., Reisch, L. M., Abraham, L., Miglioretti, D. L., Carney, P. A, Cutter, G. R. and Elmore, J. G. (2009), ‘Predictors of radiologists’ perceived risk of malpractice lawsuits in breast imaging’, American Journal of Roentgenology, 192(2): 327.CrossRefGoogle Scholar
Eddy, D. M. (1998), ‘Performance measurement: problems and solutions’, Health Affairs, 17(4): 7–25.CrossRefGoogle ScholarPubMed
Elli, L., Tenca, A., Soncini, M., Spinzi, G., Buscarini, E. and Conte, D. (2013), ‘Defensive medicine practices among gastroenterologists in Lombardy: between lawsuits and the economic crisis’, Digestive and Liver Disease, 45(6): 469–473.CrossRefGoogle ScholarPubMed
Entman, S. S., Glass, C. A., Hickson, G. B., Githens, P. B., Whetten-Goldstein, K. and Sloan, F. A. (1994), ‘The relationship between malpractice claims history and subsequent obstetric care’, Journal of the American Medical Association, 272(20): 1588–1591.CrossRefGoogle ScholarPubMed
Frakes, M. (2012), ‘Defensive medicine and obstetric practices’, Journal of Empirical Legal Studies, 9(3): 457–481.CrossRefGoogle Scholar
G’Sell-Macrez, F. (2011), ‘Medical malpractice and compensation in France: Part I: the French rules of medical liability since the patients’ Rights Law of March 4, 2002’, Chicago-Kent Law Review, 86: 1093.Google Scholar
Gallagher, T. H., Waterman, A. D., Garbutt, J. M., Kapp, J. M., Chan, D. K., Dunagan, W C., Fraser, V. J. and Levinson, W. (2006), ‘US and Canadian physicians’ attitudes and experiences regarding disclosing errors to patients’, Archives of Internal Medicine, 166(15): 1605–1611.CrossRefGoogle ScholarPubMed
Glassman, P. A., Rolph, J. E., Petersen, L. P., Bradley, M. A. and Kravitz, R. L. (1996), ‘Physicians’ personal malpractice experiences are not related to defensive clinical practices’, Journal of Health Politics, Policy and Law, 21(2): 219–241.CrossRefGoogle Scholar
Goyert, G. L, Sidney, F. B., Treadwell, M. C. and Nehra, P. C. (1989), ‘The physician factor in cesarean birth rates’, The New England Journal of Medicine, 320(11): 706–709.CrossRefGoogle ScholarPubMed
Hellinger, F. J. and Encinosa, W. E. (2006), ‘The impact of state laws limiting malpractice damage awards on health care expenditures’, American Journal of Public Health, 96(8): 1375–1381.CrossRefGoogle ScholarPubMed
Hickson, G. B., Clayton, E. W., Githens, P. B. and Sloan, F. A. (1992), ‘Factors that prompted families to file medical malpractice claims following perinatal injuries’, Journal of the American Medical Association, 267(10): 1359–1363.CrossRefGoogle ScholarPubMed
Hiyama, T., Yoshihara, M., Tanaka, S., Urabe, Y., Ikegami, Y., Fukuhara, T. and Chayama, K. (2006), ‘Defensive medicine practices among gastroenterologists in Japan’, World Journal of Gastroenterology, 12(47): 7671–7675.CrossRefGoogle ScholarPubMed
Jena, A. B, Seabury, S., Lakdawalla, D. and Chandra, A. (2011), ‘Malpractice risk according to physician specialty’, The New England Journal of Medicine, 365(7): 629–636.CrossRefGoogle ScholarPubMed
Kessler, D. P. and McClellan, M. B. (1997), ‘The effects of malpractice practice pressure and liability reforms on physicians’ perceptions of medical care’, Law and Contemporary Problems, 60(1–2): 81–106.CrossRefGoogle Scholar
Kessler, D. P. and McClellan, M. B. (2002), ‘How liability law affects medical productivity’, Journal of Health Economics, 21(6): 931–955.CrossRefGoogle ScholarPubMed
Kessler, D. P. and McClellan, M. (1996), ‘Do doctors practice defensive medicine?’, Quarterly Journal of Economics, 111(2): 353–390.CrossRefGoogle Scholar
King, J. H. (1986), The Law of Medical Malpractice in a Nutshell, St. Paul, Minn: West Pub. Co.Google Scholar
Klick, J. and Stratmann, T. (2007), ‘Medical malpractice reform and physicians in high‐risk specialties’, The Journal of Legal Studies, 36(S2): S121–S142.CrossRefGoogle Scholar
Lawthers, A. G, Laird, N. M., Lipsitz, S., Hebert, L., Brennan, T. A. and Localio, A. R. (1992), ‘Physicians’ perceptions of the risk of being sued’, Journal of Health Politics, Policy and Law, 17(3): 463–482.CrossRefGoogle ScholarPubMed
