Abstract:

Market research shows that the number and value of claims in medical malpractice cases is increasing. From the point of view of risk management processes in healthcare entities, it is important to analyze both the frequency of claims and potential damages. Research covering US, Western Europe or China markets indicates that - apart from the differences resulting from compensation systems - the frequency and value of claims depends on specialty, and their effectiveness is lower than e.g. in claims for from traffic accidents covered by compulsory liability insurance. For Poland, there is no detailed research, hence the authors in this article undertake research for the Polish market. The study hypothesized that the percentage of claims effectiveness is lower than in third party liability insurance, close to the level in developed countries, and the risk of claims arising from medical malpractice depends on specialty. The article reviews research and data on other markets. Their results were compared with data that were identified for the Polish market - general, including statistics covering lawsuits in medical malpractice cases and with detailed data obtained from a large university clinical hospital from Poland, which is to be illustrative and initiating further case study. The data includes claims and benefits paid to victims in 2017-2018 and applications submitted in 2010-2014. In the analyzed years, the structure of the size and number of claims and payments was assessed in terms of recognition of claims by the court and reimbursement by the insurer. Potential costs related to claims submitted in 2017-2018 were estimated. The methods of descriptive statistics and the triangulation method were used for the analysis. The obtained results were compared with data from other markets. FINDINGS: The results confirm that the number and value of claims depend on the ward specialty. Neurosurgery faced the highest risk and is also the specialty highly affected in other markets. However other risky specialty as gynecology and obstetrics wasn't examined due to the lack of such one in analyzed hospital. The effectiveness of medical malpractice claims on the Polish market is similar to other markets (20-30%) - which is confirmed by aggregated data on claims brought in courts and claims faced by analyzed hospital.