No-fault System Research Articles

Medico-legal management of healthcare-associated infections: a cost-effectiveness analysis in an Italian tertiary hospital.

Healthcare-associated infections are the main reported adverse event in healthcare, with significant economic costs that include those caused by medical malpractice claims. In Italy, there is a fault-based compensation system, but in this specific field, the burden of proof on the hospitals is particularly heavy. Hence, we aimed to verify the economic impact of the inclusion of experts in hospital infection surveillance into internal committees for claims assessment and to evaluate what would have been the economic impact of a mandatory no-fault system rather than the current system. We compared two 4-year periods (T1: 2015-2018 and T2: 2019-2022), investigating the medical malpractice claims related to healthcare-associated infections in a large tertiary public hospital in Florence, Italy. Decisions of the internal committee, evolutions of the claims after the decision, and conclusions of the claims were registered. No-fault system simulations were used to evaluate the cost-effectiveness of the model. We observed a decrease in the number of claims after the implementation of infection prevention and control (IPC) experts into the committee (a 24% decrease in rejections and a 19% increase in admissions). We found a 6806.98 euros difference (not statistically significant) in compensations in T1 and T2. Moreover, our simulations found that a no-fault compensation system - if alternative to the traditional fault-based approach - could lead to gains or losses for the plaintiffs depending on the approach chosen. (We observed a 52% mean decrease in compensations with a 150000 euros maximal indemnity and a 134% mean increase with an indemnity tailored considering also life expectancy). Introducing experts in IPC into hospital committees for medico-legal claims management has proven to be cost-effective, offering a no-fault compensation system as an alternative to the traditional fault-based approach, supported by a properly evaluated maximal indemnity. Due to the limitations of our models, multicentric studies are recommended to verify our results.

Examining the Law Governing Divorce and Sharing of Property in Uganda

This article examines the legal framework governing divorce and property distribution in Uganda, revealing that children's rights are often compromised during divorce proceedings. Despite constitutional guarantees ensuring children the right to know and be cared for by their parents, these rights are frequently overlooked. The article advocates for the adoption of a no-fault divorce system, suggesting that the sole ground for divorce should be the irretrievable breakdown of the marriage. This approach would eliminate discriminatory grounds for divorce, focusing instead on the spouses' inability to continue living together. Moreover, the government has a responsibility to create a conducive environment for the introduction and enforcement of new laws that uphold these principles. This includes recognizing and promoting women's rights to equal treatment and legal protection. The article further calls on the Ugandan legislature to develop a divorce law that addresses the rights of women and ensures a balanced approach to the needs of both parties during the dissolution of marriage. It proposes the repeal of the current Divorce Act (Cap 249) in favor of new legislation that better safeguards women's rights. Keywords: Children, Divorce, Legal framework, Sharing property, Spouses

자율주행자동차 상용화에 대비한 자동차보험제도 연구

On May 7, 2016, in the state of Florida, USA, a fatal accident occurred involving an autonomous vehicle and a large truck, leading to the death of the driver. This incident heightened interest in autonomous vehicles and sparked discussions on their implications, including the challenges and liability issues in the event of accidents during autonomous operation. The application of existing legal frameworks, such as Article 750 of the Civil Code on tort liability and Article 3 of the Automobile Damage Compensation Guarantee Act on operator liability, to accidents involving autonomous vehicles raises questions about identifying responsible parties and compensating victims. This study examines the applicability of these legal principles to accidents occurring during autonomous driving and proposes the introduction of a No-Fault insurance system as a novel automotive insurance mechanism to address these issues. The analysis revealed that the No-Fault insurance system, a solution to the problems posed by the current fault-based liability system and already implemented in several advanced countries since the early 2000s, was considered but ultimately not adopted in South Korea due to challenges in amending existing legislation, limitations in calculating insurance rates, and concerns over moral hazard, among other issues. However, as autonomous vehicles are poised to integrate into our lives more rapidly than anticipated, and the social concerns regarding traffic accidents during autonomous operation deepen, it is imperative to form a task force comprising the Ministry of Land, Infrastructure, and Transport, the Financial Supervisory Service, the General Insurance Association, among others, before it's too late. This task force should engage in research and discussions, while building a consensus among the public, to prepare for the new automotive market driven by the autonomous vehicle industry.

