Practice of Defensive Bureaucracy

In recent national discussions about healthcare, much was made about the practice of defensive medicine, especially its cost. Let’s add defensive bureaucracy to our list of grievances.

Defensive Medicine
The practice of defensive medicine occurs when a provider does things to make the record look better, specifically more defensible from lawsuits and more acceptable to regulators. Practicing defensive medicine includes three behaviors.

1) The doctor can order medically unnecessary tests that are usually harmless but sometimes can cause injury. All add unnecessary cost. 2) The doctor can avoid medical procedures that involve risk or refuse to accept high-risk patients. 3) The doctor can take the standard, accepted approach when something different would be better for the patient.

Doctors practice defensive medicine in order to avoid lawsuits or anything else that might put their privileges in jeopardy. In essence, they are simply trying to protect their jobs.

There is a paucity of solid evidence on the cost of defensive medicine. Virtually all the “data” are estimates and guesswork. One study reported that doctors admit that 18-28% of tests ordered and consultations requested are due to defensive posturing. Other studies report costs ranging from $2.4b to more than $200b (yes, that is “b” for billion) per year.

Defensive bureaucracy
Defensive bureaucracy is the same behavior by bureaucrats as described above for doctors. The bureaucrat does things that do not help or may actually harm the general public in order to protect his or her job. Example: the regulator in healthcare.

By promulgating a large number of regulations, then monitoring them and finding people out-of-compliance, the regulator provides for job security and expansion of the bureaucracy.

But wait you cry, We need regulations to protect us. Do we?! Regrettably, there is NO DATA showing that regulations protect us. Defenders of the regulatory machine have no evidence and invariably offer logic as a substitute. As science author David Webber wisely observes, “Logic is a way to err with confidence.”

Not only is there no evidence that regulations protect us, there is an equal lack of data about how much these useless-even-harmful regulations cost. Start with the easy stuff: the hassle and inefficiency.

I recently reported that for a 30-minute patient visit, I had to spend 7-9 minutes doing repetitious, redundant paperwork. I wrote my name five times, various diagnoses four times, filled out three separate forms each with a host of boxes to check. The waste of time and therefore dollars is significant. The much greater cost is in frustration. Nurses and doctors hate (I do not use that term lightly) the amount of bureaucratic nonsense and B.S. that dominates their lives, and that is driving them…away.

Regulations harm patients both directly and by opportunity cost. Regulatory compliance costs hundreds of billions of dollars each year. We–the Public–get virtually nothing for this expense, except more bureaucrats and fewer providers. The opportunity cost of useless regulations may be even higher than the dollar outlay.

The Joint Commission on Accreditation of Hospitals could be helping studies of best practices for long-term outcome as well as studies of optimal care-delivery-for-dollar-expended. They could be disseminating proven best practices, like checklists before surgery. Instead, they inspect for prohibited doorstops and surge protectors, and write out-of-compliance notices for writing µg instead of [the approved] mcg and for Cardiology keeping separate patient files. This is no exaggeration.

Incentives are just as perverse in healthcare bureaucracy as in medical practice. The system rewards the negative and then wonders why it keeps getting the negative. If we pay for sickness care, we get more sickness. If we pay regulators to find non-compliance, guess what they will find. Imagine if we paid doctors and regulators for the positive outcomes we want: good health and longevity.

Defensive bureaucracy is even more harmful to patients than defensive medicine: it costs more and produces worse consequences.

System MD

Post to Twitter Tweet This Post Post to Yahoo Buzz Buzz This Post Post to Delicious Delicious Post to Digg Digg This Post Post to Facebook Facebook Post to StumbleUpon Stumble This Post

25 comments ↓

#1 Repeal of Healthcare ‘Reform’ is American, Not Partisan. — Medical Malprocess on 06.20.10 at 3:45 pm

[...] 3590 dramatically increases the size of bureaucracy while simultaneously reducing the availability of providers. Repeal would do the opposite. Which [...]

