Medical mistakes are on the addition both in Europe and in the United States of America which have caused them to take serious steps to cover with the job. In Greece, more and more patients think that it is likely to see a medical mistake during wellness attention bringing and the organisations they can turn to if this happens are barely adequate and with meager response. The effects of medical mistakes are multiple and complex with important fiscal deductions. Nowadays there is an pressing demand to decide jobs that refer to be containment in the Greek Health System. Some research findings from the reappraisal of 97 court- awards for the old ages 2000 to 2009 about the fiscal cost of the medical mistakes in Greece are rather interesting. The average compensation amounted to a‚¬ 314.034 stand foring 30.6 % of claimed compensation. Merely a little proportion of medical mistakes gain promotion as the bulk of claims get settled out of tribunal, covered by the insurance policy or the infirmaries. The load of the obvious and concealed cost affects non merely the patient, his household and the infirmary but besides the whole of the society. So, there is an indicant that the fiscal load for the Grecian economic system is immense. Unfortunately merely estimates of the cost is possible due to the deficiency of statistical informations. The creative activity of a dedicated cardinal organisation for the reappraisal of medical mistakes and ailments countrywide every bit good as the modernisation of the infirmaries ‘ monitoring systems are more than obvious in order to derive control of the job. Above all, co-operation and trust between patients, wellness attention professionals, infirmary directors, medical boards and the authorities are indispensable to acquire to the root of the job.
Keywords: medical mistakes ; inauspicious events ; wellness attention system ; cost containment ; cost-effectiveness
JEL: I18, P46, H51, K32, 03
Research shows that medical mistakes exist all over the universe ‘s wellness systems, compromising the patient safety and the quality of wellness attention. The Institute of Medicine ‘s ( IOM ) studies, “ To Err is Human: Building a Safer Health System ” and “ Traversing the Quality Chasm: A New Health System for the twenty-first Century ” , highlight the importance for wellness policy shapers to taking into history the assorted deductions of medical mistakes in patient safety and healthcare quality ( IOM, 1999, 2001 ) . Escalating the above, the Eurobarometer study, which was released by the European Commission ( E.C. , 2005 ) , found that about half of those surveyed stated that patients should take in consideration that it is likely to be harmed by a medical mistake, during wellness attention bringing.
In the present paper, we highlight and discourse the preliminary research findings about the fiscal cost of medical mistakes in Greece, after the analysis of 97 instances coming from tribunals awards for the old ages 2000 to 2009. We besides formulate recommendations in order to win in the decrease of the phenomenon of medical mistakes where the most of import status is the consciousness of the job among all stakeholders in the Greek wellness system.
In the undermentioned subdivisions 2 and 3, we indicate the theoretical facets of inauspicious events and medical mistakes. In subdivisions 4 and 5, we present the research findings and draw decisions severally and eventually we propose extra policies of cut downing the figure of patients harmed by medical mistakes.
Theoretical facets of inauspicious events and medical mistakes
In the literature of wellness attention quality, we can happen assorted definitions of medical mistakes. The World Health Organization ( WHO ) in the “ Collaborating Centers for International Drug Monitoring ” and the IOM in the “ To Err is Human ” , clear up the definition of the inauspicious event and the medical mistake ( WHO, 1984 ) , ( IOM, 1999 ) :
“ An mistake is defined as the failure of a planned action to be completed as intended or the usage of a incorrect program to accomplish an purpose. ”
Furthermore, in the literature we can happen the expanded IOM definition, reported by QuIC ( QuIC, 2000 ) : “ An mistake is defined as the failure of a planned action to be completed as intended or the usage of a incorrect program to accomplish an purpose. Mistakes can include jobs in pattern, merchandises, processs, and systems. ”
In contrast with the above definitions, assorted categorizations of medical mistakes can be found, mentioning non merely in the intervention but besides in diagnosing and bar phases of wellness attention bringing ( NCC MERP, 1998 ) , ( JCAHO, 2011 ) , ( IOM, 1999 ) , ( Leap, 1993 ) . Besides, the medical mistakes can be classified based on their badness, runing from those that do n’t do any injury to those with terrible injury. Categories A, B, C and D depict medicine mistakes that do non do injury, while classs E, F, G, H, and I of the NCC MERP Index describe mistakes that do do injury.
Though medical mistakes are likely to happen, as wellness attention forces are human existences, many research workers believe that the chief causes of medical mistakes refer to systemic failures. Trusting on this premise, medical mistakes happen, in general by the complexness and time-pressured of Health Systems and less by the carelessness of wellness attention forces. Donald M. Berwick, president of the Institute for Health Care Improvement and experts in the American Medical Association espouse this point of position, as they recommend the simplification, more standardisation in the wellness attention system and the motive of wellness attention professionals to describe the medical mistakes, taking to heighten patient safety and the betterment of wellness attention quality.
