It is often said that so-called “defensive medicine” accounts for extra, perhaps unnecessary, healthcare costs. According to proponents, the motivation is to avoid expensive malpractice suits. But is this borne out of the evidence?

A study of more than 24,500 physicians from 7 different specialties and 18 million hospital admissions in Florida found that the higher the bill, the less likely the physician was to be sued. The researchers found that the rate of malpractice suits for the lowest billings was around 2.3%, whereas the rate among the highest billings was 0.4%. Noting that previous research had not clearly identified the impact of defensive medicine practices, the study found that an internist whose average charges were $20,000 had a 1.2% chance of a suit, whereas one averaging charges of $39,000 had a 0.3% chance.

The study’s results must be interpreted with caution. For example, there could have been a bias in patterns within Florida’s healthcare system. Also, controlling for disease severity was not fully possible, and the higher bills could not be directly associated with procedures generally classified as defensive medicine.

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 “Our findings suggest that healthcare reform efforts designed to get physicians to reduce utilization may be met with sluggish opposition if the unintended effect of reduced utilization is increased malpractice risk for the physician,” said researcher Anupam B. Jena, MD, PhD.

Further confounding this finding is what Modern Healthcare’s Sabriya Rice summarized as “the nationwide spotlight on value- and evidence-based health care. Those efforts reward providers for following recommended guidelines and for cutting excess costs.”

Further research will be needed to reconcile these seemingly disparate trends.


  1. Bakalar N. ‘Defensive Medicine’ May Lower Malpractice Risks. The New York Times. November 4, 2015. Accessed November 24, 2015.
  2. Toor K. Doctors following defensive medicine sued lesser for malpractice. Nature World Report. November 5, 2015. Accessed November 24, 2015.
  3. Rice S. Blog: Study defends ‘defensive medicine’ – sort of. Modern Healthcare. November 5, 2015. Accessed November 24, 2015.
  4. Walker M. ‘Defensive Medicine’ Pays Off, Study Suggests. MedPage Today. November 6, 2015. Accessed November 24, 2015.
  5. Roman J. Doctors Face Lower Number of Malpractice Lawsuits When They Order More Tests. Tech Times. November 6, 2015. Accessed November 24, 2015.
  6. Seaman AM. High-spending doctors less likely to be sued. Reuters. November 5, 2015. Accessed November 24, 2015.