Defensive Medicine and the Use of Medical Technology: The Effect of Insurance Coverage Law on Defensive Medicine

摘要

The primary purpose of this report is to analyze the effect that private health insurance coverage decisions have on malpractice litigation and on the behavior described as defensive medicine. The report has a secondary purpose, related but somewhat distinct, which is to examine the manner in which insurance coverage decisions affect the adoption and dissemination of new medical technologies. The report begins with an overview of how private health insurance contracts are typically worded, how courts have resolved coverage disputes under those contracts, and how insurers might revise their contracts in response to these judicial rulings. The report then examines the influence of both affirmative and negative reimbursement decisions on the malpractice standard of care, reporting on an informal survey of about a dozen prominent lawyers and doctors. The report concludes with a series of recommendations about how reimbursement and liability incentives might be brought more into sync without unfairly exposing providers to liability for failing to provide care that is not covered.