Welling Maiju, Takala Annika
The Finnish Patient Insurance Center, 00084 Vakuutuskeskus, P.O. Box 1, Helsinki, Finland.
University of Helsinki and Helsinki University Hospital, 00029 HUS, P.O. Box 705, Helsinki, Finland.
Patient Saf Surg. 2023 Feb 10;17(1):3. doi: 10.1186/s13037-023-00353-0.
Invasive surgical procedures carry risk of harm to patients. In addition to avoidable harm, disparities between patient expectations and the outcome of a procedure may lead to patient injury claims. The follow-up of claims and compensation is an important entity for patient safety. The number of claims should be related to the surgical volume, so that a healthcare provider can benchmark with similar organizations and see if its trends are developing favourably or deteriorating. Our objective was to find out the claims and compensation rates due to surgery in an insurance-based system.
Data related to surgical claims and reference volume in the period 2011-2015 were collected from the claim register of the Finnish Patient Insurance Centre and benchmarking community register of Finnish operating departments. The data included age, gender, hospital, year of surgery, surgical code, and outcome of the claim.
There were 8,901 claims related to the corresponding reference group of 1,470,435 surgical procedures. The claims rate was 0.61% and compensation rate was 0.22%. Trends for claims and compensation rates decreased over the study period. In high volume procedures, a low compensation rate was detected for excision of tonsils and adenoids, Caesarean section and extracapsular cataract operations using the phacoemulsification technique. A high compensation rate was detected for primary prosthetic replacement of the hip and knee joints and decompression of spinal cord and nerve roots. Unreasonable injury (death or permanent deterioration of health) was compensated in 2.4 per 100,000 procedures.
Register data research in a no-fault patient insurance system revealed a claims rate of 6 per 1,000 procedures and compensation rate of 2 per 1,000 procedures. A decreasing trend in both rates over the study period was detected. Different surgical procedures exhibit varying claims and compensation rates.
侵入性外科手术对患者存在造成伤害的风险。除了可避免的伤害外，患者期望与手术结果之间的差异可能导致患者提出伤害索赔。对索赔和赔偿的跟踪是患者安全的一个重要方面。索赔数量应与手术量相关，以便医疗服务提供者能够与类似机构进行基准对比，了解其趋势是向好还是恶化。我们的目标是在一个基于保险的系统中找出手术导致的索赔和赔偿率。
从芬兰患者保险中心的索赔登记册和芬兰手术科室的基准对比社区登记册中收集了2011 - 2015年期间与手术索赔及参考量相关的数据。数据包括年龄、性别、医院、手术年份、手术编码以及索赔结果。
在1,470,435例手术的相应参考组中，有8,901例索赔。索赔率为0.61%，赔偿率为0.22%。在研究期间，索赔率和赔偿率呈下降趋势。在高手术量的手术中，扁桃体和腺样体切除术、剖宫产以及使用超声乳化技术的白内障囊外摘除术的赔偿率较低。髋关节和膝关节初次假体置换术以及脊髓和神经根减压术的赔偿率较高。每100,000例手术中有2.4例因不合理伤害（死亡或健康永久性恶化）获得赔偿。
在无过错患者保险系统中的登记数据研究显示，每1000例手术的索赔率为6例，赔偿率为2例。在研究期间，这两个比率均呈下降趋势。不同的外科手术表现出不同的索赔率和赔偿率。
