Analisi comparata dei modelli di gestione dei sinistri in sanità. Prime evidenze empiriche sui costi dei sinistri

Journal title MECOSAN
Author/s Milena Vainieri, Elisabetta Flore, Riccardo Tartaglia, Tommaso Bellandi
Publishing Year 2015 Issue 2014/92 Language Italian
Pages 27 P. 27-53 File size 1334 KB
DOI 10.3280/MESA2014-092003
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In the last twenty years there has been a significant increase in the number of claims for damages related to healthcare and in the amount paid for these types of claims, that recently seem to have stabilized; rising costs have led to imbalances in the insurance market, with consequent increases in premiums and the application of increasingly high deductibles, such that various Italian health authorities have shown the need to experiment new ways of managing risk also with regard to the direct assessment and payment of claims for damages related to medical liability, with their own resources. This article outlines the evolution that has had the management of claims related to medical liability, with initial assessments of the economic impact of the different models applied in the Country.

Keywords: Claims management in healthcare, personal damages compensation in healthcare, insurance, auto-insurance/ direct management, healthcare insurance costs, compensation costs in healthcare

  1. ANIA Associazione Nazionale fra le Imprese Assicuratrici (2011). L’assicurazione italiana 2010/2011, pp. 178-183. Disponibile al sito: http://www.ania.it/export/sites/default/it/pubblicazioni/rapporti-annuali/Assicurazione-italiana-Appendice-statistica/Assicurazione-Italiana-2010-2011.pdf.
  2. ANIA Associazione Nazionale fra le Imprese Assicuratrici (2013). L’assicurazione italiana 2012/2013, pp. 218-225. Disponibile al sito: http://www.ania.it/export/sites/default/it/pubblicazioni/rapporti-annuali/Assicurazione-italiana-Appendice-statistica/Assicurazione-Italiana-2012-2013.pdf.
  3. ANIA Associazione Nazionale fra le Imprese Assicuratrici (2014). Malpractice, il grande caos. Dossier a cura di Sabbatini R., pp.1-82. Disponibile al sito: http://www.ania.it/export/sites/default/it/pubblicazioni/Dossier/Dossier-ANIA-Malpractice-ilgrande-caos.pdf.
  4. Aranazaz-Andres J.M., Aiobar-Remon C., Vitalle-Murillo J. (2008). Incidence of adverse events related to health care in Spain: results of the Spanish National study of Adverse events. The Journal of Epidemiology and Community Health, 62(12): 1022-1029. DOI: 10.1136/jech.2007.065227
  5. Bellandi T., Albolino S., Tomassini C. (2007). How to create a safety culture in the healthcare system: the experience of the Tuscany Region. Theoretical Issues in Ergonomics Science, 8(5): 495-507. DOI: 10.1080/14639220701193223
  6. Breannan T.A., Leape L.L., Laird N.M., Hebert L., Localio A.R., Lawthers A.G., Newhouse J.P., Weiler P.C., Hiatt H.H. (1991). Harvard Medical Practice Study. New England Journal of Med L’integraicine, 324: 370-376. DOI: 10.1056/NEJM199102073240604
  7. Briant R., Buchanan J., Lay-Yee R., Davis P. (2006). Representative case series from New Zealand public hospital admissions in 1998 III: adverse events and death. New Zealand Medical Journal, Mar 31, 119(1231): U1909.
  8. Bruce J., Russell E.M., Mollison J., Krukowski Z.H. (2001). The measurement and monitoring of surgical adverse events. Health Technology Assessment, 5(22): 1-194. DOI: 10.3310/hta5220
  9. Brusoni M., Cosmi L., Trinchero E. (2006). Prospettive regionali per la gestione del rischio clinico: una prima indagine esplorativa. Rapporto OASI, CERGAS, Bocconi. Milano: Egea.
  10. Brusoni M., Trinchero E., Marazzi L., Partenza I. (2012). Gestione, ritenzione e assicurazione del rischio: alla ricerca di una prospettiva integrata, Rapporto OASI, CERGAS, Bocconi. Milano: Egea.
