ABSTRACT
Jani and Papanikitas examine defensive medicine as a markets-related phenomenon that has increasing prevalence across healthcare systems globally. They divide defensive medicine into two broad categories: Positive defensive medicine, or assurance behaviour, occurs when unnecessary services are provided to patients to reduce the chance of patients taking legal action against a physician. Negative defensive medicine, or avoidance behaviour, occurs when physicians refuse to provide risky procedures and/or provide care to high risk patients. The authors also identify ways in which defensive medicine is harmful both to justice in healthcare-delivery and to healthcare markets themselves. They note that the factors that could quality, safety and value in healthcare are the same factors that drive defensive medicine. Healthcare markets, they suggest, need to account for irrational self-interest both on the part of the healthcare user and the healthcare professional. These key understandings of the situation have important implications for healthcare system improvement.
