Studies on filed and compensated claims for patient injuries
Year: 2012
Type: dissertation
Study design: Observational Study
Abstract: According to a number of studies, patients claims for compensation for a health-care-related injury consist of only a small and disproportionate sample of all the adverse events in health care and are therefore not an appropriate basis for conclusions regarding the total frequency or nature of all adverse events. Many claims are even argued to be groundless. Nevertheless, data on patient injury claims are relevant in solving diverse research questions that ultimately can contribute to improving the quality and patient safety of health care. The objective of the research was to identify factors that are associated with both the filing and compensating of claims. Another aim was to examine whether hospital claim rates are associated with the quality of care of these hospitals and whether they are feasible as a performance indicator. A further objective was to calculate the differential in health care costs between patient injury claimants and non-claimants. Data from the Finnish Patient Insurance Centre - the organization handling patient injury claims in Finland - were supplemented with data from other national health care registries. The compiled data were restricted to three surgical procedures: coronary artery bypass grafting (CABG), total primary hip arthroplasty (THA), and total primary knee arthroplasty (TKA). The statistical methods applied were logistic and multinomial logistic regression analyses, and generalized linear models. Some patient groups were more inclined to file a claim than others. The elderly filed a claim less often than the non-elderly, though age did not generally affect a patient s chances of obtaining compensation. Male patients were less likely to file a claim than female patients but were more likely to obtain compensation for an injury involving an infection. Patients in a worse health state were more likely to file a claim than healthier patients, but contrary to the initial hypothesis, a worse health state did not reduce patients chances of receiving compensation. An exception to this was injuries from CABG, for which patients in a worse health state were less likely to obtain compensation. The research further established that a volume of over 300 operations of TKAs per year was associated with a decreased probability of compensation for certain injury types. Moreover, following both THA and TKA, hospital claim rates were positively associated with five-year revision and one-year deep infection rates. The risk-adjusted admission costs of compensated claimants and claimants denied compensation were higher than those of non-claimants. Nevertheless, the costs of compensated claimants and claimants denied compensation did not generally differ from each other. The main implications of this research for improving quality and patient safety of health care are: (1) Health professionals and policy-makers should give more consideration to patients equal possibilities to file a claim and encourage them to pursue a claim when compensation seems justified. (2) The number of compensated patient injury claims following TKA may drop if TKAs are performed at larger hospitals. (3) Patient injury claims might be employable in performance measurement together with other indicators for monitoring treatment and surgical outcomes of selected patient groups. (4) The negligible differences in health care costs between compensated claimants and claimants denied compensation suggest that the care of claimants denied compensation has also involved substantial problems and that the claims of the latter are not groundless. Consequently, further study should focus on factors contributing to adverse events for both claimants receiving compensation and those denied compensation.
Source: Työväentutkimus Vuosikirja
Author: Jutta Järvelin
Language: English
Subfield: Law
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W1545121787