National Costs Of The Medical Liability System
Open accessAbstract
Concerns about reducing the rate of growth of health expenditures have reignited interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however. This article identifies the various components of liability system costs, generates national estimates for each component, and discusses the level of evidence available to support the estimates. Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
To Err is Human: Building a Safer Health System
Hendee, W. R. (2001) · Journal of Vascular and Interventional Radiology · doi:10.1016/s1051-0443(01)70072-3 · Cited by 10,122 · see citing works
Claims, Errors, and Compensation Payments in Medical Malpractice Litigation
Studdert, D. M., Mello, M. M., Gawande, A. A., Gandhi, T. K., Kachalia, A. B., Yoon, C. S., Puopolo, A. L., & Brennan, T. A. (2006) · New England Journal of Medicine · doi:10.1056/nejmsa054479 · Cited by 849 · see citing works
Self-citationDo Doctors Practice Defensive Medicine?
Kessler, D. P., & McClellan, M. (1996) · The Quarterly Journal of Economics · doi:10.2307/2946682 · Cited by 632 · see citing works
The impact of malpractice fears on cesarean section rates
Dubay, L. C., Kaestner, R. J., & Waidmann, T. (1999) · Journal of Health Economics · doi:10.1016/s0167-6296(99)00004-1 · Cited by 272 · see citing works
First Do No Harm? Tort Reform and Birth Outcomes *
Currie, J., & MacLeod, W. B. (2008) · The Quarterly Journal of Economics · doi:10.1162/qjec.2008.123.2.795 · Cited by 270 · see citing works
Relationship Between Malpractice Claims and Cesarean Delivery
Localio, A. R. (1993) · JAMA · doi:10.1001/jama.1993.03500030064034 · Cited by 197 · see citing works
Malpractice Liability Costs And The Practice Of Medicine In The Medicare Program
D, K. B. A., Fisher, E. S., & Chandra, A. (2007) · Health Affairs · doi:10.1377/hlthaff.26.3.841 · Cited by 175 · see citing works
Self-citationThe Role of Medical Liability Reform in Federal Health Care Reform
Mello, M. M., & Brennan, T. A. (2009) · New England Journal of Medicine · doi:10.1056/nejmp0903765 · Cited by 163 · see citing works
Self-citationIs there empirical evidence for “Defensive Medicine”? A reassessment
Sloan, F. A., & Shadle, J. (2008) · Journal of Health Economics · doi:10.1016/j.jhealeco.2008.12.006 · Cited by 152 · see citing works
How Liability Law Affects Medical Productivity
Kessler, D. P., & McClellan, M. (2000) · Journal of Health Economics · doi:10.1016/s0167-6296(02)00076-0 · Cited by 145 · see citing works
Malpractice law and health care reform: optimal liability policy in an era of managed care
Kessler, D. P., & McClellan, M. (2002) · Journal of Public Economics · doi:10.1016/s0047-2727(01)00124-4 · Cited by 132 · see citing works
Physicians' Perceptions of the Risk of Being Sued
Lawthers, A. G., Localio, A. R., Laird, N. M., Lipsitz, S. R., Hebert, L. E., & Brennan, T. A. (1992) · Journal of Health Politics Policy and Law · doi:10.1215/03616878-17-3-463 · Cited by 110 · see citing works
Defensive medicine and obstetrics.