#2 Lux Libertas – Light and Liberty » Meet Your New M.D. on 07.27.12 at 1:55 pm

[...] The larger bureaucracies — Medical Boards, Professional Associations, AMA, AARP — treat federal agencies the same way that sharks treat lawyers: with professional courtesy due “their own.”  They never bite the hand that feeds them. [...]

#3 Please Pass the Kool-aid | Insurance on 12.24.12 at 8:44 am

[...] away from health care (the service). The outright theft of dollars from paying for care to pay for more bureaucracy makes me [...]

#4 Please Pass the Kool-aid | Insurance News Depot on 12.24.12 at 9:54 am

[...] away from health care (the service). The outright theft of dollars from paying for care to pay for more bureaucracy makes me [...]

#5 ACA, Affordable Care Act, bureaucracy, competition, cost shifting, entitlements, health care, healthcare, health care costs, healthcare costs, health exchanges, health insurance exchanges, healthcare reform, health insurance, illegals, illegal residents, on 12.24.12 at 4:24 pm

[...] away from health care (the service). The outright theft of dollars from paying for CARE to pay for more bureaucracy makes me [...]

#6 Please Pass the Kool-aid | Insurance Comparison Guide on 12.24.12 at 5:37 pm

[...] away from health care (the service). The outright theft of dollars from paying for care to pay for more bureaucracy makes me [...]

#7 Please Pass the Kool-aid | Insurance News Hub on 12.24.12 at 6:50 pm

[...] away from health care (the service). The outright theft of dollars from paying for care to pay for more bureaucracy makes me [...]

#8 scott on 12.23.13 at 5:09 am

dictatorial@hettys.rejects” rel=”nofollow”>.…

good info!…

#9 andy on 01.19.14 at 6:01 am

guiftes@watchers.coordinated” rel=”nofollow”>.…

tnx for info!…

#10 Michael on 01.19.14 at 1:45 pm

mantles@holdovers.approximated” rel=”nofollow”>.…

áëàãîäàðþ….

#11 Wendell on 01.21.14 at 3:58 am

peg@plainclothes.population” rel=”nofollow”>.…

ñïñ çà èíôó!…

#12 alan on 01.21.14 at 9:58 am

termination@thermally.outline” rel=”nofollow”>.…

ñïñ….

#13 george on 02.11.14 at 2:50 am

mortals@symptomatic.sincere” rel=”nofollow”>.…

ñýíêñ çà èíôó!…

#14 jacob on 02.14.14 at 11:44 am

pumped@television.declining” rel=”nofollow”>.…

tnx for info!…

#15 salvador on 02.18.14 at 10:59 pm

fathers@murrin.consternation” rel=”nofollow”>.…

good!!…

#16 clyde on 02.19.14 at 7:07 am

hemorrhoids@hazelnuts.submit” rel=”nofollow”>.…

tnx for info!…

#17 luis on 02.19.14 at 9:35 pm

desprez@liberty.unrestricted” rel=”nofollow”>.…

ñïñ!!…

#18 Lyle on 02.22.14 at 3:22 am

dabbling@tibialis.dromozoa” rel=”nofollow”>.…

tnx….

#19 Curtis on 02.22.14 at 4:11 am

director@gamin.what” rel=”nofollow”>.…

ñïñ çà èíôó….

#20 Joshua on 02.24.14 at 1:42 am

hydraulic@lehmann.furnishings” rel=”nofollow”>.…

thanks for information!…

#21 Floyd on 02.25.14 at 7:06 pm

anodes@waded.unwire” rel=”nofollow”>.…

ñïàñèáî çà èíôó….

#22 joey on 02.26.14 at 6:49 am

nationhood@borders.hubbell” rel=”nofollow”>.…

tnx for info….

#23 jesse on 02.26.14 at 9:37 am

transition@brightness.retracted” rel=”nofollow”>.…

tnx for info….

#24 Corey on 02.27.14 at 1:09 pm

dwyers@marksman.arguing” rel=”nofollow”>.…

good!!…

#25 nathan on 02.28.14 at 12:26 pm

galleys@paternalism.prophet” rel=”nofollow”>.…

ñýíêñ çà èíôó!!…

Leave a Comment