Do Physicians Respond to Media Coverage of Medical Dispute? Evidence from China

One explanation for the soaring medical costs in the U.S. is “defensive medicine”, the practice of physicians recommending unnecessary diagnostic tests or treatments to reduce the risks of legal liability. Regarding defensive medicine, studies in the U.S. focus on evaluating physicians’ response to regulations on uninsured liability, namely tort reform. In this study, we investigate the case in places where the malpractice legal system is less developed and plays a small role in physicians’ behavior.

Specifically, we examine how physicians in China respond to media coverage of medical disputes, which arguably alters their perception of risks. The less developed legal system has generated more medical disputes on the street than in the courts, putting physicians at particularly high risk of violence. There has been a substantial increase in the media coverage for violent cases in the past 10 years, which has raised doctors’ awareness of the potential risks and could potentially induce defensive medicine.

The main purpose of this study is to quantify the defensive medicine induced by media coverage. We focus on a single incidence that increased media coverage dramatically within a short time frame: a murder case on Nov. 25, 2013, in which a patient publicly murdered his doctor due to dissatisfaction with the treatment he received. Administrative records on internet search history confirm that this incident led to a drastic increase in the volume of media coverage and public attention on patient-physician relationship.

We investigate if the drastic increase in public attention, and thus the perceived risk among physicians, had any effects on physician procedure choice. To do so, we compare physician behaviors before and after the occurrence of the incidence. We use rich individual level microdata from administrative records of all inpatients in a major public hospital. Information includes patient demographics, occupation, home address, diagnosis and procedure history, various expenditures and health status at discharge. Importantly, we use the date of admission as an indicator for whether the initial procedure choice is affected by the sharp increase in media coverage.

Preliminary findings suggest that physicians altered their behavior in response to the increased awareness of risk. One week after the increase in public attention, the total number of first-time inpatient admissions decreased. Importantly, the decrease was driven by a reduction in admissions through the outpatient department, where the physicians have greater discretion on who to admit. Meanwhile, the number of patients admitted through the emergency room remained unchanged. For the admitted patients, we find a longer length of stay and higher expenditures.