Baldwin, L., Hart, L. G., Lloyd, M., Fordyce, M. A., & Rosenblatt, R. A. (1995) · PubMed · Cited by 93 · see citing works
Defensive Medicine and Obstetrics
Baldwin, L. (1995) · JAMA · doi:10.1001/jama.1995.03530200042034 · Cited by 64 · see citing works
Estimating the Effect of Damages Caps in Medical Malpractice Cases: Evidence from Texas
Hyman, D. A., Black, B. S., Silver, C. M., & Sage, W. M. (2009) · The Journal of Legal Analysis · doi:10.4159/jla.v1i1.16 · Cited by 59 · see citing works
The Effect of Malpractice Liability on the Delivery of Health Care
Baicker, K., & Chandra, A. (2005) · Forum for Health Economics & Policy · doi:10.2202/1558-9544.1010 · Cited by 53 · see citing works
Self-citationAre Damages Caps Regressive? A Study Of Malpractice Jury Verdicts In California
Studdert, D. M., Yang, Y. T., & Mello, M. M. (2004) · Health Affairs · doi:10.1377/hlthaff.23.4.54 · Cited by 49 · see citing works
Self-citationDanzon, P. M., Pauly, M. V., & Kington, R. S. (1990) · PubMed · Cited by 48 · see citing works
Medical Malpractice: Claims, Legal Costs, And The Practice Of Defensive Medicine
Zuckerman, S. (1984) · Health Affairs · doi:10.1377/hlthaff.3.3.128 · Cited by 35 · see citing works
Defensive Medicine and Tort Reform: A Wide View
Studdert, D. M., Mello, M. M., & Brennan, T. A. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1319-8 · Cited by 32 · see citing works
Self-citationImpact of the National Practitioner Data Bank on Resolution of Malpractice Claims
Waters, T. M., Studdert, D. M., Brennan, T. A., Thomas, E. J., Almagor, O., Mancewicz, M., & Budetti, P. P. (2003) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.5034/inquiryjrnl_40.3.283 · Cited by 17 · see citing works
Self-citation
Flagged first, then by citations
1 of the 22 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [12]Baker T Kritzer HM Vidmar N Jackpot justice and the American tort system: thinking beyond junk science [Internet] Rochester (NY) Social Science Research Network 2008 Jul 1 [cited 2010 Jul 1]. Available from: http://ssrn.com/abstract=1152306
Cited by
Sorted by citations
Malpractice Risk According to Physician Specialty
Jena, A. B., Seabury, S., Lakdawalla, D., & Chandra, A. (2011) · New England Journal of Medicine · doi:10.1056/nejmsa1012370 · Cited by 1,180 · see citing works
Self-citationDelivering affordable cancer care in high-income countries
Sullivan, R., Peppercorn, J., Sikora, K., Zalcberg, J., Meropol, N. J., Amir, E., Khayat, D., Boyle, P., Autier, P., Tannock, I. F., et al. (2011) · The Lancet Oncology · doi:10.1016/s1470-2045(11)70141-3 · Cited by 718 · see citing works
The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis
Zhi, M., Ding, E. L., Theisen-Toupal, J., Whelan, J., & Arnaout, R. (2013) · PLoS ONE · doi:10.1371/journal.pone.0078962 · Cited by 535 · see citing works
Technology Growth and Expenditure Growth in Health Care
Chandra, A., & Skinner, J. (2011) · Journal of Economic Literature · doi:10.1257/jel.50.3.645 · Cited by 416 · see citing works
Self-citationPersonal Consequences of Malpractice Lawsuits on American Surgeons
Balch, C. M., Oreskovich, M. R., Dyrbye, L. N., Colaiano, J. M., Satele, D., Sloan, J. A., & Shanafelt, T. D. (2011) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2011.08.005 · Cited by 335 · see citing works
Saini, V., García-Armesto, S., Klemperer, D., Paris, V., Elshaug, A. G., Brownlee, S., Ioannidis, J. P. A., & Fisher, E. S. (2017) · The Lancet · doi:10.1016/s0140-6736(16)30947-3 · Cited by 269 · see citing works
Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging
Kanzaria, H. K., Hoffman, J. R., Probst, M. A., Caloyeras, J. P., Berry, S. H., & Brook, R. H. (2015) · Academic Emergency Medicine · doi:10.1111/acem.12625 · Cited by 214 · see citing works
The (Paper)Work of Medicine: Understanding International Medical Costs
Cutler, D., & Ly, D. P. (2011) · The Journal of Economic Perspectives · doi:10.1257/jep.25.2.3 · Cited by 203 · see citing works
Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons
Nahed, B. V., Babu, M. A., Smith, T. R., & Heary, R. F. (2012) · PLoS ONE · doi:10.1371/journal.pone.0039237 · Cited by 197 · see citing works
“Regardless of actual outcomes, the threat of litigation influences how neurosurgeons utilize defensive medicine practices [18].”