  11. Caracci G., Labella B. (a cura di) (2009). Rapporto sull’indagine relativa ai sistemi regionali di gestione sinistri. Roma: Agenzia Nazionale per i Servizi Sanitari Regionali (Age.na.s.). Caracci G., Labella B., De Matteis G., De Blasi R., Raho V. (2013). Indagine sui modelli regionali di gestione sinistri e polizze, supplemento alla rivista Monitor. Quaderni di Monitori, Ottobre. Disponibile al sito: http://www.agenas.it/images/agenas/monitor/quaderno/Quaderno_di_Monitor_2013.pdf.
  12. Classen D.C., Resar R., Griffin F., Federico F., Frankel T., Kimmel N., Whittington J.C., Frankel A., Seger A., James B.C. (2011). Global trigger tool’ shows that adverse events in hospitals may be ten times greater than previously measured. Health Affairs, 7: 581-589. DOI: 10.1377/hlthaff.2011.0190
  13. Comande G., Turchetti G. (a cura di) (2004). La Responsabilita Sanitaria. Valutazione del rischio e assicurazione. Padova: CEDAM.
  14. Comande G., (2010). Dalla responsabilita sanitaria al no-blame regionale tra conciliazione e risarcimento. Danno e Responsabilita, 11: 977-988.
  15. Comande G., (2013). Risarcimento del danno: analisi delle norme di riferimento – l’evoluzione giurisprudenziale – Le questioni ancora aperte – Il danno risarcibile. Guida al Diritto, XXI: 30-53. Disponibile al sito: http://web1.sssup.it/pubblicazioni/ugov_files/419379_RISARCIMENTODANNOridotto%20DIC.2013.pdf.
  16. Commissione parlamentare di inchiesta sugli errori in campo sanitario e sulle cause dei disavanzi sanitari regionali (2012), Relazione Conclusiva, Doc. XXIIbis N. 10, Relatore: On. A. Palagiano, approvata dalla
  17. Commissione nella seduta del 22 gennaio 2013, pp. 1-184. Disponibile al sito: http://leg16.camera.it/_dati/leg16/lavori/documentiparlamentari/indiceetesti/022bis/010/INTERO.pdf.
  18. Dalton G.D., Samaropoulos X.F., Dalton A.C. (2008). Improvements in the safety of patient care can help end the medical malpractice crisis in the United States. Health Policy, 86(2-3): 153-62, DOI: 10.1016/j.healthpol.2007.10.005
  19. Department of Health (2000). An Organisation with a Memory. Report of an expert group on learning from adverse events in the NHS chaired by the Chief Medical Officer.. London: The Stationery Office, pp. viii, 9-11, 40-41. Disponibile al sito: http://www.aagbi.org/sites/default/files/An%20organisation%20with%20a%20memory.pdf.
  20. De Vries E.N., Ramrattan M.A., Smorenburg S.M., Gouma D.J., Boermeester M.A. (2008). The incidence and nature of in-hospital adverse events: a systematic review. Quality and Safety in Health Care, Jun, 17(3): 216-23. DOI: 10.1136/qshc.2007.023622
  21. Etchells E., Mittmann N., Koo M., Baker M., Krahn M., Shojania K., McDonald A., Rupinder Taggar R., Matlow J., Daneman N. (2012a). Economics of Patient Safety in Acute Care-Technical Report, Canadian Patient Safety Institute publication. pp. 1-72. Disponibile al sito: http://www.patientsafetyinstitute. ca/English/research/commissionedResearch/EconomicsofPatientSafety/Documents/Economics%20of%20Patient%20Safety%20-%20 Acute%20Care%20-%20Final%20Report.pdf.
  22. Etchells E., Koo M., Daneman N., McDonald A., Baker M., Matlow A., Krahn M., Mittmann N. (2012b). Comparative economic analyses of patient safety improvement strategies in acute care: a systematic review. BMJ Quality & Safety, 21: 448-456. DOI: 10.1136/bmjqs-2011-000585
  23. Flin R., Patey R. (2009). Improving patient safety through training in non-technical skills. British Medical Journal, 339(sep23 2): b3595. DOI: 10.1136/bmj.b3595
  24. Gawande A.A., Thomas E.J., Zinner M.J., Brennan T.A. (1999). The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery, 1999, 7: 66-75. DOI: 10.1067/msy.1999.98664
  25. Gerbi M., Sardella I. (2013). Il danno alla persona derivante da attivita sanitarie. Danno e Responsabilita, 12/2013: 1221-1245.
