A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

I think that if you were to plot "c-section deliveries as a percentage of all pregnancies" through the years before and after Edwards' string of winning court cases, you would see that c-sections did increase.

Yup. Then it comes down to capacity - how many scans you can do a day vs. how many people need the diagnostic vs. how many people could use the diagnostic.

It's not entirely true that extra tests are only an issue because they reveal untreated disease that insurers would rather not pay for.

There are non-trivial false positive rates for many diagnostics that can and do lead to unnecessary follow-up tests, procedures, and emotional distress.

For example, "About half of the women getting annual mammograms over a 10-year period will have a false-positive finding." [0]

The US Task Force for Preventative Services works to clarify when diagnostics are appropriate given rates of false positives and false negatives for many different preventative services. And there are many groups that work to establish and record evidence-based guidelines for escalations of care outside of preventative care as well. Intermountain is one example.

[0] https://www.cancer.org/cancer/breast-cancer/screening-tests-...

So make tests cheaper - sounds like an opportunity that gets a win for everyone without political miracles.

(I don’t know the market I am talking about at all, but) Maybe they could incentivize cheap tests by capping the cost per test that can be administered without some large red tape process. The market will provide tests under that cap where possible, so they can be administered more frequently & frictionessly. Patients are thoroughly tested, Doctors cover their butts, and test supply companies get to keep selling lots of tests.

I see no issue with Extra Medical Tests. More data points do not hurt a diagnoisis if a proper scientific method is followed.

The primary issue here is the resulting cost.

As the article points out: "about 26 percent of every dollar spent."

You probably won't complain paying 26 cents for a $1 popsicle, but if the same popsicle cost you $100, you might be upset paying $26.

But is not the bigger question: Why is the popsicle $100 when it could have cost $1?

Here is a useful chart to show where the money goes: https://qph.fs.quoracdn.net/main-qimg-d68aea3ca1e466f166752e...

Where do you think malpractice costs fit there?

I personally feel sad everytime malpractice fears enter the discussion of costs - its a tiny, ignorable portion right now of total expenses.

However, to a typical layperson, it sounds like a big deal to worry about but actually distracts the attention costs should be getting.

As a result, I have tried to cover it here: https://www.quora.com/Why-does-one-believe-that-malpractice-...

Real input from real practitioners in the industry in the real world.

Sure, Malpractice overhead exists but it's analogous to a drop in the ocean. There is severe waste elsewhere that need to be handled first.

It's a nosebleed in a patient hemorrhaging blood through a punctured artery.

The argument that ordering extra tests offer doctors "additional defense" in case of a lawsuit is absolute hogwash. If anything, the test results put the doctor at a further disadvanatge wrt defense because they had an additional datapoint they should have considered in their diagnoisis but did not.

The primary issue with Healthcare in the U.S. is cost - for those who have the money and the will to spend it, it's one of the best in the world. A lot of the rich visit the US for their Healthcare needs.

Healthcare in the U.S. is optimized for profit: https://www.quora.com/What-makes-the-US-healthcare-system-so...

This is very wrong as it encourages short term profit seeking behavior which is absolutely the opposite of what healthcare should be (eg: C Sections being preferred over natural but long childbirth)

A for-profit system does not help the doctor/provider either (although it gives an illusion of it) - in such a system, the patient's only recourse is to sue the doctor/provider for damages instead of both parties focusing on the root cause which brought the patient to the doctor/provider in the first place.

Extra Medical Tests might be suboptimal but the real pain points are the marginal costs of each test.

Tests in the U.S. are extremely expensive. There is no standardized pricing for any test in the U.S. unlike the rest of the world.

While the rest of the world has pretty much agreed, for example, that a blood group test might be no more than $10 (In India, it costs 20 cents upto 70 cents at current INR-USD exchange rates), in the U.S. depending on which lab you go to, your insurance coverage, your ability to pay and other factors, you might be billed anywhere from $0 - $2000.

That is completely insane.

Also, labs in the U.S are not setup to take requests from customers directly. There are kits you can order and all that

Everytime I try to send a blood sample to a lab on my own, the lab staff seem to be lost - they want my insurance information, my EHR information, my NPI ID and when I explain to them I am not a doctor they ask me to provide my physcian's who ordered the test. (my physcian didn't order the test - I did).

I have had a few labs bill me outrageous out of network fees because the lab tests were not ordered by an in network provider (because I ordered them and I am not a doctor) and the amount of calls and paperpushing I had to do to correct the billing has made me just give up and let a doctors office handle this.

I can read a lipid panel. I don't need to go to a doctor's office to drive in traffic, wait an hour or more just to draw my blood and have it sent to a lab and then have the doctor read the panel to me. I read spreadsheets every hour of the day. I know what mean median and mode is and the lab result often offer these values anyways as part of the report.

I just need the test report.

Now, if my HDLs are too high and I cannot figure out why, sure, I do need to discuss this with a professional.

The solution to this madness?

An "all payer rate set" system. EVERYONE pays the same for the same procedure. Who pays for the care, while important, comes later, not before.