BackgroundWho Ordered That? The Economics of Treatment Choices in Medical Care
Chandra, A., Cutler, D., & Song, Z. (2011) · Handbook of health economics · doi:10.1016/b978-0-444-53592-4.00006-2 · Cited by 191 · see citing works
Self-citation(1989) · Choice Reviews Online · doi:10.5860/choice.26-2665 · Cited by 188 · see citing works
Prevalence and Characteristics of Physicians Prone to Malpractice Claims
Studdert, D. M., Bismark, M., Mello, M. M., Singh, H., & Spittal, M. J. (2016) · New England Journal of Medicine · doi:10.1056/nejmsa1506137 · Cited by 155 · see citing works
“Significant physical injury 25,447 (38)”
Self-citationHow much diagnostic safety can we afford, and how should we decide? A health economics perspective
Newman‐Toker, D. E., McDonald, K. M., & Meltzer, D. O. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2012-001616 · Cited by 138 · see citing works
Evaluating the Medical Malpractice System and Options for Reform
Kessler, D. P. (2011) · The Journal of Economic Perspectives · doi:10.1257/jep.25.2.93 · Cited by 130 · see citing works
Seabury, S. A., Chandra, A., Lakdawalla, D. N., & Jena, A. B. (2013) · Health Affairs · doi:10.1377/hlthaff.2012.0967 · Cited by 129 · see citing works
Self-citationNew Directions in Medical Liability Reform
Kachalia, A. B., & Mello, M. M. (2011) · New England Journal of Medicine · doi:10.1056/nejmhpr1012821 · Cited by 126 · see citing works
Self-citationSegal, G., Segev, A., Brom, A., Lifshitz, Y., Wasserstrum, Y., & Zimlichman, E. (2019) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocz135 · Cited by 108 · see citing works
Outcomes of Medical Malpractice Litigation Against US Physicians
Jena, A. B., Chandra, A., Lakdawalla, D. N., & Seabury, S. A. (2012) · Archives of Internal Medicine · doi:10.1001/archinternmed.2012.1416 · Cited by 104 · see citing works
Self-citationDo health information technology investments impact hospital financial performance and productivity?
Wang, T., Wang, Y., & McLeod, A. J., Jr. (2017) · International Journal of Accounting Information Systems · doi:10.1016/j.accinf.2017.12.002 · Cited by 95 · see citing works
“HIT can contribute to hospital profitability by reducing paper chart pulling and document transportation (Wang and Biedermann, 2010), reducing medical errors, potentially lowering medical liability costs (Mello et al., 2010) as well as decreasing back office expense (McLeod et al., 2008).”
BackgroundCarrier, E. R., Reschovsky, J. D., Katz, D. A., & Mello, M. M. (2013) · Health Affairs · doi:10.1377/hlthaff.2013.0233 · Cited by 94 · see citing works
Self-citationThe Effect of Malpractice Reform on Emergency Department Care
Waxman, D. A., Greenberg, M. D., Ridgely, M. S., Kellermann, A. L., & Heaton, P. (2014) · New England Journal of Medicine · doi:10.1056/nejmsa1313308 · Cited by 94 · see citing works
Physician spending and subsequent risk of malpractice claims: observational study
Jena, A. B., Schoemaker, L., Bhattacharya, J., & Seabury, S. A. (2015) · BMJ · doi:10.1136/bmj.h5516 · Cited by 91 · see citing works
Medical Errors, Malpractice, and Defensive Medicine: An Ill-Fated Triad
Berlin, L. (2017) · Diagnosis · doi:10.1515/dx-2017-0007 · Cited by 132 · see citing works
The Medical Liability Climate and Prospects for Reform
Mello, M. M., Studdert, D. M., & Kachalia, A. B. (2014) · JAMA · doi:10.1001/jama.2014.10705 · Cited by 89 · see citing works
Self-citationMalpractice Liability and Health Care Quality
Mello, M. M., Frakes, M., Blumenkranz, E., & Studdert, D. M. (2020) · JAMA · doi:10.1001/jama.2019.21411 · Cited by 87 · see citing works
Self-citationThe Cost of Defensive Medicine on 3 Hospital Medicine Services
Rothberg, M. B., Class, J., Bishop, T. F., Friderici, J. L., Kleppel, R., & Lindenauer, P. K. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.4649 · Cited by 87 · see citing works
Defensive medicine: It is time to finally slow down an epidemic
Vento, S., Cainelli, F., & Vallone, A. (2018) · World Journal of Clinical Cases · doi:10.12998/wjcc.v6.i11.406 · Cited by 81 · see citing works
Bourne, T., Shah, H., Falconieri, N., Timmerman, D., Lees, C. C., Wright, A., Lumsden, M. A., Regan, L., & CALSTER, B. V. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-030968 · Cited by 81 · see citing works
Intolerance of error and culture of blame drive medical excess
Hoffman, J. R., & Kanzaria, H. K. (2014) · BMJ · doi:10.1136/bmj.g5702 · Cited by 79 · see citing works
Sethi, M. K., Obremskey, W. T., Natividad, H., Mir, H. R., & Jahangir, A. A. (2012) · PubMed · Cited by 75 · see citing works
Reschovsky, J. D., & Saiontz-Martinez, C. (2017) · Health Services Research · doi:10.1111/1475-6773.12660 · Cited by 74 · see citing works
Medical Malpractice in Neurosurgery: A Comprehensive Analysis
Thomas, R., Gupta, R., Griessenauer, C. J., Moore, J. M., Adeeb, N., Motiei-Langroudi, R., Guidal, B., Agarwal, N., Alterman, R. L., Friedlander, R. M., et al. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.11.051 · Cited by 74 · see citing works
Prevalence and costs of defensive medicine: a national survey of Italian physicians
Panella, M., Rinaldi, C., Leigheb, F., Knesse, S., Donnarumma, C., Kul, S., Vanhaecht, K., & Stanislao, F. D. (2017) · Journal of Health Services Research & Policy · doi:10.1177/1355819617707224 · Cited by 74 · see citing works
“In the United States, DM is estimated to cost US $50–100 billion annually.(18,19) At the patient level, the practice of DM is also estimated to cost hospitals US$ 226, which is 13% of the mean patient cost (US $1695).”