Mello, M. M. (2006), ‘Medical Malpractice: Impact of the Crisis and Effect of State Tort Reforms’, in The Synthesis Project – New Insights From Research Results, Princeton: Robert Wood Johnson Foundation, 1–26.Google Scholar
Mello, M. M., Studdert, D. M., DesRoches, C. M., Peugh, J., Zapert, K., Brennan, T. A. and Sage, W. M. (2005), ‘Effects of a malpractice crisis on specialist supply and patient access to care’, Annals of Surgery, 242(5): 621.CrossRefGoogle ScholarPubMed
Nahed, B. V., Babu, M. A., Smith, T. R. and Heary, R. F. (2012), ‘Malpractice liability and defensive medicine: a national survey of neurosurgeons’, PLoS One, 7(6): e39237.CrossRefGoogle ScholarPubMed
Nash, L. M., Walton, M. M., Daly, M. G., Kelly, P. J., Walter, G., van Ekert, E. H., Willcock, S. M. and Tennant, C. C. (2010), ‘Perceived practice change in Australian doctors as a result of medicolegal concerns’, Medical Journal of Australia, 193(10): 579.CrossRefGoogle ScholarPubMed
OTA (1994), Office of Technology Assessment. Defensive Medicine and Medical Malpractice, Washington, DC: US Government Printing Office.Google Scholar
RIZIV (2015), Activiteitenverslag van het Fonds voor de Medische Ongevallen – 2014. Brussels: RIZIV.Google Scholar
Sloan, F. A., Mergenhagen, P. M., Burfield, W. B., Bovbjerg, R. R. and Hassan, M. (1989), ‘Medical malpractice experience of physicians: predictable or haphazard?’, Journal of the American Medical Association, 262(23): 3291–3297.CrossRefGoogle ScholarPubMed
Studdert, D. M., Mello, M. M. and Brennan, T. A. (2004), ‘‘Medical malpractice.’’, The New England Journal of Medicine, 350(3): 283–292.CrossRefGoogle ScholarPubMed
Studdert, D. M., Mello, M. M., Sage, W. M., DesRoches, C. M., Peugh, J., Zapert, K. and Brennan, T. A. (2005), ‘Defensive medicine among high-risk specialist physicians in a volatile malpractice environment’, Journal of the American Medical Association, 293(21): 2609–2617.CrossRefGoogle Scholar
Summerton, N. (1995), ‘Positive and negative factors in defensive medicine: a questionnaire study of general practitioners’, British Medical Journal, 310(6971): 27–29.CrossRefGoogle ScholarPubMed
Taragin, M. I., Wilczek, A. P., Karns, M. E., Trout, R. and Carson, J. L. (1992), ‘Physician demographics and the risk of medical malpractice’, The American Journal of Medicine, 93(5): 537–542.CrossRefGoogle ScholarPubMed
Van Velthoven, B. C. J. and van Wijck, P. W. (2012), ‘Medical liability: do doctors care?’, Recht der Werkelijkheid, 33(2): 28–47.Google Scholar
Vansweevelt, T. (1997), De beroepsaansprakelijkheidsverzekering van artsen en ziekenhuizen: een vergelijkende analyse, Gent: Mys & Breesch.Google Scholar
Vansweevelt, T. (2011), ‘De Wet Medische Ongevallen: De krachtlijnen, de filosofie en het toepassingsgebied’, in I. Boone and S. Lierman eds) Vergoeding van slachtoffers van medische ongevallen: Praktijkgerichte analyse van de wet van 31 maart 2010, Antwerpen, Cambridge: Intersentia.Google Scholar
Vimercati, A., Greco, P., Kardashi, A., Rossi, C., Loizzi, V., Scioscia, M. and Loverro, G. (2000), ‘Choice of cesarean section and perception of legal pressure’, Journal of Perinatal Medicine, 28(2): 111–117.CrossRefGoogle ScholarPubMed
Vlayen, A., Schrooten, W., Wami, W., Aerts, M., Barrado, L. G., Claes, N. and Hellings, J. (2015), ‘Variability of patient safety culture in Belgian acute hospitals’, Journal of Patient Safety, 11(2): 110–121.CrossRefGoogle ScholarPubMed
Weisman, C. S., Morlock, L. L., Teitelbaum, M. A., Klassen, A. C. and Celentano, D. D. (1989), ‘Practice changes in response to the malpractice litigation climate: results of a Maryland physician survey’, Medical Care, 27(1): 16–24.CrossRefGoogle Scholar
Weycker, D. A. and Jensen, G. A. (2000), ‘Medical malpractice among physicians: who will be sued and who will pay?’, Health Care Management Science, 3(4): 269–277.CrossRefGoogle Scholar