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Australia’s medical indemnity claims – why should we care?

Evidence-based medicine is the conscientious, explicit and judicious use of the best current evidence in making decisions about patient care. The same approach should be taken when patients are harmed…

Adverse outcomes in health care have a deeply personal impact on patients and on medical practitioners. Zoriah/Flickr

Evidence-based medicine is the conscientious, explicit and judicious use of the best current evidence in making decisions about patient care. The same approach should be taken when patients are harmed by adverse events in the course of medical treatment and advice.

Only recently has data on compensation claims for harm suffered by patients become publicly available in Australia. It is published by the Australian Institute for Health and Welfare (AIHW) – most recently for the 2010–2011 financial year.

The 2,800 new claims identified for that year by AIHW appear quite modest bearing in mind that there are about 88,000 medical practitioners across Australia, as the Australian Health Practitioner Regulation Agency (AHPRA) tells us. Curiously, until the recent advent of AHPRA and a national regulation scheme, even the number of medical practitioners in Australia was a little unclear.

More medical indemnity claims are made by women than men, and the difference appears to be as much as 15%.

But the number of claims is not growing, as least not recently. The claims for the preceding year numbered 2,900, including Western Australia which disappointingly appears to have fallen out of the public sector reporting in the most recent data. But recently-included data on claims over time does show an increase over earlier years.

More than a third of all claims resolve for modest amounts – less than $10,000. But at the other end of the spectrum, serious harm must have been suffered by the 6% of claimants (something in the order of 150 people) for whom the claim cost exceeded $500,000.

Not all claims require determination by a court. Far from it, in fact. The data shows that a mere 3% of claims require a court hearing, revealing a sensible approach to claims management and compensation payment.

Obstetric practice produce high-cost claims because of the need to provide care to an injured infant over her entire lifespan. Brad Brundage

Claims are split across general surgery, which covers 25%, emergency department 17% and obstetrics 13%. It would be wise to contrast these numbers to clinician and service numbers. Of course, raw numbers may do little to reflect severity of injury and total cost of claims. Obstetric practice, for example, can produce high-cost claims because of the need to provide care to an injured infant over his or her entire lifespan.

Good quality health care is a core expectation in Australian society. Major efforts to improve standards continue, such as the work of the Australian Commission on Safety and Quality in Health Care.

Adverse outcomes in health care have a deeply personal impact on patients and on medical practitioners. While private insurance schemes substantially provide for compensation in the private sector, the community as a whole partially funds the private sector claims and bears the cost of the public sector claims. With the National Injury Insurance Scheme on the horizon, the cost to the community may well increase.

Why then, should we care? Not only for economic reasons. Sound evidence, such as the increasingly valuable AIHW medical indemnity data, must surely assist in identifying problem areas and developing responses to benefit the medical profession and its patients.