BackgroundMethodResultHow defensive medicine is defined in European medical literature: a systematic review
Baungaard, N., Skovvang, P. L., Hvidt, E. A., Gerbild, H. N., Andersen, M. K. K., & Lykkegaard, J. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-057169 · Cited by 70 · see citing works
Schoenfeld, E. M., Mader, S. C., Houghton, C., Wenger, R. J., Probst, M. A., Schoenfeld, D., Lindenauer, P. K., & Mazor, K. M. (2019) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2018.11.017 · Cited by 69 · see citing works
Menon, N. M., & Kohli, R. (2013) · Information Systems Research · doi:10.1287/isre.2013.0484 · Cited by 68 · see citing works
Use of Cardiac Biomarker Testing in the Emergency Department
Makam, A. N., & Nguyen, O. K. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.5830 · Cited by 67 · see citing works
Descriptive Analysis of State and Federal Spine Surgery Malpractice Litigation in the United States
Agarwal, N., Gupta, R., Agarwal, P., Matthew, P., Wolferz, R., Shah, A., Adeeb, N., Prabhu, A. V., Kanter, A. S., Okonkwo, D. O., et al. (2017) · Spine · doi:10.1097/brs.0000000000002510 · Cited by 65 · see citing works
The Social Cost Of Adverse Medical Events, And What We Can Do About It
Goodman, J. C., Villarreal, P. M., & Jones, B. (2011) · Health Affairs · doi:10.1377/hlthaff.2010.1256 · Cited by 64 · see citing works
Histological coherent Raman imaging: a prognostic review
Cicerone, M. T., & Camp, C. H. (2017) · The Analyst · doi:10.1039/c7an01266g · Cited by 64 · see citing works
The determinants of defensive medicine in Italian hospitals: The impact of being a second victim
Panella, M., Rinaldi, C., Leigheb, F., Donnarumma, C., Kul, S., Vanhaecht, K., & Stanislao, F. D. (2016) · Revista de Calidad Asistencial · doi:10.1016/j.cali.2016.04.010 · Cited by 63 · see citing works
Defensive Medicine in Neurosurgery
Smith, T. R., Habib, A., Rosenow, J. M., Nahed, B. V., Babu, M. A., Cybulski, G. R., Fessler, R. D., Batjer, H. H., & Heary, R. F. (2014) · Neurosurgery · doi:10.1227/neu.0000000000000576 · Cited by 59 · see citing works
“2 billion per year.(7) Defensive-medicine practices tend to predominate in high-risk specialties such as neurosurgery, obstetrics and gynecology, and orthopedic surgery.”
BackgroundHealth perspectives: International epidemiology of ageing
Ward, S. A., Parikh, S., & Workman, B. (2011) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2011.05.002 · Cited by 59 · see citing works
Does medical malpractice law improve health care quality?
Frakes, M., & Jena, A. B. (2016) · Journal of Public Economics · doi:10.1016/j.jpubeco.2016.09.002 · Cited by 59 · see citing works
“3 In the context of medical malpractice jurisprudence alone, the United States spends over $7 billion annually in litigation expenses for defendants and plaintiffs and for the overhead incurred by medical liability insurers (Mello et al, 2010).”
