Sloan F A, Whetten-Goldstein K, Stout E M, Entman S S, Hickson G B
Center for Health Policy, Law and Management, and the Department of Economics, Duke University, Durham, North Carolina 27708, USA.
Obstet Gynecol. 1998 Mar;91(3):437-43. doi: 10.1016/s0029-7844(97)00705-9.
To determine whether Florida's implementation of a no-fault system for birth-related neurologic injuries reduced lawsuits and total spending associated with such injuries, and whether no-fault was more efficient than tort in distributing compensation.
We compared claims and payments before and after implementation of a no-fault system in 1989. Data came from the Department of Insurance's medical malpractice closed claim files and no-fault records. Descriptive statistics were compiled for tort claims before 1989 and for tort and no-fault claims for 1989-1991. We developed two projection approaches to estimate claims and payments after 1989, with and without no-fault. We assessed the program's performance on the basis of comparisons of actual and projected values for 1989-1991.
The number of tort claims for permanent labor-delivery injury and death fell 16-32%. However, when no-fault claims were added to tort claims, total claims frequency rose by 11-38%. Annually, an estimated 479 children suffered birth-related injuries; however, only 13 were compensated under no-fault. Total combined payments to patients and all lawyers did not decrease, but of the total, a much larger portion went to patients. Compensation of patients after plaintiff lawyers' fees rose 4% or 44%, depending on the projection method used. Less than 3% of total payments went to lawyers under no-fault versus 39% under tort.
Some claimants with birth-related injuries were winners, taking home a larger percentage of their awards than their tort counterparts. Lawyers clearly lost under no-fault. Because of the narrow statutory definition, many children with birth-related neurologic injuries did not qualify for coverage.
确定佛罗里达州实施的针对分娩相关神经损伤的无过错赔偿制度是否减少了此类损伤相关的诉讼及总支出，以及无过错赔偿制度在分配赔偿方面是否比侵权责任制度更高效。
我们比较了1989年无过错赔偿制度实施前后的索赔及赔付情况。数据来源于保险部门的医疗事故结案索赔档案和无过错赔偿记录。对1989年之前的侵权索赔以及1989 - 1991年的侵权和无过错索赔进行了描述性统计。我们开发了两种预测方法来估计1989年之后有无无过错赔偿制度情况下的索赔及赔付情况。我们根据1989 - 1991年实际值与预测值的比较来评估该制度的表现。
因分娩永久性损伤和死亡的侵权索赔数量下降了16% - 32%。然而，将无过错索赔与侵权索赔相加后，总索赔频率上升了11% - 38%。每年估计有479名儿童遭受分娩相关损伤；然而，无过错赔偿制度下仅13人获得赔偿。支付给患者和所有律师的总金额并未减少，但其中支付给患者的比例大幅增加。扣除原告律师费后患者获得的赔偿根据所使用的预测方法上升了4%或44%。无过错赔偿制度下支付给律师的金额占总支付金额不到3%，而侵权责任制度下这一比例为39%。
一些分娩相关损伤的索赔者是赢家，他们带回家的赔偿比例高于侵权索赔者。律师在无过错赔偿制度下显然受损。由于法定定义狭窄，许多分娩相关神经损伤的儿童不符合赔偿条件。
