15 July 2014

Medical Indemnity Claims Data

The Australian Institute of Health & Welfare has released a 175 page report [PDF] on Medical Indemnity Claims 2012-2013.

The report offers data on Australia’s public sector medical indemnity claims, and public and private sector claims combined, from 2008–09 to 2012–13. (There is an exclusion regarding public sector claims for Western Australia, which did not report claims data for 2010–11 to 2012–13.)

The AIHW comments that
Claims arise from allegations of negligence or breach of duty of care by health-care practitioners during the delivery of health services. A new claim is created when a reserve amount is placed against the costs expected to arise in closing the claim. A claim is closed after being finalised through a court decision, a negotiated settlement between claimant and insurer, or discontinuation (either by the insurer, or the claimant’s withdrawing the claim). 
Claim numbers 
The number of new public sector claims was less in 2012–13 (about 950) than any of the previous 4 years (1,200–1,400) while the number of closed public sector claims was higher (about 1,500) compared with the previous 4 years (1,100–1,400). 
The number of new private sector claims remained steady at 3,200 to 3,300 per year from 2010–11 to 2012–13. This was higher than the 2,300–2,500 new private sector claims in 2008–09 and 2009–10.  The number of closed private sector claims increased each year, from 2,400 to 3,800. 
There were about 14,000 public and private sector claims open at some stage during the year for the 2010–11 to 2012–13 years, compared with 12,500 for 2008–09 and 2009–10. 
New claims 
The proportion of new public and private sector claims (combined) against general practitioners was less in 2012–13 (23%) than any of the previous 4 years (28–32%). 
The proportion of new claims against Obstetrics and gynaecology specialists decreased from 12% in 2008–09 to 8% in 2012–13. The proportion of new claims allegedly associated with Digestive, metabolic and endocrine systems increased from 10% to 24% between 2008–09 and 2012–13. 
Closed claims 
Between 2008–09 and 2012–13, there was a decrease in the proportion of public sector claims closed for less than $10,000 and a corresponding increase in the proportion closed for $100,000 to less than $500,000. For public and private sector claims combined, there was little change over the years in the claim size category proportions, including the 63–65% closed for less than $10,000. 
Between 2008–09 and 2012–13 there was a trend towards 2 features associated with less costly claims: a higher proportion of claims associated with a mild rather than a severe extent of harm to the patient, and a shift towards more claims connected with a private medical clinic rather than a public hospital/day surgery. 
Length of time between health-care incident and claim closure 
With public sector claims, the length of time between health-care incident and when a claim was opened was on average about 2 years, and 3 to 4 years between the incident and when a claim was closed. 
The proportion of claims closed within 5 years of the incident fluctuated between 70% and 78% of claims with incident years between 2001–02 and 2007–08.