InfluentialCarlson, J. N., Foster, K. M., Pines, J. M., Corbit, C. K., Ward, M. J., Hydari, M. Z., & Venkat, A. (2017) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2017.06.023 · Cited by 55 · see citing works
“Emergency physicians are likely to be involved in malpractice claims; more than 75% of emergency physicians will be named in a malpractice claim at some point in their career.1On average, physicians spend 50.7 months of their career involved in litigation.2 To help reduce risk, 9 in 10 physicians report overusing or o…”
InfluentialDefensive Medicine: Evidence from Military Immunity
Frakes, M., & B, J. G. A. (2019) · American Economic Journal Economic Policy · doi:10.1257/pol.20180167 · Cited by 55 · see citing works
Agarwal, R. K., Gupta, A., & Gupta, S. (2019) · Health Services Research · doi:10.1111/1475-6773.13157 · Cited by 55 · see citing works
Rohacek, M., Buatsi, J., Szucs‐Farkas, Z., Kleim, B., Zimmermann, H., Exadaktylos, A. K., & Stoupis, C. A. (2012) · Intensive Care Medicine · doi:10.1007/s00134-012-2595-z · Cited by 55 · see citing works
“However, there are estimates that defensive medicine costs the US health-care system up to 45–100 billion dollars annually and is thought to account for 5–25 % of all medical care costs in the USA [7, 9, 18, 19].”
BackgroundOver-testing: Why More Is Not Better
Greenberg, J., & Green, J. B. (2014) · The American Journal of Medicine · doi:10.1016/j.amjmed.2013.10.024 · Cited by 52 · see citing works
Communicating Value in Simulation: Cost Benefit Analysis and Return on Investment
Asche, C. V., Kim, M., Brown, A., Golden, A., Laack, T. A., Rosario, J., Strother, C. G., Totten, V. Y., & Okuda, Y. (2017) · Academic Emergency Medicine · doi:10.1111/acem.13327 · Cited by 54 · see citing works
Defensive Medicine: A Case and Review of Its Status and Possible Solutions
Katz, E. (2019) · Clinical Practice and Cases in Emergency Medicine · doi:10.5811/cpcem.2019.9.43975 · Cited by 53 · see citing works
Will Tort Reform Bend the Cost Curve? Evidence from Texas
Paik, M., Black, B. S., Hyman, D. A., & Silver, C. M. (2012) · Journal of Empirical Legal Studies · doi:10.1111/j.1740-1461.2012.01251.x · Cited by 52 · see citing works
“11Mello et al. (2010) estimate direct costs in 2010 at $10 billion, or 0.”
BackgroundMedical Studentsʼ and Residentsʼ Clinical and Educational Experiences With Defensive Medicine
O’Leary, K. J., Choi, J. N., Watson, K., & Williams, M. V. (2011) · Academic Medicine · doi:10.1097/acm.0b013e31823f2c86 · Cited by 51 · see citing works
Defensive medicine among antibiotic stewards: the international ESCMID AntibioLegalMap survey
Tebano, G., Dyar, O. J., Beovič, B., Béraud, G., Thilly, N., Pulcini, C., & ESCMID Study Group for Antimicrobial stewardshiP (ESGAP) (2018) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dky098 · Cited by 51 · see citing works
The Role of Practice Guidelines in Medical Malpractice Litigation
Mackey, T. K., & Liang, B. A. (2011) · The AMA Journal of Ethic · doi:10.1001/virtualmentor.2011.13.1.hlaw1-1101 · Cited by 50 · see citing works
Analysis of Factors Associated With Rhytidectomy Malpractice Litigation Cases
Kandinov, A., Mutchnick, S. A., Nangia, V., Svider, P. F., Zuliani, G. F., Shkoukani, M. A., & Carron, M. A. (2017) · JAMA Facial Plastic Surgery · doi:10.1001/jamafacial.2016.1782 · Cited by 49 · see citing works
Review of Neurosurgery Medical Professional Liability Claims in the United States
Elsamadicy, A. A., Sergesketter, A. R., Frakes, M., & Lad, S. P. (2018) · Neurosurgery · doi:10.1093/neuros/nyx565 · Cited by 47 · see citing works
“63 $668 086 055 [4] $287 844 [17] $165 000 $7239 248”
Zhu, L., Li, L., & Lang, J. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019752 · Cited by 47 · see citing works
“4% of total healthcare spending.(18) Within specialty and after adjustment for patient characteristics, higher resource use by physicians is associated with fewer malpractice claims.”
BackgroundBester, J. C. (2020) · Medicine Health Care and Philosophy · doi:10.1007/s11019-020-09950-7 · Cited by 47 · see citing works
The medicolegal landscape of spine surgery: how do surgeons fare?
