AGENAS. Defensive medicine accounts for 14% of total annual per capita pharmaceutical expenditure

agenas, the National Agency for Regional Health Services, has released the data from the study on defensive medicine (MD), «understood as the set of acts and behaviors put in place by those exercising the health profession in order to avoid possible disputes by patients», carried out in the years 2013-2014 as part of the project Defensive medicine: experimentation of a model for evaluating its diffusion and related economic impact, funded by the Ministry of Health with the involvement of four regions, namely, Lombardy, Marche, Umbria and Sicily.

For the professionals interviewed, "the cause mainly attributed to MD behavior is unfavorable legislation for the medical professional" (31%), followed by the "risk of being sued and incurring legal proceedings for malpractice” (16%). At 12% we find the "risk of compromising one's career and losing the professional image", at 11% the "pressure from public opinion and the mass media", at 7% the "mistrust in insurance protection and/or increase of insurance costs" together with the "distrust of protection by one's own administration", at 6% the "risk of suffering a claim for damages", at 5% the "imbalance of the doctor-patient relationship due to excessive pressure and expectations of the patient and his family members" and finally to 5% the "perception of having to make up for organizational health deficiencies in his sector"".

To contrast the phenomenon of defensive medicine, the 36% of the interviewees "hopes for the reform of the rules governing professional liability", while the 23%, "greater protection by the insurance companies".

Estimate of annual per capita expenditure (€), for the specific pharmaceutical item of expenditure, extrapolated from Table 5, calculated in excess for the doctors participating in the Agenas Survey compared to the Italian national reference economic figure

Pharmaceutical

National average value per capita per year: 170.82

Average annual expenditure per capita (estimated in the study): 163.50

IC 95%: 156.5-170.5

Overspending (estimated in the study): 23.90

IC 95%: 23.5-24.3

For the economic impact of the MD, the calculations carried out estimate an incidence equal to 10.5% of the total annual national health expenditure with a detailed analysis that recognizes the MD 14% of total annual per capita pharmaceutical expenditure, 11% of annual per capita expenditure for specialist visits, 23 % of annual per capita expenditure for laboratory tests and 25% of annual per capita expenditure for diagnostic/instrumental activities. Table 5 shows the data relating to the estimate of the cost of MD by type of service expressed in monetary value

AGENAS. DEFENSIVE MEDICINE: Diffusion and economic impact. An evaluation model