Defensive Medicine and Healthcare Costs

Defensive medicine is considered an important cost since medical malpractice premiums are such a low percent of personal healthcare spending in the U.S. However, the cost of defensive medicine is questionable. The most cited article on defensive medicine is by Dan Kessler and Mark McClellan, published in 1996. A recent study by John Shadle and myself seeks to replicate their findings not only for heart disease but for stroke, breast cancer, and diabetes as well. While the results for heart disease almost replicate the Kessler and McClellan findings, the results for the other diseases do not. This calls into question the generalizablility of their findings. Other studies have found some effects of tort reform on amount and type of care delivered, but in no case is there hard empirical evidence that medical malpractice is the cost driver the advocates of tort reform would have it be.
Is there Empirical Evidence for “Defensive Medicine”? A Reassessment