Makhni, M. C., Park, P., Jimenez, J., Saifi, C., Caldwell, J.-M. E., Ha, A. S., Figueroa-Santana, B., Lehman, R. A., & Weidenbaum, M. (2017) · The Spine Journal · doi:10.1016/j.spinee.2017.06.038 · Cited by 45 · see citing works
Exploring the motivators of technology adoption in healthcare
Alrahbi, D., Khan, M., & Hussain, M. (2019) · International Journal of Healthcare Management · doi:10.1080/20479700.2019.1607451 · Cited by 45 · see citing works
Marx‐Fleck, S., Junker, N. M., Artinger, F. M., & van Dick, R. (2021) · Journal of Occupational and Organizational Psychology · doi:10.1111/joop.12353 · Cited by 51 · see citing works
Mathew, R. G., Ferguson, V., & Hingorani, M. (2012) · Ophthalmology · doi:10.1016/j.ophtha.2012.01.009 · Cited by 44 · see citing works
Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists
Reuveni, I., Pelov, I., Reuveni, H., Bonne, O., & Canetti, L. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-014153 · Cited by 43 · see citing works
Overuse of Testing in Preoperative Evaluation and Syncope
Kachalia, A. B., Berg, A., Fagerlin, A., Fowler, K. E., Hofer, T. P., Flanders, S. A., & Saint, S. K. (2015) · Annals of Internal Medicine · doi:10.7326/m14-0694 · Cited by 43 · see citing works
In Pursuit of Value-Based Maternity Care
Sudhof, L. S., & Shah, N. T. (2019) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000003113 · Cited by 43 · see citing works
Association of Emotional Intelligence With Malpractice Claims
Shouhed, D., Beni, C. E., Manguso, N., IsHak, W. W., & Gewertz, B. L. (2019) · JAMA Surgery · doi:10.1001/jamasurg.2018.5065 · Cited by 43 · see citing works
Zhang, J. K., del Valle, A. J., Alexopoulos, G., Patel, N., van Nispen, J., Patel, M. S., Xu, E., Mercier, P., Kohn, N. A., & Mattei, T. A. (2022) · The Spine Journal · doi:10.1016/j.spinee.2022.03.015 · Cited by 41 · see citing works
Yan, S. C., Hulou, M. M., Coté, D. J., Roytowski, D., Rutka, J. T., Gormley, W. B., & Smith, T. R. (2016) · World Neurosurgery · doi:10.1016/j.wneu.2016.07.069 · Cited by 41 · see citing works
The Receding Tide of Medical Malpractice Litigation: Part 1—National Trends
Paik, M., Black, B. S., & Hyman, D. A. (2013) · Journal of Empirical Legal Studies · doi:10.1111/jels.12021 · Cited by 41 · see citing works
“18For 2008, Mello et al. (2010) estimate the sum of indemnity payments and insurance company administrative expenses at $9.”
Fargen, K. M., & Friedman, W. A. (2014) · World Neurosurgery · doi:10.1016/j.wneu.2014.03.030 · Cited by 41 · see citing works
Damage caps and defensive medicine, revisited
Paik, M., Black, B. S., & Hyman, D. A. (2016) · Journal of Health Economics · doi:10.1016/j.jhealeco.2016.11.001 · Cited by 41 · see citing works
Plastic Surgery and the Malpractice Industry
Boyd, J. B., Moon, H. K., Martin, S., & Mastrogiovanni, D. B. (2020) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000007497 · Cited by 40 · see citing works
Wan, P. K., Satybaldy, A., Huang, L., Holtskog, H., & Nowostawski, M. (2020) · Journal of Medical Internet Research · doi:10.2196/22013 · Cited by 39 · see citing works
“CDS failures and errors caused by individuals have resulted in direct costs of more than US $20 billion in the United States [14,15].”
BackgroundReasons for ordering computed tomography scans of the head in patients with minor brain injury
Rohacek, M., Albrecht, M., Kleim, B., Zimmermann, H., & Exadaktylos, A. K. (2012) · Injury · doi:10.1016/j.injury.2012.01.001 · Cited by 39 · see citing works
Defensive medicine among neurosurgeons in the Netherlands: a national survey
Yan, S. C., Hulsbergen, A. F. C., Muskens, I. S., van Dam, M., Gormley, W. B., Broekman, M. L. D., & Smith, T. R. (2017) · Acta Neurochirurgica · doi:10.1007/s00701-017-3323-9 · Cited by 39 · see citing works
“2 billion annually to healthcare expenditures in the United States alone [8, 12, 17].”