  26. Gluck P.A. (2008). Medical error theory. Obstetrics and Gynecology Clinics of North America, 35(1): 11-17. DOI: 10.1016/j.ogc.2007.12.006
  27. Gregorio D. (2008). Risk management in sanita: strategie, modelli di attuazione, analisi comparata fra alcune regioni italiane e stati europei. L’integraicine zione con i sistemi di valutazione della qualita, Rapporto finale, Istituto Regionale di Ricerca della Lombardia, Milano.
  28. Grembi V., Garoupa N. (2013). Delays in medical malpractice litigation in civil law jurisdictions: some evidence from the Italian Court of Cassation. Health Economics, Policy and Law, 8(4): 432-452. DOI: 10.1017/s1744133112000436
  29. Harris M.H. (2004). To err is human-the fallible physician. South Dakota Journal of Medicine, 57(1): 9-11.
  30. Howard J., Levy F., Mareiniss D.P., Patch M., Craven C.K., McCarthy M., Epstein-Peterson Z.D., Wong V., Pronovost P. (2010). New legal protections for reporting patient errors under the Patient Safety and Quality Improvement Act: a review of the medical literature and analysis. Journal of Patient Safety, 6(3): 147-52. DOI: 10.1097/pts.0b013e3181ed623a
  31. Kable A., Gibberd R., Spigel A. (2008). Predictors of adverse events in surgical admissions in Australia. International Journal for Quality in Health Care, 20(6): 406–411. DOI: 10.1093/intqhc/mzn032
  32. Kohn L.T., Corrigan J.M., Donaldson M.S. (U.S. Institute of Medicine) (2000). To err is human: building a safer health system. Washington, DC: National Academy Press.
  33. Kopec D., Tamang S., Levy K., Eckhardt R., Shagas G. (2006). The state of the art in the reduction of medical errors. Studies in health technology and informatics, 121: 126-37.
  34. Labella B. (2013), I risultati dell’indagine Agenas sui modelli regionali di gestione dei sinistri. Monitor, Elementi di analisi e osservazione del sistema salute, 34: 12-20.
  35. Laboratorio MES (2014), Il Sistema di valutazione della performance della sanita toscana – Report 2013, Edizioni ETS. Disponibile al sito: http://www.meslab.sssup.it/it/index.php?page=reporttoscana-2013.
  36. Leape L.L. (2008). Scope of problem and history of patient safety. Obstetrics and Gynecology Clinics of North America, 35(1): 1-10. DOI: 10.1016/j.ogc.2007.12.001
  37. Localio A.R., Lawthers A.G., Brennan T.A., Laird N.M., Hebert L.E., Peterson L.M., Newhouse J.P., Weiler P.C., Hiatt H.H. (1991). Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III. New England Journal of Medicine, 325(4): 245-251. DOI: 10.1056/NEJM199107253250405
  38. Marshall M, Ovretveit J. (2011). Can we save money by improving quality? BMJ Quality and Safety 20(4): 293-6. DOI: 10.1136/bmjqs.2010.050237.MarshRiskConsulting(2013).Medicalmalpracticeclaimsanalysis.Ved.Disponibilealsito:http://www.sanita.ilsole24ore.com/pdf2010/Sanita2/_Oggetti_Correlati/Documenti/Imprese/STUDIO_MARSH.pdf?uuid=66674138-9e21-11e3-9f80-88df8305bae5
  39. Ministero della salute (2006). Rapporto nella 1° rilevazione nazionale relativa agli aspetti assicurativi in ambito di gestione aziendale del rischio clinico.
