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re: How Denmark Dumped Medical Malpractice and Improved Patient Safety
Posted on 3/15/17 at 5:24 pm to NC_Tigah
Posted on 3/15/17 at 5:24 pm to NC_Tigah
quote:
Common to all these programs is a commitment to provide information and compensation to patients regardless of whether negligence is involved. That lowers the bar of entry for patients and doesn’t pit doctors against them, enabling providers to be open about what happened.
So they basically take the idea behind Worker's Compensation and apply it to the doctor-patient relationship.
The problem is a worker's compensation scheme comes with its own set of problems.
0
Posted on 3/15/17 at 5:24 pm to NC_Tigah
quote:
Danish.
and I'm sure the rest of it seemed to make more sense before you uploaded it
Sorry, Danish I was caught up in the Dutch elections thread.
That said the point still stands- if we can't use the Dutch Healthcare System as a model for our own due to "reasons" why wouldn't those same "reasons" invalidate using this aspect of the Dutch approach to Healthcare?
Posted on 3/15/17 at 5:28 pm to Bullethead88
quote:
Not that meaningful a stat since the cases that end up having to go to trial are usually weak on liability.
It's actually the opposite in Louisiana.
Posted on 3/15/17 at 5:34 pm to stniaSxuaeG
quote:
Regular malpractice goes away in a no fault system. No more malpractice insurance or litigation.
Worker's Comp is a no fault system. Businesses pay an shite ton of money in WC insurance. Unless you think payout money in a no fault system comes from money trees
Posted on 3/15/17 at 5:58 pm to montanagator
quote:"This aspect of the Dutch approach," i.e., nonadversarial adjudication, decreases cost, increases quality, decreases wait time for settlement, decreases stress, and time to recovery and would do the same in any system. That's why.
if we can't use the Dutch Healthcare System as a model for our own due to "reasons" why wouldn't those same "reasons" invalidate using this aspect of the Dutch approach to Healthcare?
You are probably referring to someone else's comments comparing the Dutch (or Danish?) healthcare system to ours. IDK what was said in that regard. I've never actually set foot in a Danish Medical Facility. So I can only opine on what I've read.
However, if we are talking Dutch healthcare, I have visited Netherlands facilities. The Dutch are very patient patients. They are accustomed to waits, and know little else. With one exception, their facilities, care quality, and care patterns are uncannily similar to our VA system.
The exception is Dutch nurses are far far far more likely to be found at bedside rather than locked to a computer station. In the US, our tort system dictates "if it wasn't written it wasn't done." Our care providers write tomes.
Their medical documentation include brief pertinent notes. When I discussed this with them, they couldn't even relate to the problem. They repeatedly asked, "Why would a caregiver spend more time documenting than providing care?"
Posted on 3/15/17 at 6:09 pm to Antonio Moss
quote:Correct.
Worker's Comp is a no fault system. Businesses pay an shite ton of money in WC insurance.
"No fault" would not significantly affect "malpractice premiums".
Posted on 3/15/17 at 6:36 pm to NC_Tigah
quote:
In 86% of medmal courtrooms, the jury finds the physician not negligent.
Still it costs $24,000 - $90,000 to defend each case.
so one out of 7 are legit.
looks like we need a less expensive way to address the matter.
two parts.
patient wants "damages". or the family wants vengeance
public wants mistakes to be found out and behavior mod to happen if necessary.
More info, not less. AMA has to police itself much better. the impression the public has is that no one is watching the hen house.
Posted on 3/15/17 at 6:42 pm to NC_Tigah
quote:
Doctors should pay about what they pay now, at least for the initial period.
Actual tort reform would be about helping injured patients receive timely awards, with less stress, and at far lower cost. It would concomitantly lower costs of defensive medicine, and allow greater public access to error tracking and quality analysis.
Just crazy this is not receiving air time in the US.
That was basically what I was speaking to.
I just pointed it out because, and I think you spoke to it as well, when the more callous and brutish approach to this problem has been used - where malpractice claims are just capped - cost savings to the market did come, but insurers often held on to them. So the hoped for result of that reform where savings would be passed down the chain eventually to consumers in the form of less overuse of medicine, those particular benefits never became realized.
I fully agree this reform has value even if malpractice insurance didn't get pushed down, but since we are ultimately all just thought experimenting, I would want to try and add ways to make sure the market operates as intended and those insurers don't kink up the functioning of the reform like has happened.