3. Medical Mistakes: Figures and Cost
As supra mentioned, the phenomenon of medical mistakes is common to the Health Systems all over the universe. In the United States, the figures of medical mistakes are really high and half of the inauspicious events happening because of medical mistakes that could be prevented, ensuing in the decease of 1000s. On the other manus, medical mistakes, except of physical injury, cost a batch of money in the Health System of the United States, as table 1 shows ( Null 2007 ) , ( Lazarou, Pomeranz, Corey, 1998 ) , ( IOM, 1999 ) , ( Xakellis, Frantz, Lewis, 1995 ) , ( Barczak, Barnett, Childs, Bosley, 1997 ) , ( Weinstein, 1998 ) , ( MMW, 2000 ) , ( Burger, Kayser-Jones, Bell. , 2003 ) , ( Starfield, 2000a ) , ( HCUP, 2003 ) , ( Tunis, Gelband, 1994 ) .
Table 1. Estimated Annual Mortality and Economic Cost of Medical Intervention
Condition Deaths Cost
Adverse Drug Reactions 106,000 $ 12 billion
Medical mistake 98,000 $ 2 billion
Bedsores 115,000 $ 55 billion
Infection 88,000 $ 5 billion
Malnutrition 108,800 — — — — — –
Outpatients 199,000 $ 77 billion
Unnecessary Procedures 37,136 $ 122 billion
Surgery-Related 32,000 $ 9 billion
Entire 783,936 $ 282 billion
Beginning: USNCHS, 2003
In Europe, the landscape is n’t different, as the research indicates a important proportion of patients is harmed by a medical mistake during a infirmary stay ( GeneralCologneRe, 2002 ) , ( National Coalition on Health Care and the Institute for Healthcare Improvement, 2000 ) , ( Thomas et al, 2000 ) . In Greece, there is n’t a cardinal national authorization to describe instances of medical mistakes. However, recent findings show that approximately 20 to 30 patients die every twenty-four hours and other 200 are harmed because of medical mistakes that could be prevented ( Vozikis, Riga, 2008 ) .
The range of this paper is to show the economic load of medical mistakes in Greece. For the present research, an extended hunt was carried out to happen the cost containment of Greek Heath Care System. The stuff of our analysis consists from 97 instances coming from the tribunals awards for the old ages 2000 to 2009. For every instance, we record the twelvemonth of the resort or the award publication, the legal position of the wellness attention organisation, the physician ‘s forte, the type of medical mistake, the badness of the inauspicious event and the sum which the Court of First Instance imputed.
In Greece, contrary to other states, the appraisal of the entire fiscal load because of medical mistakes includes many branchings of which most are hard to be approached due to the deficiency of informations from an organized information system. Therefore, the execution of a system with the ability to acknowledge, study and analyze instances of inauspicious events and medical mistakes following the international criterions is important. Our research pointed out that in Greece, the economic cost arising by medical mistakes is worryingly high. In add-on, the sum of average compensation has been dramatically increased. The most deleterious fortes are Anaesthesiologists and Obstetrics-Gynecology, while Anaesthesiologists have the higher average compensation ( Graph 1 ) .
Graph1. Mean Compensation for assorted fortes ( & gt ; a‚¬100,000.00 )
The highest average compensation awarded to the badness of inauspicious events Category I: Patient decease and to the Category H: Intervention required to prolong life. It is singular that the awarded mean compensations for the Category G: Permanent patient injury, is higher than those to inauspicious events classs with minor badness ( Graph 2 ) .
Graph 2. Average Compensation for Adverse Events badness classs
The highest average compensation awarded to the public infirmaries due to a large figure of instances extracted by Administrative Courts.
Graph 3. Average Compensation by Type of Heath Unit
5. Discussion – Policy Proposals
Our research points out, that medical mistakes are a common phenomenon in the Greek Health Care System ( as in every Health Care System worldwide ) . In a comparative research in Austria, in a sample of 14.179 hospitalized patients, inauspicious events were identified in the 16,6 % of them, of which 13,7 % impacted to permanent patient injury, 4,9 % related to decease and 51 % could be prevented ( Wilson et al. , 1995 ) . Our findings show that the allotment in the classs I, H and G which referred to patient decease, to intercession required to prolong life and to permanent patient injury severally, are in conformity with a survey for medicine mistakes which took topographic point in New York ( Duthie, et al. , 2005 ) . A survey in 9,758 medical claims, points out that 32 % refer to decease and 15 % to important lasting hurt ( Public Citizen ‘s Congress Watch, 2012 ) . Furthermore, a research indicates that the cost of inauspicious events with impermanent injury reached to $ 324 million ( Center for Justice and Democracy, 2011 ) . Another research shows that in the U.S.A. 5.000 deceases by medical mistakes are recorded every twelvemonth ( Hayward, 2001 ) .