  40. Mohr J.C. (2000). American Medical Malpractice Litigation in Historical Perspective. JAMA, 283(13): 1731-1737. DOI: 10.1001/jama.283.13.1731
  41. Murff H.J., Patel V.L., Hripcsak G., Bates D.W. (2003), Detecting adverse events for patient safety research: a review of current methodologies. Journal of Biomedical Informatics, Feb-Apr, 36(1-2): 131-143. DOI: 10.1016/j.jbi.2003.08.003
  42. Naessens J.M., Campbell C.R., Huddleston J.M., Berg B.P., Lefante J.J., Williams A.R., Culbertson R.A. (2009). A comparison of hospital adverse events identified by three widely used detection methods. International Journal for Quality in Health Care, 21(4): 301-307. DOI: 10.1093/intqhc/mzp027
  43. Naessens J.M., O’Byrne T.J., Johnson M.G., Vansuch M.B., McGlone C.M., Huddleston J.M. (2010). Measuring hospital adverse events: assessing inter-rater reliability and trigger performance of the Global Trigger Tool. International Journal for Quality in Health Care, 7: 266-274. DOI: 10.1093/intqhc/mzq026
  44. Nocco L. (2013). Le novita giurisprudenziali e legislative in tema di danno alla persona, Danno e Responsabilita, 12: 1143-1146.
  45. Nuti S., Tartaglia R., Niccolai F. (a cura di) (2007). Rischio clinico e sicurezza del paziente. Modelli e soluzioni nel contesto internazionale. Bologna: il Mulino.
  46. Penprase B., Elstun L., Ferguson C., Schaper M., Tiller C. (2010). Preoperative communication to improve safety. Nursing Management, 41(11): 18-24; quiz 24-5. DOI: 10.1097/01.NUMA.0000390370.89205.74
  47. Pinkus R.L. (2001). Mistakes as a social construct: an historical approach. Kennedy Institute of Ethics Journal 11(2): 117-33. DOI: 10.1353/ken.2001.0016
  48. Ponzanelli G. (2013a). Non e tanto il danno esistenziale, ma il ‘quantum’ il vero problema del danno non patrimoniale. Danno e responsabilita, 18(2): 135-138.
  49. Ponzanelli G. (2013b). Tabelle, prova del danno e concezione unitaria del danno non patrimoniale. Danno e responsabilita, 18(6): 597-600.
  50. Pronovost P.J., Thompson D.A., Holzmueller C.G., Lubomski L.H., Morlock L.L. (2005). Defining and measuring patient safety. Critical Care Clinics, 21(1): 1-19. DOI: 10.1007/s11606-010-1291-3
  51. Reason J. (2000). Human error. Models and management. British Medical Journal, 320(7237): 768-770. DOI: 10.1136/bmj.320.7237.768
  52. Sari A.B., Sheldon T.A., Cracknell A., Turnbull A., Dobson Y., Grant C., Gray W., Richardson A. (2007). Extent, nature and consequences of adverse events: results of a retrospective casenote review in a large NHS hospital. Quality and Safety in Health Care, 7: 434-439. DOI: 10.1136/qshc.2006.021154
  53. Zegers M., De Bruijne M.C., De Keizer B., Merten H., Groenewegen P.P., Van Der Wal G., Wagner C. (2011a). The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies. Patient Safety in Surgery, 5: 13. DOI: 10.1186/1754-9493-5-13.Disponibilealsito:http://www.pssjournal.com/content/pdf/1754-9493-5-13.pdf
  54. Zegers M., De Bruijne M.C., Spreeuwenberg P., Wagner C., Van Der Wal G., Groenewegen P.P. (2011b). Variation in the rates of adverse events between hospitals and hospital departments. International Journal for Quality in Health Care, 23(2): 126-133. DOI: 10.1093/intqhc/mzq086
  55. Zegers M., De Bruijne M.C., Wagner C., Hoonhout L.H., Waaijman R., Smits M., Hout F.A., Zwann L., Christiaans-Dingelhoff I., Timmermans D.R., Groenewegen P.P., Van Der Wal G. (2009). Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study. Quality and Safety in Health Care, 18(4): 297-302. DOI: 10.1136/qshc.2007.025924
  56. Wilson T., Runciman W.B., Gibber R.W., Harrison B.T., Newby L., Hamilton J.D. (1995). The quality in Australian healthcare study. The Medical Journal of Australia, 163(9): 458-71.
