New Zealand: open and honest approach and no Fault Compensation system

Publications by Marie Bismark and Ron Paterson clarify the situation of patient safety in New-Zealand,give recommendations to approach victims of medical errors and their families in an open and honest way (see nr. 1) and describe and comment on the No Fault Compensation System in New-Zealand (see nr. 2).

1.“Doing the right thing” after an adverse event.Bismark M, Paterson R. N Z Med. J. 2005 Jul 15;118 (1219):U1593
Citation from PMID: 16059413 [PubMed – indexed for MEDLINE]

Each year, the New Zealand Health and Disability Commissioner receives over a thousand letters of complaint from patients and their families, many of whom have suffered an adverse event. Often, the focus of their hurt and anger is not the injury itself, but the failure of a health professional to ‘do the right thing’ in the aftermath of the event. And in most cases, ‘the right thing’ requires no more, and no less, than living up to the ethical standards that we practise in everyday life: honesty, compassion, saying sorry, and a willingness to learn. Acknowledging that an adverse event has occurred can be hard, and facing up to an injured patient or bereaved family can be even harder. But the alternative scenario of silence and abandonment is worse: for patients, their families, and their health professionals.

2. No-fault compensation in New Zealand: harmonizing injury compensation, provider accountability, and patient safety. Bismark M, Paterson R. Health Aff (Millwood) 2006;25:278�83. [PubMed]
Citation from PMID: 16403765 [PubMed – indexed for MEDLINE]

In 1974 New Zealand jettisoned a tort-based system for compensating medical injuries in favor of a government-funded compensation system. Although the system retained some residual fault elements, it essentially barred medical malpractice litigation. Reforms in 2005 expanded eligibility for compensation to all “treatment injuries,” creating a true no-fault compensation system. Blame-free compensation increases confidence, speeds resolution, and promotes safety, although corrections are still necessary.
Compared with a medical malpractice system, the New Zealand system offers more-timely compensation to a greater number of injured patients and more-effective processes for complaint resolution and provider accountability.
The New Zealand system for patients� harmed by treatment puts litigation to shame
Fear of litigation is one of the biggest barriers to creating a culture of safety in health care. Finding the individual �at fault� and proving negligence is at the core of the tort based legal process for compensating patients harmed by health care and this is entirely at odds with error reporting, open communication with patients, and the development of a collective responsibility for safety within health care.
But it doesn�t have to be this way, as Bismark and Paterson explain in a comprehensive description of the no-fault compensation system in New Zealand. Compensation can be delivered to patients quickly�in a system that expects claims to be settled within nine months, without pitching patient against doctor�as medical error has been re-framed as �treatment injuries� and efficiently. In the New Zealand system 10% of the total budget is spent on administration compared with the 50�60% costs incurred in medical litigation in the USA�not to mention the massive difference in insurance premiums for those practising in New Zealand (NZ$1000 for all specialisms) with those in the USA.
The authors are aware that the system is not without its faults; compensation tends to be lower, favours those who are in employment, and has been criticised for not promoting accountability within health care. However, one cannot help conclude that the system is better for patients, the healthcare professionals treating them, and the tax payer who ultimately foots the bill of both New Zealand�s healthcare and compensation system. The only people who lose out, it would appear, are those in the legal profession. Could that be why a system with so many obvious benefits has failed to inspire the mass rejection of tort and malpractice by health systems striving to reduce expenditure beyond the antipodes?

The IEU-alliance appreciates the honest approach towards victims of medical errors as recommended in these articles by M. Bismark and R. Paterson and values the advantages of a No Fault Compensation System.