BackgroundLeCraw, F. R., Montanera, D., Jackson, J. P., Keys, J. C., Hetzler, D. C., & Mroz, T. A. (2018) · Journal of Patient Safety and Risk Management · doi:10.1177/1356262217751808 · Cited by 39 · see citing works
“limited association of medical error with compensation,(3) and increased healthcare cost due to the practice of defensive medicine.(4) It has also been suggested that (1)St Joseph/Candler, Northside, and Wellstar Atlanta Medical Centers;”
BackgroundToward safer practice in otology: A report on 15 years of clinical negligence claims
Mathew, R., Asimacopoulos, E. P., & Valentine, P. (2011) · The Laryngoscope · doi:10.1002/lary.22136 · Cited by 38 · see citing works
“Successful claims from 2009 to 2010 cost the NHS approximately 787 million Great British pounds (GBP) (1.20 billion United States dollars [USD]).1 A recent report from the United States estimated the annual cost of malpractice claims at 9.85 billion USD.”
BackgroundInfluentialThe safety of emergency medicine
Ramlakhan, S. L., Qayyum, H., Burke, D. P., & Brown, R. (2015) · Emergency Medicine Journal · doi:10.1136/emermed-2014-204564 · Cited by 38 · see citing works
A 12-year analysis of closed medical malpractice claims of the Taiwan civil court
Hwang, C.-Y., Wu, C.-H., Cheng, F.-C., Yen, Y.-L., & Wu, K.-H. (2018) · Medicine · doi:10.1097/md.0000000000010237 · Cited by 38 · see citing works
Li, S., & Brantley, E. (2015) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2015.09.015 · Cited by 41 · see citing works
Burnout in the Plastic Surgeon: Implications and Interventions
Prendergast, C., Ketteler, E. R., & Evans, G. R. D. (2016) · Aesthetic Surgery Journal · doi:10.1093/asj/sjw158 · Cited by 38 · see citing works
“4 percent of the total healthcare spending.(33)”
Gartland, R. M., Bloom, J. P., Fong, Z. V., DeRoo, C., Dwyer, K., Quinn, G. R., Lillemoe, K. D., & Mort, E. A. (2019) · Annals of Surgery · doi:10.1097/sla.0000000000003155 · Cited by 37 · see citing works
Dahlawi, S. M. A., Menezes, R., Khan, M., Waris, A., Saifullah, & Naseer, M. M. (2021) · F1000Research · doi:10.12688/f1000research.37448.1 · Cited by 32 · see citing works
Surgical Malpractice in the United States, 1990–2006
Orosco, R. K., Talamini, J., Chang, D. C., & Talamini, M. A. (2012) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2012.04.028 · Cited by 36 · see citing works
Changes in Practice among Physicians with Malpractice Claims
Studdert, D. M., Spittal, M. J., Zhang, Y., Wilkinson, D. S., Singh, H., & Mello, M. M. (2019) · New England Journal of Medicine · doi:10.1056/nejmsa1809981 · Cited by 35 · see citing works
Self-citationSchaffer, A. C., Babayan, A., Einbinder, J. S., Sato, L., & Gardner, R. (2021) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000004464 · Cited by 35 · see citing works
Pediatric Malpractice Claims in the Emergency Department and Urgent Care Settings From 2001 to 2015
Glerum, K. M., Selbst, S. M., Parikh, P. D., & Zonfrillo, M. R. (2018) · Pediatric Emergency Care · doi:10.1097/pec.0000000000001602 · Cited by 35 · see citing works
The Ecology of Defensive Medicine and Malpractice Litigation
Antoci, A., Maccioni, A. F., & Russu, P. (2016) · PLoS ONE · doi:10.1371/journal.pone.0150523 · Cited by 35 · see citing works
Seabury, S. A., Helland, E. A., & Jena, A. B. (2014) · Health Affairs · doi:10.1377/hlthaff.2014.0492 · Cited by 33 · see citing works
“Appendix verifies that our findings and conclusions are robust to several sensitivity analyses, including: (1) a discrete, nonparametric approach to incorporating the size of the cap on average payments, (2) inclusion of lead effects of tort reforms in order to assess for pre-existing trends in malpractice awards in s…”
ResultZheng, J., Lu, Y., Li, W., Zhu, B., Yang, F., & Shen, J. (2023) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzad096 · Cited by 39 · see citing works
Overuse of Cardiovascular Services
Huang, X., & Rosenthal, M. B. (2015) · Circulation · doi:10.1161/circulationaha.114.012668 · Cited by 32 · see citing works
“low-value from high-value care), it appears to play a disproportionate role in physicians’ perceptions of cost drivers.(40,41)”
BackgroundDefensive Medicine in U.S. Spine Neurosurgery
Din, R. S., Yan, S. C., Coté, D. J., Acosta, M. A., & Smith, T. R. (2016) · Spine · doi:10.1097/brs.0000000000001687 · Cited by 32 · see citing works
“Although the contribution of defensive practices to total healthcare costs is difficult to quantify, current estimates attribute over $55 billion of annual healthcare spending to medical liability costs.(10) Furthermore, needless spending motivated by fear of malpractice is estimated to cost over $210 billion annually.”
