School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China.
School of Government, Sun Yat-sen University, Guangzhou, China.
Front Public Health. 2022 Sep 20;10:883822. doi: 10.3389/fpubh.2022.883822. eCollection 2022.
Despite growing evidence focusing on health inequalities in older adults, inequalities in medical compensation compared with younger adults and gender disparities of medical errors among older patients have received little attention. This study aimed to disclose the aforementioned inequalities and examine the disparities in medical errors among older patients.
First, available litigation documents were searched on "China Judgment Online" using keywords including medical errors. Second, we compiled a database with 5,072 disputes. After using systematic random sampling to retain half of the data, we removed 549 unrelated cases. According to the age, we identified 424 and 1,563 cases related to older and younger patients, respectively. Then, we hired two frontline physicians to review the documents and independently judge the medical errors and specialties involved. A third physician further considered the divergent results. Finally, we compared the medical compensation between older and younger groups and medical errors and specialties among older patients.
Older patients experienced different medical errors in divergent specialties. The medical error rate of male older patients was over 4% higher than that of females in the departments of general surgery and emergency. Female older patients were prone to adverse events in respiratory medicine departments and primary care institutes. The incidence of insufficient implementation of consent obligation among male older patients was 5.18% higher than that of females. However, females were more likely to suffer adverse events at the stages of diagnosis, therapy, and surgical operation. The total amount of medical compensation obtained by younger patients was 41.47% higher than that of older patients.
Except for the common medical errors and departments involved, additional attention should be paid to older patients of different genders according to the incidence of medical errors. Setting up the department of geriatrics or specialist hospitals is also an important alternative to improve patient safety for older people. Furthermore, there may be inequality in medical compensation in older patients due to the tort liability law of China.
尽管越来越多的证据集中在老年人中的健康不平等问题上，但与年轻人相比，老年人在医疗补偿方面的不平等以及老年患者的医疗失误性别差异问题却很少受到关注。本研究旨在揭示上述不平等现象，并研究老年患者的医疗失误差异。
首先，我们使用“中国裁判文书网”上的关键词（包括医疗失误）搜索了可用的诉讼文件。其次，我们编制了一个包含 5072 起纠纷的数据库。在使用系统随机抽样保留一半数据后，我们删除了 549 起不相关的案件。根据年龄，我们分别确定了 424 例和 1563 例与老年和年轻患者相关的病例。然后，我们聘请了两名一线医生审查文件，并独立判断医疗失误和涉及的专业。第三位医生进一步考虑了分歧结果。最后，我们比较了老年和年轻组之间的医疗赔偿以及老年患者的医疗失误和专业。
老年患者在不同专业中经历了不同的医疗失误。普通外科和急诊部门的老年男性患者的医疗失误率比女性高 4%以上。呼吸内科和基层医疗机构的老年女性患者更容易发生不良事件。男性老年患者在未充分履行同意义务方面的发生率比女性高 5.18%。然而，女性在诊断、治疗和手术阶段更容易发生不良事件。年轻患者获得的医疗赔偿总额比老年患者高 41.47%。
除了常见的医疗失误和涉及的科室外，还应根据医疗失误的发生率关注不同性别老年患者。此外，设立老年科或专科医院也是提高老年人患者安全的重要替代方案。此外，由于中国的侵权责任法，老年患者的医疗赔偿可能存在不平等现象。
