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Administrative Approaches to Compensating for Medical Injuries: National and International PerspectivesOctober 31, 2005
Location: Carnegie Endowment for International Peace The effort to reform America’s broken system of medical justice continued to build momentum on Monday, October 31st with Common Good’s second public forum exploring the concept of health courts. The forum, “Administrative Approaches to Compensating for Medical Injuries: National and International Perspectives,” was co-hosted by the Harvard School of Public Health and included an update of the research being performed by Harvard into the potential design elements of health courts, as well as an examination of existing administrative compensation systems for medical injuries in Denmark, Sweden, Florida, and Virginia.
Professors Troyen Brennan, M.D., Michelle Mello, and David Studdert of the Harvard School of Public Health reported that the basic design elements of a health court system are almost complete. In their presentation, they recommended that:
- The system start as state demonstration projects with voluntary participation;
- The demonstration projects start in select clinical areas where the types, ranges, and causes of adverse events are relatively well understood and prospective patient consent is easy to obtain;
- The compensation standard should be based on avoidability – which asks whether the injury would have occurred had proper care been provided – rather than the current negligence standard;
- The system should be privately financed, with a stop-loss guarantee from the government or a reinsurance entity; and
- To improve patient safety, health courts should be vested with responsibility for safety improvement and claims data should be shared with organizations and government agencies that have a stake in patient safety and health care delivery.
The research team is now addressing how to make the system operational, focusing on issues such as the cost of a potential system, as well as its compensation criteria and payment schedules.
Harvard Professors Troyen Brennan, M.D., Michelle Mello, and David Studdert
The audience, which included nearly 150 health care providers, policy analysts, and patient safety advocates, next heard from Carl Espersson and Martin Erichsen about the successes of their respective administrative compensation systems in Sweden and Denmark. Mr. Espersson is a legal advisor for Sweden’s Patient Insurance Association, the country’s patient compensation fund, and Martin Erichsen heads Patientforsikringen, the Danish Patient Insurance Association.
Mr. Espersson and Mr. Erichsen answer audience questions.
Perspectives on how existing administrative compensation systems for medical injuries work in the U.S., including their benefits and challenges, were shared by George Deebo, Executive Director of the Virginia Birth-Related Neurological Injury Compensation Program, and Kenney Shipley, Executive Director of the Florida Birth Related Neurological Injury Compensation Association.
Audience members discussing the presentations
The final panel included Martin J. Hatlie, President of the Partnership for Patient Safety, Stephen R. Sleigh, Director of Strategic Resources for the International Association of Machinists and Aerospace Workers, David A. Swankin, President and CEO of the Citizen Advocacy Center, and Jackson Williams, a senior policy advisor at the American Association of Retired Persons Public Policy Institute, who added their insights into the issues presented and responded to audience questions. Mr. Swankin and MR. Williams expressed support for demonstration projects, while Mr. Sleigh stated that a new system needs to help consumers make informed decisions about health care, and Mr. Hadley underscored the importance of uniting both patient safety and medical malpractice movements to support a new system.
Respondent panel members (left to right): Martin J. Hatlie, Stephen R. Sleigh, David A. Swankin, and Jackson Williams
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