Sole Custody and The Implication of Fault-based Divorce Under the Indonesian Legal System

This study analyses the reasons why most judges in Indonesia’s religious courts tend to rule in favour of the sole custody model over the joint custody model following a divorce, even though the state, through the Child Protection Act, has enacted regulations emphasizing the granting of child custody using the joint custody model. This study is an evaluative review of the dominant sole custody model decided in the Religious Court concerning the Indonesian divorce law system, which emphasizes that divorce must be filed for a reason. The study results show that the divorce law requiring divorce to be accompanied by a reason and adopted by the Religious Court makes Indonesia a country that adopts a fault-based divorce system. This impacts the contestation and efforts of one party to find fault with the other party through the proof process in the Religious Court. Furthermore, to show that one party is better and more moral, there is a struggle for child custody rights while affirming the presumption that the party winning child custody is the better and more moral party. This means that child custody is always given to one party, not to both parties. The Religious Court needs to consider the use of a no-fault divorce system for several reasons: (1) Islamic jurisprudence recognizes no-fault divorce, namely, divorce with khuluk (khul’), and (2) efforts not to defame the couple in court are more in line with Islamic teachings.

보상제도의 선호도 분석을 통한 현행 보험제도의 한계점과 개선방안

This study aims to investigate the relationship and preference regarding satisfaction with the compensation process under the current liability insurance system among 500 car drivers who have experienced automobile accidents in the last five years. It also seeks to identify the limitations of South Korea's current insurance system based on a survey of perceptions towards the system and to propose improvements. Firstly, the attribute of safe driving had a significant negative (-) impact on cost satisfaction within insurance processing satisfaction. Insurance attributes had a significant positive (+) impact on satisfaction with adjudication fairness, cost satisfaction, and procedural satisfaction. However, accident attributes had no significant impact on satisfaction with adjudication fairness, cost satisfaction, or procedural satisfaction. Secondly, the biggest complaint in determining compensation was 'fault determination' (36%), with 'filing complaints against insurance companies' (15.8%) being the most cited method for handling dissatisfaction with traffic accidents, and 'mutual fault processing' (37%) as the main issue with fault determination. Among respondents, 13.6% had experience with litigation due to traffic accidents, 70.8% pointed out equity issues between offenders and victims in handling traffic accidents, and 78.8% indicated problems with fault determination. Therefore, it is expected that the implementation of a no-fault insurance system, which would alleviate the burden of proof of fault from all citizens and allow for rapid compensation without the need for litigation, would increase compensation satisfaction among insurance consumers in the event of traffic accidents. This would also reduce disputes between victims and offenders, thereby enhancing the stability of the insurance system through swift compensation. Additionally, it is anticipated that unnecessary complaints due to fault disputes and the unnecessary costs incurred by victims in hiring loss adjusters or lawyers would decrease.

Exploring Digital Health Horizons: A Narrative Review of E-Health Innovations in Poland, Spain, Romania and Estonia.

E-health offers new opportunities for self-management, health and social care and access to health information. Over the last decade, the use of e-health solutions by patients, healthcare providers, professionals and citizens has increased significantly. This article provides an overview of e-health innovations in Poland, Spain, Romania and Estonia, focussing on the digital development of healthcare services. It outlines the concept of e-health and the innovative solutions the countries listed have introduced in this area. They all face challenges such as the cost of implementing new technologies, data access and the security of patient data. As a result, there is a constant need for coordinated collaboration, legislation and clear guidelines for the use of technology in healthcare. The lessons learnt from these countries are helping to shape the digital future of healthcare in Europe. In Poland, the Ministry of Health oversees the eHealth Centre, which has made remarkable progress in the field of eHealth services such as the Internet patient account, electronic prescriptions and electronic referrals. The biggest challenges include financing innovation and improving digital skills. Poland has also recently introduced the no-fault system as an alternative compensation system for medical errors, modelled on similar systems in Denmark and Sweden. Technological progress is driving the transformation of the Spanish healthcare system, which is particularly evident in the area of telemedicine and innovative healthcare systems. The Spanish Digital Health Strategy lines up with broader national initiatives. Despite challenges such as underfunding, Romania has introduced digital healthcare with the Health Electronic Record since 2014. As an absolute pioneer in the digitalisation of healthcare in Europe, Estonia is proud of its achievements in the digitalisation of healthcare data and services. The Estonian eHealth Foundation and the nationwide health information system are an example of seamless integration and set a benchmark for comprehensive digital healthcare.