Based on our findings, the fortes of Anaesthesiologist, Obstetrics-Gynecology, Neurosurgeon and General Surgeon appears to hold increased engagement in medical mistakes, which are consistent with the findings of other studies ( Studdert et al. , 2004a ) , ( Bates, 1995 ) . Furthermore, a survey by the Ministry of Health of USA, concludes that the fortes of General Surgery and Obstetrics and Gynaecology are the top two fortes which are burdened with medical malpractice ( US Dept of Health and Human Services, 2002 ) . These findings confirm old similar research that pointed out that the fortes of Vascular Surgery, Obstetrics and Gynecology, Cardiology and Neurosurgery had more opportunities for doing an inauspicious event ( U.S. Congress, 1994 ) . Another survey shows that in a sample of 465 inauspicious events, 127 are due to medical malpractice where 61 % is related with surgical process hurts, 12 % refers to drug hurts and 11 % trades with nonsurgical process ( Mello et al. , 2007 ) .
Furthermore, medical mistakes cause terrible injury and significant economic load to the patients and to their relations, professional medical liability to the physicians involved and a high economic load to the Health System and to the Insurance Industry. The involvement for analyzing medical mistakes in all developed states is due to the impact on the quality of wellness services and besides to a figure of legal actions for amendss from the patients where the tribunal determination many times is condemning for the physicians ( Zhan, Miller, 2003 ) . In an American survey, 27 % of inauspicious events was consequence of medical malpractice ( Studdert et al. , 2000b ) and an extended survey based in the old, with a sample of 465 medical records, showed that $ 1,791,358 was related with medical hurts and for 127 of instances due to negligence, the American wellness system was burdened with $ 905,719 ( Mello et al. , 2007 ) . Another survey, indicates that medical hurts cost 6.3 million of which 1.5 million were due to medical mistake ( Clark, 2010 ) . Based on our findings, we point out that the average compensation for the forte Obstetrics-Gynecology scaled up over 600,000 euros. This is consistent with the findings of a survey which references that the Obstetrics-Gynecology and Emergency Department cover the 28 % of all fiscal demands or $ 2 million ( Larcher, Dulberger, 2008 ) . Another recent research from Utah of Department of Health finds that 58 % of inauspicious events are surgical, of which 25 % refer to foreign objects staying during surgery, particularly in surgeries of obstetric/gynecology. The undermentioned instances deal with nonsurgical events like attention direction and infirmary environment ( Utah Department of Health, 2010 ) .
Of class, it should be noted that the root cause of medical mistakes, is due to a systemic attack where should take into history the part of wellness system construction and organisation ( Kelly, 2006 ) , ( Council of Europe, 2006 ) . Specifically, the systemic factors are chiefly due to staff deficit ( quantitative and qualitative attack ) , to insecure working environment, to the badness of the patients admitted, to the increased work load and to the professional burnout. The unequal staffing of health care system and their deficient instruction are among the most of import parametric quantities that may compromise the safety of patients and the quality wellness attention proviso ( Konver, Gergen, 1998 ) , ( Aiken et al. , 1993 ) , ( Mitsis, et al. , 2012 ) .
For accomplishing a high degree of wellness attention quality and patient safety in Health System, the actions of cut downing medical mistakes should be strategically designed, affecting the wellness attention professionals and utilizing new medical engineerings for observing, coverage and analyzing the inauspicious events and medical mistakes ( National Quality Forum ( NQF ) , 2010 ) , ( House of Commons, 2009 ) , ( European Commission, 2008 ) , ( U.S. Department of Health and Human Services, 2011 ) , ( Gregory, 2008 ) . In Greece a similar system has already been developed and its pilot execution runs out in a public Intensive Care Unit ( ICU ) and so far is considered as important to the attempts for bettering the quality of wellness services proviso and patient safety ( Vozikis et al, 2012 ) , ( Vozikis, 2009 ) . In the USA, an information system which reports inauspicious events was developed, which was accompanied by a root-cause analysis faculty ( Leapfrog Group, 2006 ) , ( Consumers Union, 2009 ) .
It is obvious, that the wellness policy shapers should earnestly take into consideration the phenomenon of medical mistakes and act in the way of cut downing these instances, chiefly due to the high costs associated with them ( National Coalition on Health Care and the Institute for Healthcare Improvement, 2000 ) .