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Medical practice and malpractice litigation in an evolutionary context

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Abstract

We model the interactions between the behaviors of physicians and patients, subject to clinical and legal risks, by means of evolutionary game theory. We propose an original game in which patients may sue their physician for medical malpractice, and physicians have to choose between two alternative treatments, with different levels of benefits and risks. The safer treatment is also the less effective, therefore its provision corresponds, under the assumptions of our model, to practicing negative defensive medicine. We study the Nash equilibria, test their stability in the replicator dynamics, and analyze their welfare properties. We find that the accuracy of the judicial system plays an important role, with possible counter-intuitive effects related to legal reforms. If the court is not sufficiently accurate, defensive medicine can be favored, paradoxically, by an increase in the probability that defensive physicians are sanctioned by the court. A similar outcome can be generated also by an increase in the compensation paid to patients by physicians, when sanctioned for medical malpractice.

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Notes

  1. The literature on defensive medicine has almost exclusively considered static or multi-stage models (Ellis and McGuire 1986; Ma 1994; Ma and McGuire 1997; Ellis 1998; Quinn 1998; Gal-Or 1999; Lien et al. 2004; Olbrich 2008; Allard et al. 2009; Feess 2012).

  2. Non-monetary factors can be important drivers of agents’ behavior (Vincent et al. 1994; Madarász 2012).

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Authors and Affiliations

  1. Department of Economics (DiSea), University of Sassari, Via Muroni 25, 07100, Sassari, SS, Italy

    Angelo Antoci, Alessandro Fiori Maccioni & Paolo Russu

Authors
  1. Angelo Antoci
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  2. Alessandro Fiori Maccioni
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  3. Paolo Russu
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Corresponding author

Correspondence to Alessandro Fiori Maccioni.

Ethics declarations

A. Antoci and P. Russu received research grants from Regione Autonoma della Sardegna (L.R. 7/2007) under the project ‘Capitale sociale e divari economici regionali’. A. Fiori Maccioni received research grants from P.O.R. FSE Sardegna 2007/13 under the project ‘Risk Management System per aziende sanitarie’.

Conflict of interests

The authors declare that the funding sources had no involvement in the research and have no conflicts of interest.

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Antoci, A., Fiori Maccioni, A. & Russu, P. Medical practice and malpractice litigation in an evolutionary context. J Evol Econ 28, 915–928 (2018). https://doi.org/10.1007/s00191-018-0578-0

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