Obstructing the Right to Divorce Freedom? Comparison of Divorce Barriers in the UK And China

The decision to establish a cooling-off period for divorce in China has sparked widespread discussion in society. Through historical research on China’s divorce system, it has been found that the barriers to divorce in China are constantly increasing. The comparison of the barriers to divorce between China and the UK highlights the differences in legislation and judicial practices that affect the freedom of divorce between the two countries. Intervention measures such as the fault divorce system and the cooling-off period for divorce indicate that China’s divorce barriers are increasing; In contrast, the UK has shifted towards a no-fault divorce system, providing more freedom for individual divorce. Despite these changes, the difficulty of divorce in China is lower than in the UK.

Clinical negligence: should the NHS consider a no-fault system?

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, considers recent discussions and recommendations to review the current compensation scheme.

Manipulating Auto-Insurance Systems to Minimize Car Accident Rates Among U.S. Teens

This paper explores various auto insurance systems and their impact on teenage driving behaviors and crash rates. The manipulation of auto insurance systems can be effective in minimizing car accident rates among teenage drivers in the United States. Auto insurance systems encompass the regulations governing insurance coverage for motor vehicles, influencing driving behaviors through incentives, penalties, and risk perceptions. The primary auto insurance systems in the U.S. are fault-based, no-fault, add-on, and choice-based systems, each with distinct implications for driving behaviors and road safety. The leading cause of death for teenagers in the U.S. is car accidents, underscoring the urgency of implementing effective strategies to mitigate crash risk among this demographic. The literature review details the factors influencing crash risk among teenagers by highlighting behavioral science theories, and the factors contributing to elevated crash risk among teenage drivers. A meta-analysis was conducted, revealing correlations between insurance system types, driving behaviors, and crash rates among teenagers. Findings suggest that fault-based auto insurance systems, due to their tort liability principles, are the most effective auto insurance systems in promoting safe driving habits among teenage drivers. The fault-based system increases accountability, mitigates moral hazard, and incentivizes cautious driving practices, thereby reducing crash rates. This research provides compelling evidence supporting the adoption of fault-based insurance systems as a critical measure to minimize car accidents among teenage drivers in the United States.

NetballSmart, Implementation of a National Injury Prevention Program

Reducing lower-limb injuries in netball, particularly anterior cruciate ligament injuries, is a priority. The Accident Compensation Corporation (a no-fault national insurance system) partnered with Netball New Zealand to create the “NetballSmart” injury prevention program. Targeted research informed the successful implementation, dissemination, and adoption of the injury prevention program. Research included a nationwide epidemiological study, video analysis investigating netball injury risk maneuvers, and intervention studies exploring the effectiveness of injury prevention program warm-up resources on physical capability in youth netball. An identified spike in ankle-knee injury incidence of school-age netball players at season start and prior to tournaments along with a high overall prevalence within these ages led to the creation of age-specific educational workshops and resources focused on effective preparation, skill transition, strengthening, and balance. Observational video analysis highlighted behaviors that potentially increased the risk of anterior cruciate ligament injury and a progressive landing skills program was developed. The NetballSmart Dynamic Warm-up and Power Warm-up significantly improved player physical capability. Consequently, time to perform the Power Warm-up before all games at a national intermediate school tournament was incorporated into competition-time, reducing workload by 25%. A targeted social media and ambassador endorsement plan increased performance of the NetballSmart Dynamic Warm-up/Power Warm-up by 14% prior to games and 15% before trainings nationally. Accident Compensation Corporation injury data between 2018 and 2022 showed a 6,050 (32%) reduction of all body site and a 2,968 (33%) decrease of combined ankle-knee injury claims. Similarly, by 2021 there was a 11% decrease in fractures/dislocations, a 13% decrease in soft tissue injuries, and a 9% decrease in anterior cruciate ligament surgical repairs. During this delivery period, Accident Compensation Corporation reported that the whole of life returns on investment was NZD$4.10, for every dollar funded to the NetballSmart Injury Prevention Programme.

