Sprechi e medicina difensiva

Defensive medicine has recently escalated as a problem of progressively increasing magnitude and concern. Targeted studies report that a high percentage of health professionals in Italy prescribe drugs in excess, request blood tests and radiological investigations, refer patients to specialist services or admit them to the hospital explicitly for the purpose of averting malpractice suits. For the same reason, high-risk cases, perceived as dangerous from a legal point of view, are often avoided by the professionals and do not receive adequate care. Such a behavior decreases the quality of healthcare also exposing patients to significant risks of harm and generates a highly negative economic impact, with a waste estimated around 10 billion euros per year, more than 10% of the whole Italian healthcare cost. The practice of defensive medicine can be associated with the rising number of medical malpractice lawsuits, which is consequence of several contributing factors, particularly the increased risks in healthcare, the impact of social and cultural changes and some facilitating aspects of the legal system. Various solutions have been adopted internationally with the aim of reducing defensive medical acts. The use of mediation to favour dispute settlements out of the court of law and the adoption of no-fault systems have turned out to be the most effective approaches. In Italy, the first attempt to face the issue of defensive medicine has been the “Balduzzi law”, which intended to limit the uncontrolled expansion of the field of liability. Although many obstacles against its implementation have limited the efficacy of the law by itself, it has with no doubt nourished the parliamentary debate so that ten new laws have been proposed in a oneyear interval. The suggested fields of intervention ranged from preventive measures of medical malpractice, to optimization in management of adverse events, to redefinition of disciplinary and legal consequences. Unfortunately, none of the proposed laws were issued. The present paper analyzes the phenomenon of defensive medicine, looking at its causes, its consequences and its epidemiologic and economic burden. After reviewing the various international approaches to the problem, it describes the current Italian law and the details of the new laws proposed by the Parliament, aiming at highlighting the main obstacles towards their implementation, in order to give a useful starting point for concrete actions to minimize the use of defensive medicine and its associated economic wastes.