In the numerous healthcare reform discussions taking place in Washington D.C and across the country about reducing healthcare costs, one issue that creates a lot of tension is that of malpractice costs and defensive medicine.

For starters, it is important to distinguish between the two. When a doctor commits a mistake during the course of their patient care and the patient ends up suing the doctor, the cost of legal defense and payment of the claims are the medical malpractice costs. There are estimated to be around $30 billion dollars per year, thus amounting to less than 1% of national healthcare spending.

Defensive medicine, on other hand, happens because the doctor is trying to avoid committing the mistake, and is much more difficult to measure. A doctor is said to be practicing defensive medicine when he/she orders a test or a procedure that are not medically needed in order to evade the threat of litigation.

So why is that such as bad thing? One might wonder. Isn’t more care equivalent to better care? Not necessarily! All additional tests and procedures have their own risks that sometimes outweigh the benefits. Also, many tests can lead to “false-positives,” meaning that the test says that the patient has the disease while the patient actually does not have it.

How common is defensive medicine, and most importantly, how much does it cost us a healthcare system? A 2005 study showed that 93% of specialist doctors in Pennsylvania admitted to practicing defensive medicine. A more recent study including Massachusetts physicians concluded that 83% of them admitted to the same. In this latter study, 25% of all imaging tests (radiology tests such as X-rays) are ordered for defensive purposes.

There are no definite numbers as to how much defensive medicine costs the healthcare system in terms of unnecessary tests and procedures. The estimates range between $100 billion of to $300 billion (3%-10% of overall healthcare costs), which a very significant amount.

However, what is also important to remember is that defensive medicine does not only result in overuse of healthcare. In the Massachusetts study mentioned above, 28% of the physicians admitted to reducing the number of high-risk patients that they saw, and 38% admitted to limiting the number of high-risk procedures that they performed. So while scared doctors are more likely to order unnecessary care, sometimes they try to avoid giving care all together if they perceive the patient as being too sick or too risky.