Swift compensation in sight for treatment errors

Photo: SCANPIX

While currently a lengthy path to prove medical treatment mistakes must be trodden by patients, in order to get complications compensations from providers of healthcare, the process will be simplified and shortened for both parties – by medical institutions liability insurance now in the pipeline. Compensations may shrink, though.

Right now, only a few isolated cases reach public ears about patients suing medical institutions or doctors for complications arising from alleged treatment errors. In reality, cases of people being paid compensation are much more numerous.

In Estonia, there are no statistics on treatment error compensations. A large share of medical institutions having insured themselves, it is known that for abovementioned reasons, insurance companies make yearly payments of up to €100,000, for 20-30 cases a year.

According to Urmas Sule, head of Pärnu hospital as well as of Estonian Hospitals Association, the cases are even more abundant; even so, being mostly extrajudicial or pre-trial agreements between hospitals and patients, the delicate personal data and confidentiality clauses exclude official publication thereof.

As, starting this October, European Union’s free cross-border movement of patients enters into force in Estonia, an unavoidable need has arisen to create insurance covering all patients and medical institutions.

«When patients come to Estonia from other European countries and suffer complications while treated here, claims of damages may rise to new heights,» said Katrin Rehemaa, secretary general of Estonian Medical Association, adding that, currently, 70 per cent of doctors have insurance cover, as well as some of the hospitals.

One principle, agreed this spring in at a goodwill committee at Ministry of Social Affairs, is to apply the no-wrongful-intent approach, as is the custom in Finland and other Nordic countries.

«The main difference with the current wrongful intention based system being that while now a handful of people get large sums of money, then there will be more of those compensated, but the sums will be smaller,» explained Mr Sule. «In Estonia, an attitude prevails that more people should get more money... We need to realise, however, that it would be at somebody else’s expense,» warned Mr Sule.

«Compared to the current system, the main difference would be the end of culprit-hunting, no more disputes – an expert will assess the probability of treatment error; and should this appear highly probable, the law prescribes definite compensations for definite complications, a central compensating body making the payments,» explained Andres Piirsalu, board member of Estonian Insurance Association.

«In Finland, for instance, the system is based on a central compensations body, with clear compensating principles applied. There is no hunt for culprits for errors made in medical institutions,» said Mr Piirsalu. «Should a patient detect a health disorder, possibly due to error in treatment, he/she addresses the central compensation body, which will provide counselling and will organise proceedings as well as compensations.»

According to Ministry of Social Affairs, it is still being discussed whether compensation would be based on public or private compensations system would be applied, or a mix of the two.

According to the ministry, insurance companies have proposed the latter i.e. public-private cooperation. «Risk assessment, risk acceptance and compensation of damages might be carried out involving the private sector; establishing the principles of compensation and monitoring compliance could be left to the public sector,» is how Mr Piirsalu describes the insurers’ proposal. In essence, this would resemble traffic insurance – on a much smaller scale, of course.  

Mr Sule would rather prefer the unemployment insurance (Töötukassa) principle where the entire activity, including control over money, is in public hands and transparent. «To draw comparisons, we have public unemployment insurance and then the private pension funds... Should the system be launched as we propose, in our estimation health care system costs would rise by 1 per cent, with up to 500 possible claims for damage a year,» said Mr Piirsalu.

«Health care keeps getting more and more complicated; the more complicated it becomes, the more complications there will be. That’s nobody’s ill will; it is inevitable if you intrude a person’s body. Who is to blame if, for instance, 5 per cent of deliveries are pathological,» said Mr Sule. Which means that with 5 per cent of babies born, complications loom.

«We have proposed to... also create an error reporting system, allowing to analyse errors and learn from these, thus raising quality of health care,» said Mr Rehemaa, in the name of the medical association.