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The Ecology of Defensive Medicine and Malpractice Litigation

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  • Angelo Antoci
  • Alessandro Fiori Maccioni
  • Paolo Russu

Abstract

Using an evolutionary game, we show that patients and physicians can interact with predator-prey relationships. Litigious patients who seek compensation are the ‘predators’ and physicians are their ‘prey’. Physicians can adapt to the risk of being sued by performing defensive medicine. We find that improvements in clinical safety can increase the share of litigious patients and leave unchanged the share of physicians who perform defensive medicine. This paradoxical result is consistent with increasing trends in malpractice claims in spite of safety improvements, observed for example in empirical studies on anesthesiologists. Perfect cooperation with neither defensive nor litigious behaviors can be the Pareto-optimal solution when it is not a Nash equilibrium, so maximizing social welfare may require government intervention.

Suggested Citation

  • Angelo Antoci & Alessandro Fiori Maccioni & Paolo Russu, 2016. "The Ecology of Defensive Medicine and Malpractice Litigation," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-15, March.
    • Handle: RePEc:plo:pone00:0150523
    DOI: 10.1371/journal.pone.0150523
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    References listed on IDEAS

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    Cited by:

    1. A. Antoci & S. Borghesi & G. Iannucci, 2016. "Green licenses and environmental corruption: a random matching model," Working Paper CRENoS 201615, Centre for North South Economic Research, University of Cagliari and Sassari, Sardinia.
    2. Angelo Antoci & Alessandro Fiori Maccioni & Paolo Russu, 2018. "Medical practice and malpractice litigation in an evolutionary context," Journal of Evolutionary Economics, Springer, vol. 28(4), pages 915-928, September.
    3. Livio Garattini & Anna Padula, 2020. "Defensive medicine in Europe: a ‘full circle’?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 165-170, March.
    4. Stefano Bartolini, 2018. "Social capital as disease prevention," Department of Economics University of Siena 778, Department of Economics, University of Siena.
    5. Livio Garattini & Anna Padula, 2020. "Defensive medicine in Europe: a ‘full circle’?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(4), pages 477-482, June.
    6. Antoci, Angelo & Fiori Maccioni, Alessandro & Russu, Paolo & Sacco, Pier Luigi, 2022. "Curing is caring? Liability reforms, defensive medicine and malpractice litigation in a post-pandemic world," Socio-Economic Planning Sciences, Elsevier, vol. 80(C).
    7. Danilo Delpini & Paolo Russu, 2022. "The Effects of Defensive Medicine in Physician–Patient Dynamics: An Agent-Based Approach," Dynamic Games and Applications, Springer, vol. 12(4), pages 1067-1085, December.

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