Posted on 3/15/17 at 6:47 pm to bonhoeffer45
quote:
I would want to try and add ways to make sure the market operates as intended and those insurers don't kink up the functioning of the reform like has happened.
The AMA sold out to insurers years ago and now just sit in the corner, they have no power.
Posted on 3/15/17 at 6:48 pm to CelticDog
quote:The AMA has less to do with this than the AARP does with Medicare. Not being hyperbolic.
AMA has to police itself much better
I believe you're probably referring to local credentialing and state medical boards, and in that sense, I do not disagree at all. Though "policing" is far stricter than comparable bodies (e.g., state bars), it could absolutely be improved. Part of the problem is the protected nature of internal clinical and quality reviews (PI), specifically as a result of our tort system.
This post was edited on 3/15/17 at 6:57 pm
Posted on 3/15/17 at 9:46 pm to NC_Tigah
quote:This x 1000. The only ones that should be against this type of system are malpractice attorneys. It essentially puts the money into the hands of the injured patients instead of in the pockets of attorneys. The overall cost to health systems and providers is sometimes tricky to calculate, but from everything I've read, it's similar in both systems, with maybe slightly lower costs in a no fault system.
Since the current US system is adversarial, discovery and case prep are an expensive and prolonged process. The result is extremely high overhead cost. Only 46% of settlement money actually gets to plaintiffs. A European style system only runs a 5-10% overhead. That would effectively DOUBLE AVAILABLE SETTLEMENTS to US plaintiffs. It would concomitantly limit incentive for defensive medicine, knocking 10-20% off of US healthcare costs.
quote:I may be wrong on this, but I think some also require the injury to have been deemed avoidable.
Option Two: A Worker's Comp type system. Injured patients would bring claims before a review board responsible for determining if compensation is in order and, if so, how much. The Board would then authorize payment out of a "compensation pool" which would be immediately awarded to the plaintiff. For a patient to get paid, the board would not have to find the doctor at fault, or that medical negligence caused whatever pain and suffering the patient is experiencing. Money for patient relief would come from a national compensation fund paid for by malpractice premiums placed on doctors, hospitals, pharmaceutical companies, etc. The goal of such a system is not to find fault or establish causation. It is to provide compensation to injured patients regardless of cause.
quote:LINK
The eligibility standard for compensation in Sweden is "avoidability," defined as whether the injury would have occurred in the hands of an experienced specialist, or if there were other, less risky alternative treatments that could have been chosen instead.
It's surprising that you don't hear more talk about this type of system in the US. It seems like it would be beneficial to everyone involved.
Posted on 3/15/17 at 9:48 pm to Gaspergou202
quote:Some (maybe all? not sure) no-fault systems require the injury to have been deemed avoidable.
If I decide that the risk/reward is worth taking for an operation, and I die from the anesthesia through no fault of the anesthesiologist. Should everybody pay me when they access health care? I'm a firm believer in shite happens.
quote:
The eligibility standard for compensation in Sweden is "avoidability," defined as whether the injury would have occurred in the hands of an experienced specialist, or if there were other, less risky alternative treatments that could have been chosen instead. This is a looser standard than “negligence,” but stricter than the standard in New Zealand. Some unavoidable injuries caused by equipment failure or hospital-acquired infections are also covered.
LINK
Posted on 3/15/17 at 10:00 pm to Antonio Moss
quote:No I don't. I guess I meant to say that it would come from a common fund that health systems and providers would pay into. Call it insurance if you like, but I'd bet you the cost would be much less than malpractice insurance currently costs, particularly since most of the money put into the fund would go towards paying injured patients rather than a large percentage going toward profits for insurance companies.
Worker's Comp is a no fault system. Businesses pay an shite ton of money in WC insurance. Unless you think payout money in a no fault system comes from money trees
This post was edited on 3/15/17 at 10:16 pm
Posted on 3/15/17 at 10:11 pm to NC_Tigah
quote:So true. If it's not documented, the patient can claim whatever they like and it's their word against his.
The exception is Dutch nurses are far far far more likely to be found at bedside rather than locked to a computer station. In the US, our tort system dictates "if it wasn't written it wasn't done." Our care providers write tomes.
The other reason for the crazy amount of documentation is what is required by CMS in order to bill for a service. They purposefully make it cumbersome to make it more likely that people screw it up, allowing them to deny reimbursement on a review.
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