Editorial: the manifold matters of medical errors

Photo: Urmas Nemvalts

Apparently, good may come from the European Union, after blunders with banana bends prescribed. The cross-border treatment directive entering into force this October necessitates general insurance for all patients and medical institutions alike. Estonia’s current lack of such system does pose and extra risk for doctors, while not hindering implementation of the directive.

True: numerous physicians and hospitals have insurance cover, as it is. Even so, Estonia’s standing system of patients having to fight to prove treatment errors and go to court to get compensated may, with cross-border treatment coming, cause compensations to skyrocket. That’s for starters. Secondly: absence of transparent compensation mechanism will scare away affluent foreign patients, who do have that at home. In Finland, for instance, patient insurance is in place for 20 years already.

Thirdly, the Nordic inspired no-wrongful-intent assumption principle must grant Estonia its treatment errors statistics – currently lacking. Presumably, insurance companies pay patients yearly damages of up to €100,000. For what, precisely? That is not known, as issues are usually settled between hospitals and patients, quietly. And the current wrongfulness-based system geared to search out culprits closes the lips of health care providers, regarding errors.

Doctors knowingly damaging patients are a rarity. Even so, complications happen – and, according to doctors, the trend is for increase, as treatment methods are getting ever more complex. Should non-wrongful clause equal transparency at getting compensated, we might be ready to accept that the sums will shrink but be better accessible. Plus the cheaper and swifter proceedings.

Still, many issues arise in connection to the overall insurance. First: should this be private or public, or a mix of both? And: how much will it cost? Already, Estonia has traffic, pensions and unemployment insurance. Thus, we have what to learn from. We might ask: how would a private-only scheme affect health care providers’ insurance costs; and how would a public-only system shape sizes of compensation? A goal being to avoid uncontrollable rise of costs while ensuring patient security.

Secondly: definitely determining health damage and compensation size will not do away with the need for impartial proceedings – who will do that? Indeed, no-wrongfulness assumption ought to take lots of stress off hospitals. Even so, with the lack of attending physicians plaguing Estonian hospitals – how do we secure impartial judgement?