title: The Ecology of Defensive Medicine and Malpractice Litigation.
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.
authors.affiliation: Department of Economics and Management, University of Sassari, Sassari, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Antoci
authors.affiliation: Department of Economics and Management, University of Sassari, Sassari, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiori Maccioni
authors.affiliation: Department of Economics and Management, University of Sassari, Sassari, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Russu
mesh_terms: D003675:Defensive Medicine; D005716:Game Theory; D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence*; D061214:Patient Safety; D010820:Physicians