Here are two ways that happens:

• Higher overhead costs from rising malpractice rates force doctors to push for more pay from insurers. Insurers in recent years have often agreed to increase doctor pay for medical services, which in turn drives up what employers and employees pay for benefits.

How much of that bigger paycheck deduction for health benefits can be traced to malpractice fees is nearly impossible to say. Workers' health-insurance fees also are influenced by factors such as rising medication costs and a growing demand for service from an aging population.

• Doctors practice more "defensive medicine" in hopes of avoiding lawsuits, which also drives up costs.

There are no local estimates on how many people are getting "just-in-case" lab tests, diagnostic scans, prescriptions and other treatments so doctors can prove quality care now and avoid legal action later. But there is no dispute that the practice exists.

Nearly 56 percent of Ohio doctors say rising malpractice insurance costs have prompted them to increase the tests they order, according to a survey of 874 doctors released in April by the Ohio State Medical Association.

Dr. Robyn Chapman, 40, is a family medicine specialist. She switched from a solo practice to a group practice in April after watching her malpractice fees jump from $8,000 to $12,000 a year.

"Defensive medicine is very common," she says. "If there's a question in our mind and a diagnostic test can provide an answer, I'm ordering that test. I can't afford to miss anything."

Tim Bonfield