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The Ecology of Defensive Medicine and Malpractice Litigation

Angelo Antoci1, Alessandro Fiori Maccioni1, Paolo Russu1

  • 1Department of Economics and Management, University of Sassari, Sassari, Italy.

Plos One
|March 17, 2016
PubMed

Insights

Litigious patients act as predators to physicians, who become prey. Despite clinical safety improvements, malpractice claims may rise due to increased patient litigation, suggesting a need for intervention.

Area of Science:

  • Game Theory
  • Medical Malpractice
  • Healthcare Economics

Background:

  • Physicians face risks of malpractice lawsuits, leading to defensive medicine.
  • Litigious patients seeking compensation can be viewed as 'predators' in a healthcare interaction model.
  • Existing trends show rising malpractice claims despite advancements in clinical safety.

Purpose of the Study:

  • To model the interaction between patients and physicians using an evolutionary game.
  • To analyze the impact of clinical safety improvements on patient litigation and defensive medicine.
  • To explore conditions for optimal social welfare in healthcare interactions.

Main Methods:

  • Utilized an evolutionary game theory framework.
  • Modeled patient-physician dynamics as a predator-prey relationship.
  • Analyzed the effects of safety improvements on strategic behaviors.

Main Results:

  • Clinical safety enhancements can paradoxically increase the proportion of litigious patients.
  • Physician adoption of defensive medicine may remain unchanged despite safety improvements.
  • The Pareto-optimal solution of cooperation may not be a Nash equilibrium.

Conclusions:

  • Rising malpractice claims despite safety improvements can be explained by increased patient litigiousness.
  • Maximizing social welfare may necessitate external interventions, such as government regulation.
  • The current healthcare interaction model may not inherently lead to optimal outcomes without policy adjustments.

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