TY - JOUR
T1 - Defensive medicine in Israel - a nationwide survey
AU - Asher, Elad
AU - Greenberg-Dotan, Sari
AU - Halevy, Jonathan
AU - Glick, Shimon
AU - Reuveni, Haim
N1 - Funding Information:
Israel has maintained a system of socialized health care since its establishment in 1948. In 2010, there were 25,542 doctors in Israel – 3·36 doctors for every 1,000 people. Since 1995 all Israeli citizens are entitled by law to the same health care Uniform Benefits Package, for example: medical diagnosis and treatment, preventive medicine, hospitalization (general, maternity, psychiatric, and chronic), surgery and transplants, preventive dental care for children, and first aid. In cross-country comparisons between health care systems in the Organization for Economic Co-operation and Development (OECD) countries, the Israeli healthcare system was similar to the quality of care and technologically advanced to these countries. The Israeli malpractice system is somewhat similar to the U.S. malpractice system and there are no features like a no-fault system. In the previous few years, there were between 4200–4500 medical lawsuits in Israel every year and the average compensation for every patient was $62,000 in the years 2008/9 compared to only $22,000 5 years earlier . Researchers from the Faculty of Health Sciences and the Guilford Glazer School of Business and Management at the Ben-Gurion University of the Negev collaborated with the Israel Medical Association (IMA) to conduct the study. The IMA is the official organization representing the physicians in Israel. The survey was supported by the Israel national institute for health policy research.
PY - 2012/8/16
Y1 - 2012/8/16
N2 - Background: Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily as a safeguard against possible malpractice liability. We studied the extent, reasons, and characteristics of defensive medicine in the Israeli health care system. Methods and Findings: Cross-sectional study performed in the Israeli health care system between April and July 2008 in a sample (7%) of board certified physicians from eight medical disciplines (internal medicine, pediatrics, general surgery, family medicine, obstetrics and gynecology, orthopedic surgery, cardiology, and neurosurgery). A total of 889 physicians (7% of all Israeli board certified specialists) completed the survey. The majority [60%, (95%CI 0·57-0·63)] reported practicing defensive medicine; 40% (95%CI 0·37-0·43) consider every patient as a potential threat for a medical lawsuit; 25% (95%CI 0·22-0·28) have previously been sued at least once during their career. Independent predictors for practicing defensive medicine were surgical specialty [OR = 1.6 (95%CI 1·2-2·2), p = 0·0004], not performing a fellowship abroad [OR = 1·5 (95%CI 1·1-2), p = 0·027], and previous exposure to lawsuits [OR = 2·4 (95%CI 1·7-3·4), p&0·0001]. Independent predictors for the risk of being sued during a physician's career were male gender [OR = 1·6 (95%CI 1·1-2·2), p = 0·012] and surgery specialty [OR = 3·2 (95%CI 2·4-4·3), p&0·0001] (general surgery, obstetrics and gynecology, orthopedic surgery, and neurosurgery). Conclusions: Defensive medicine is very prevalent in daily physician practice in all medical disciplines. It exposes patients to complications due to unnecessary tests and procedures, affects quality of care and costs, and undermines doctor-patient relationships. Further studies are needed to understand how to minimize defensive medicine resulting from an increased malpractice liability market.
AB - Background: Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily as a safeguard against possible malpractice liability. We studied the extent, reasons, and characteristics of defensive medicine in the Israeli health care system. Methods and Findings: Cross-sectional study performed in the Israeli health care system between April and July 2008 in a sample (7%) of board certified physicians from eight medical disciplines (internal medicine, pediatrics, general surgery, family medicine, obstetrics and gynecology, orthopedic surgery, cardiology, and neurosurgery). A total of 889 physicians (7% of all Israeli board certified specialists) completed the survey. The majority [60%, (95%CI 0·57-0·63)] reported practicing defensive medicine; 40% (95%CI 0·37-0·43) consider every patient as a potential threat for a medical lawsuit; 25% (95%CI 0·22-0·28) have previously been sued at least once during their career. Independent predictors for practicing defensive medicine were surgical specialty [OR = 1.6 (95%CI 1·2-2·2), p = 0·0004], not performing a fellowship abroad [OR = 1·5 (95%CI 1·1-2), p = 0·027], and previous exposure to lawsuits [OR = 2·4 (95%CI 1·7-3·4), p&0·0001]. Independent predictors for the risk of being sued during a physician's career were male gender [OR = 1·6 (95%CI 1·1-2·2), p = 0·012] and surgery specialty [OR = 3·2 (95%CI 2·4-4·3), p&0·0001] (general surgery, obstetrics and gynecology, orthopedic surgery, and neurosurgery). Conclusions: Defensive medicine is very prevalent in daily physician practice in all medical disciplines. It exposes patients to complications due to unnecessary tests and procedures, affects quality of care and costs, and undermines doctor-patient relationships. Further studies are needed to understand how to minimize defensive medicine resulting from an increased malpractice liability market.
UR - http://www.scopus.com/inward/record.url?scp=84865085811&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0042613
DO - 10.1371/journal.pone.0042613
M3 - Article
C2 - 22916140
AN - SCOPUS:84865085811
SN - 1932-6203
VL - 7
JO - PLoS ONE
JF - PLoS ONE
IS - 8
M1 - e42613
ER -