An economic assessment of defensive medicine

Thesis (Ph. D.)--University of Hawaii at Manoa, 1991.Includes bibliographical references (leaves 68-75)Microfiche.ix, 75 leaves, bound ill. 29 cmDefensive medicine is defined as an alteration of medical practice by physicians to reduce the possibility of malpractice litigation. The purpose of this study is to investigate the extent to which doctors in emergency room situations practice defensive medicine. The frequencies at which three types of medical diagnostic procedures are requested for emergency room patients are compared across three types of hospitals that each represents a different malpractice environment. The difference in the frequencies at which tests are being performed at one particular hospital versus the control hospital (without malpractice) represents the quantification of the practice of defensive medicine when other causes of variation are controlled for. Three clinical procedures are studied: skull x-rays "for head trauma patients, cervical spine x-rays for neck injury patients, and computed tomography for suspected stroke patients. Primary data was gathered from the individual patient records from the selected hospitals. Various attributes were specifically selected in order to get sufficiently similar and yet a representative sample from each source. statistical test based on normal probability distribution showed that physicians practicing in hospitals with threats of malpractice ordered significantly greater numbers of tests compared to the control hospital verifying the practice of defensive medicine. The samples of selected patients across the three types of hospitals were tested to be homogeneous with respect to age and sex. However, homogeneity of severity of cases can only be attained in head-trauma and neck injury cases across the sample hospitals