“Health Courts” and Accountability for Patient Safety

Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
Milbank Quarterly (Impact Factor: 3.38). 02/2006; 84(3):459-92. DOI: 10.1111/j.1468-0009.2006.00455.x
Source: PubMed


Proposals that medical malpractice claims be removed from the tort system and processed in an alternative system, known as administrative compensation or "health courts," attract considerable policy interest during malpractice "crises," including the current one. This article describes current proposals for the design of a health court system and the system's advantages for improving patient safety. Among these advantages are the cultivation of a culture of transparency regarding medical errors and the creation of mechanisms to gather and analyze data on medical injuries. The article discusses the experiences of foreign countries with administrative compensation systems for medical injury, including their use of claims data for research on patient safety; choices regarding the compensation system's relationship to physician disciplinary processes; and the proposed system's possible limitations.

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    • "This discourages many potential litigants from pursuing their claims, and cases that are pursued are unrepresentative of the number of medical errors occurring while of claims made only a small proportion received compensation. According to studies by Localio et al. (1991)and Mello et al. (2006),under best circumstances, negligence file claims resulted in a mere 2% to 3% of awards for injuries and only half of applicants received financial compensation. Often, litigation is balanced incongruously with the value of the claim where no award was made in 25% of cases that merited compensation. "
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    ABSTRACT: Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting government policy makers, oversight agencies and the medical profession itself to take appropriate action. The increasing dissatisfaction with the current tort litigation system requires exploring alternatives and new approaches for handling medical malpractice cases. This study aims to examine the difficulties inherent in the tort system in Malaysia for solving medical malpractice claims and evaluates the structure of this system from the perspective of effectiveness, fairness, compensation, accessibility, and accountability.
    Preview · Article · Jul 2014 · Global journal of health science
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    • "Judges in these courts could have special training and would grow in expertise and have comparative experience across medical liability cases. Neutral independent experts could assist them, with limited scope for trial lawyers (Barringer, Studdert, Kachalia, & Mello, 2008; Common Good, 2006; Mello, Studdert, Kachalia, & Brennan, 2006). Health courts could facilitate legal system use of abundant systematic reviews and foster evidencebased maternity care practice. "
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    ABSTRACT: The present liability system is not serving well childbearing women and newborns, maternity care clinicians, or maternity care payers. Examination of evidence about the impact of this system on maternity care led us to identify seven aims for a high-functioning liability system in this clinical context. Herein, we identify policy strategies that are most likely to meet these aims and contribute to needed improvements. A companion paper considers strategies that hold little promise. We considered whether 25 strategies that have been used or proposed for improvement have met or could meet the seven aims. We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability when available, and considered other studies when unavailable. Ten strategies seem to have potential to improve liability matters in maternity care across multiple aims. The most promising strategy-implementing rigorous maternity care quality improvement (QI) programs-has led to better quality and outcomes of care, and impressive declines in liability claims, payouts, and premium levels. A number of promising strategies warrant demonstration and evaluation at the level of states, health systems, or other appropriate entities. Rigorous QI programs have a growing track record of contributing to diverse aims of a high-functioning liability system and seem to be a win-win-win prevention strategy for childbearing families, maternity care providers, and payers. Effective strategies are also needed to assist families when women and newborns are injured.
    Full-text · Article · Feb 2013 · Women s Health Issues
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    • "They would be similar to Workman’s Compensation courts, which take normal injury claims out of the tort system and put them into the administrative system. The concept of health courts has recently been revived by the Harvard School of Public Health as a means of deterring frivolous litigation and preventing miscarriages of justice.27 One problem for juries is that they can be confused by the difference between adverse events and negligence. "
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    ABSTRACT: Not all medical injuries are the result of negligence. In fact, most medical injuries are the result either of the inherent risk in the practice of medicine, or due to system errors, which cannot be prevented simply through fear of disciplinary action. This paper will discuss the differences between adverse events, negligence, and system errors; the current medical malpractice tort system in the United States; and review current and future solutions, including medical malpractice reform, alternative dispute resolution, health courts, and no-fault compensation systems. The current political environment favors investigation of non-cap tort reform remedies; investment into more rational oversight systems, such as health courts or no-fault systems may reap both quantitative and qualitative benefits for a less costly and safer health system.
    Preview · Article · Feb 2013 · International Journal of General Medicine
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