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Patient Safety and Quality

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Few patients seek compensation for medical injuries through New Zealand's no-fault medical malpractice system

In contrast to the medical malpractice system in the United States, New Zealand has a national no-fault compensation program for patients who suffer an injury due to medical care. Despite this no-fault system, only 3 percent of eligible patients seek compensation. Those least likely to seek compensation are older, poor, and minority patients, according to a study supported by the Agency for Healthcare Research and Quality (HS11886 and HS11285). Researchers estimated the percentage of eligible patients who claimed no-fault compensation by linking a national claims database (Accident Compensation Corporation, ACC) to records reviewed in the New Zealand Quality of Healthcare Study (NZQHS).

Claims included 741 patients who suffered from an adverse event associated with care in New Zealand public hospitals in 1998 and claimed compensation with the ACC, the national no-fault insurer. The claims also included 839 injured patients who did not file a compensation claim. Among patients judged by NZQHS reviewers to be eligible for compensation, only 2.9 percent filed claims. Compared with claimants, non-claimants were older (mean age of 52 vs. 42 years), more likely to be male (45 vs. 39 percent), and more likely to be of Maori or Pacific ethnicity (16 vs. 9 percent and 4 vs. 2 percent). Non-claimants were also more likely to live in the most socioeconomically deprived areas (27 vs. 18 percent).

The small proportion of New Zealand claimants was very close to the proportion estimated to file claims for medical injury in tort systems in New York in the late 1980s and Utah and Colorado in the late 1990s. The findings are also consistent with estimates from Denmark, another country with a comprehensive no-fault system. Thus, the problem of chronic underclaiming appears to be insensitive to the structure of the compensation system.

See "Claiming behaviour in a no-fault system of medical injury: A descriptive analysis of claimants and non-claimants," by Marie M. Bismark, M.B., Ch.B., L.L.B., Troyen A. Brennan, M.D., Peter B. Davis, M.D., and David M. Studdert, L.L.B., Sc.D., M.P.H., in the August 21, 2006, Medical Journal of Australia 185(4), pp. 203-207.

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