BackgroundMedical Practice Guidelines as Malpractice Safe Harbors: Illusion or Deceit?
Mehlman, M. J. (2012) · The Journal of Law Medicine & Ethics · doi:10.1111/j.1748-720x.2012.00664.x · Cited by 31 · see citing works
Saving Money or Just Saving Lives? Improving the Productivity of US Health Care Spending
D, K. B. A., Chandra, A., & Skinner, J. (2012) · Annual Review of Economics · doi:10.1146/annurev-economics-080511-110942 · Cited by 31 · see citing works
“The evidence on the magnitude of defensive medicine, however, suggests that it is not a primary driver of higher health care spending, accounting for less than 3% of health care spending in the United States (Mello et al. 2010).”
BackgroundSelf-citationIncorporating Artificial Intelligence into Healthcare Workflows: Models and Insights
Dai, T., & Abràmoff, M. D. (2023) · Tutorials in Operations Research: Advancing the Frontiers of OR/MS: From Methodologies to Applications · doi:10.1287/educ.2023.0257 · Cited by 29 · see citing works
Kessler, R. A., Benzil, D. L., Loewenstern, J., Chen, S. L., Bhammar, A., Kohli, K. M., Hadjipanayis, C. G., Scarrow, A. M., Bederson, J. B., & Shrivastava, R. K. (2018) · World Neurosurgery · doi:10.1016/j.wneu.2018.11.112 · Cited by 29 · see citing works
Medical Malpractice in Pediatric Orthopaedics: A Systematic Review of US Case Law
Galey, S. A., Margalit, A., Ain, M. C., & Brooks, J. T. (2019) · Journal of Pediatric Orthopaedics · doi:10.1097/bpo.0000000000001348 · Cited by 29 · see citing works
Medical professional liability risk among US cardiologists
Mangalmurti, S. S., Seabury, S. A., Chandra, A., Lakdawalla, D. N., Oetgen, W. J., & Jena, A. B. (2014) · American Heart Journal · doi:10.1016/j.ahj.2014.02.007 · Cited by 29 · see citing works
“h United States.(1) Despite growing evidence on how MPL risk varies according to physician specialty,(2-11) limited data are available on the liability risk faced by US cardiologists,(12,13) specialists for whom the MPL landscape may be particularly complicated.”
BackgroundInfluentialSelf-citationVariables That Impact Medical Malpractice Claims Involving Plastic Surgeons in the United States
Boyll, P., Kang, P. T., Mahabir, R. C., & Bernard, R. W. (2017) · Aesthetic Surgery Journal · doi:10.1093/asj/sjx182 · Cited by 29 · see citing works
“04) Conclusions: Variables that may reduce malpractice claims, and thereby both improve the quality and affordability of healthcare, include: (1) the use of procedure-specific patient education brochures; and (2) physician participation in malpractice insurance carrier-required courses.”
Background
- Authors
- Mello, M. M., Chandra, A., Gawande, A. A., & Studdert, D. M.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- The University of Melbourne (AU)
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2010-09
- Volume
- 29
- Issue
- 9
- Pages
- 1569-1577
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- PMC
- PMC3048809
- OpenAlex
- W2145204630
- Cited by
- 498
- References
- 22
- Citations by year
- 2026: 16 · 2025: 23 · 2024: 25 · 2023: 30 · 2022: 29 · 2021: 41 · 2020: 41 · 2019: 49 · 2018: 29 · 2017: 40 · 2016: 33 · 2015: 33 · 2014: 28 · 2013: 19 · 2012: 27
- FWCI
- 57.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (P01AG19783, P01AG019783)
- Topics
- Health Sciences › Health Professions › Pharmacy › Medical Malpractice and Liability Issues
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Law, Economics, and Judicial Systems
- Keywords
- defensive medicine, health care costs, professional liability insurance, health care expenditure, health care spending growth
- MeSH terms
- Defensive Medicine, Health Expenditures, Humans, United States, Liability, Legal, Health Care Reform
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
