Abstract
Starting from an extensive database, pooling 9 years of data from the top three insurance brokers in Italy, and containing 38125 reported claims due to alleged cases of medical malpractice, we use an inhomogeneous Poisson process to model the number of medical malpractice claims in Italy. The intensity of the process is allowed to vary over time, and it depends on a set of covariates, like the size of the hospital, the medical department and the complexity of the medical operations performed. We choose the combination medical department by hospital as the unit of analysis. Together with the number of claims, we also model the associated amounts paid by insurance companies, using a two-stage regression model. In particular, we use logistic regression for the probability that a claim is closed with a zero payment, whereas, conditionally on the fact that an amount is strictly positive, we make use of lognormal regression to model it as a function of several covariates. The model produces estimates and forecasts that are relevant to both insurance companies and hospitals, for quality assurance, service improvement and cost reduction.
Highlights
The subject of clinical risk management and patient safety is one of the main critical points in the supply of health services
We focus our attention on the Italian case, where the growing financial restrictions placed on the Italian National Health Service, and the more pressing need for insurance companies to cover specific risks in the health sector are leading to changes in the basic risk management practices, and to the development of new local strategies
For each unit of analysis i, i = 1, . . ., m, with m the number of units, we modeled the number of claims by an inhomogeneous Poisson process whose time-varying intensity function is linearly dependent on a set of covariates
Summary
The subject of clinical risk management and patient safety is one of the main critical points in the supply of health services. We focus our attention on the Italian case, where the growing financial restrictions placed on the Italian National Health Service, and the more pressing need for insurance companies to cover specific risks in the health sector are leading to changes in the basic risk management practices, and to the development of new local strategies. These trends, do PLOS ONE | DOI:10.1371/journal.pone.0153362. These trends, do PLOS ONE | DOI:10.1371/journal.pone.0153362 April 14, 2016
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