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Comment & Response
June 11, 2019

Solutions to Reduce Unnecessary Imaging—Reply

Author Affiliations
  • 1Division of Hematology and Oncology, Mayo Clinic, Rochester, Minnesota
  • 2Department of Surgery, Stanford University School of Medicine, Stanford, California
  • 3Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California
JAMA. 2019;321(22):2243. doi:10.1001/jama.2019.4021

In Reply Dr Simeone argues that the litigious medical milieu in the United States is a key driver of overutilization of diagnostic imaging compared with a litigation-free environment like Finland. We agree that defensive medicine may contribute to the rise in the use of diagnostic imaging, including nonindicated testing. However, liability fear may not explain most of the excess medical tests. An economic analysis suggested that, in the no-liability model of the military in which patients can seek treatment from medical institutions but are barred from suing for negligent care, health care spending decreased by only 5% in active-duty compared with non–active-duty patients and the clinical outcomes (mortality and readmission rates) were similar.1 Nevertheless, systemic efforts to reduce litigation are worth exploring, even if a legislative landscape similar to Finland is unlikely to happen in the United States any time soon.

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