  57. Wilson K.A., Burke CS, Priest HA, Salas E. (2005). Promoting health care safety through training high reliability teams. Quality and Safety in Health Care, 14(4): 303-9. DOI: 10.1136/qshc.2004.010090
  58. Von Laue N.C., Schwappach D.L., Koeck C.M. (2003). The epidemiology of medical errors: a review of the literature. Wien Klin Wochenschr, 115(10): 318-325. DOI: 10.1007/BF03041483
  59. Vincent C. (2000), Presentation at BMJ conference “Reducing Error in Medicine” i cui contenuti sono stati in seguito pubblicati in Vincent C. (2001). Adverse events in British hospitals: preliminary retrospective record review. British Medical Journal, 322(7285): 517-519. DOI: 10.1136/bmj.322.7285.517
  60. Unbeck M., Schildmeijer K., Henriksson P., Jurgensen U., Muren O., Nilsson L., Pukk Harenstam K. (2013). Is detection of adverse events affected by record review methodology? an evaluation of the “Harvard Medical Practice Study” method and the “Global Trigger Tool”. Patient Safety in Surgery, 7(1): 10. DOI: 10.1186/1754-9493-7-10
  61. disponibile al sito Altalex del 18/02/2014 http:// www. lider- lab. sssup. i t / lider/it/odp/inevidenza/461-assicurazione-responsabilita-sanitaria-le-aperture-del-2014-dopo-gli-eventi-difine-2013.html.
  62. Tartaglia R., Matranga C., De Matteis G., Ciampichetti C., Caricati R. (2013), Modalita di segnalazione alla Corte dei Conti – Comitato Tecnico delle Regioni e PP.AA. Sicurezza del Paziente. Tita A. (2014). Assicurazione responsabilita sanitaria: le aperture del 2014, dopo gli eventi di fine 2013,
  63. Tartaglia R., Albolino S., Bellandi T., Bianchini E., Biggeri A., Fabbro G., Bevilacqua L., Dell’Erba A., Privitera G., Sommella L. (2012). Eventi avversi e conseguenze prevenibili: studio retrospettivo in cinque grandi ospedali italiani. Epidemiologia e Prevenzione, 36 (3-4): 151-161.
  64. Soop M., Fryksmark U., Koster M., Haglund B. (2009). The incidence of adverse events in Swedish hospitals: a retrospective medical record review study. International Journal for Quality in Health Care, 21(4): 285-291. DOI: 10.1093/intqhc/mzp025
  65. Silver M.P., Hougland P., Elder S., Haug J., Pritchett T., Donnelly S., Link C.L., Xu W. (2007). Statewide identification of adverse events using retrospective nurse review: methods and outcomes. Jurnal of Nursing Measurement, 15(3): 220-232.
  66. Sharek P.J., Parry G., Goldmann D., Bones K., Hackbarth A., Resar R., Griffin F.A., Rhoda D., Murphy C., Landrigan C.P. (2010). Performance Characteristics of a Methodology to Quantify Adverse Events over Time in Hospitalized Patients. Health Services Research, 46(2): 654-678. DOI: 10.1111/j.1475-6773.2010.01156.x
  67. Semel M.E., Resch S., Haynes A.B., Funk L.M., Bader A., Berry W.R., Weiser T.G., Gawande A.A. (2010). Adopting A Surgical Safety Checklist Could Save Money And Improve The Quality Of Care In U.S. Hospitals. Health Affairs, 29( 9): 1593-1599. DOI: 10.1377/hlthaff.2009.0709

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Milena Vainieri, Elisabetta Flore, Riccardo Tartaglia, Tommaso Bellandi, Analisi comparata dei modelli di gestione dei sinistri in sanità. Prime evidenze empiriche sui costi dei sinistri in "MECOSAN" 92/2014, pp 27-53, DOI: 10.3280/MESA2014-092003