Defensive medicine in Europe: which solutions? [Comunicazione breve]

Background Defensive medicine has recently escalated as a problem of progressively increasing magnitude and concern. The practice of defensive medicine is mainly associated to the rising number of medical malpractice lawsuits. This study was aimed to perform a literature review to analyze the economic burden of defensive medicine in Italy and to identify which solutions, adopted in Europe, have proven effective in reducing the phenomenon. Methods A literature review was performed, during the period November 2014-April 2015, by consulting the main electronic databases, institutional websites and grey literature. Specific key words and MeSH terms were used. Results In Italy defensive medicine costs 10 billion/year (10.5% of GDP) and it represents the first category of healthcare wastes (26% of the total). In Europe the number of litigations for medical malpractice has increased significantly over the last decade; this increase ranges from more 50% in Britain, Scandinavia, the Baltic countries and Eastern Europe, to more 200–500% in Germany, Italy, the Iberian and Mediterranean Area countries. In countries where a no-fault system or a system of conflict mediation is in force, most of the litigations are disputed out of the court of law: the claims resolved in court are 0.1% in Sweden, 0.3% in Finland, 0.5% in Denmark and 4% in Britain compared to 100% of cases resolved through judicial in Portugal and the Netherlands, 98% in Malta, 86% in Italy and 60% in France. Conclusions Defensive medicine is consequence of several 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. Key messages The medicine defensive acts are widespread among physician and determine an increase of healthcare costs and a reduction of healthcare quality The adoption of no-fault systems and extra- judicial mediation are shown to be the most effective strategies to reduce the number of litigation in courts of law, with consequent economic savings.