Comparisons Between Macedonian and A U.S. State’s Automobile Accident Insurance Law

Abstract This paper explores some of the basic similarities and differences between fault-based and no-fault systems of automobile accident insurance from the perspective of a U.S. state and the laws of Macedonia. The majorities of U.S. states have adopted an at-fault system of compensation and therefore share more similarities with Macedonia than the laws of a dozen U.S. states that have adopted a no-fault system. Whereas Macedonia employs a system of nearly universal health care, such is not the case in the United States. The respective states have adopted either a fault-based system or a no-fault system, but in either case issues of coverage for automobile accidents is more complicated for the lack of a nationalized health care system that at minimum acts as a safety net for treatment of injuries related to automobile accidents. It is posited that complications relating to the lack of universal health care coverage in the United States has led to significantly heightened regulatory intervention by the several states such that the similarities between the free-market approach of the states and of civil law (code) systems are greater than the differences. The paper is not based on empirical data of the legal systems or the medical systems, nor is the undeniable interrelation between a medical system and the corresponding legal system with regard to insurance coverage of primarily health-based issues considered other than to highlight how both may play a part in regulation of the automobile accident insurance industry in light the involvement of public health, safety and welfare.

The Impact of Medical Malpractice on the Patient’s Rights in the Context of South Africa

The vast majority of accidents that take place in clinical settings are the direct consequence of unavoidable mistakes made by individuals operating within the confines of dysfunctional institutions. An increase in patient safety is the result of healthcare professionals' efforts to encourage blameless reporting and organisational learning. The fault-based civil liability law that inhibits more open discussion between physicians and patients about medical conditions is in opposition with this because of the aforementioned reason. When there is no universally accepted definition of the phrase medical error, litigation and, as a consequence, providing fast and sufficient financial compensation to patients may be rendered more difficult. In this aspect, the performance of no-fault systems is much superior. A dual-track liability system for medical malpractice may be the only option that may sufficiently safeguard patient rights. Despite the fact that it is complicated to create and difficult to administer, this system may be the only one. The objective of the study was to investigate the ways in which patients' legal rights might be affected by substandard medical treatment. In this study, a qualitative research approach was adopted, and primary and secondary sources of information were consulted. The most significant conclusions from this study related to the significance of patients' rights being affected by medical malpractice. Patients are the ones who end up being victims of such practises, thus it makes sense that patients would be affected by such practises. It is for this reason that a high-quality health care system is desired, since it will both extend and improve the rights of patients.

Outpatient Spine Surgery in Poland: A Survey on Popularity, Challenges, and Future Perspectives.

This study aimed to investigate the popularity of outpatient spine surgery in Poland, identify factors influencing its adoption, and assess its benefits, challenges, and impact on patient outcomes and healthcare costs. Additionally, the study proposes strategies to improve outpatient spine surgery adoption and ensure its safe implementation in Poland. An electronic survey was distributed to members of the Polish Spine Surgery Society and the Polish Neurosurgery Society. Data were analyzed using Matlab R2020b statistical software, employing descriptive statistics to summarize the responses. The survey indicated that 67% of respondents provide spinal procedures commercially, with 58% performing them on an outpatient basis, showing the growing role of the private sector in providing spinal surgery services in Poland. Root nerve blocks and joint blocks were the most common outpatient procedures, followed by microdiscectomy, endoscopic discectomy, and L-S spinal fusion. The public NHF was the most common payer for outpatient procedures. Outpatient spine surgery in Poland is not yet widespread, but improvements can be made to reduce hospital stays and enhance recovery. Changes in reimbursement systems to cover outpatient procedures and addressing physicians' liability concerns, particularly by emphasizing the NO-fault system, are essential. With proper support, outpatient spine surgery could become a valuable addition to Poland's healthcare system.

Patterns of malpractice claims and compensation after surgical procedures: a retrospective analysis of 8,901 claims from the Finnish patient insurance registry

BackgroundInvasive 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.MethodsData 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.ResultsThere 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.ConclusionsRegister 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.

No-Fault Auto Insurance Reform in Michigan: An Initial Assessment

When Michigan instituted no-fault auto insurance in 1973, its proponents argued that it would be a more efficient and less costly system for administering auto insurance claims than tort liability. Unfortunately, the opposite eventually proved to be true. Michigan’s system was unique among states because it provided unlimited no-fault medical benefits, and insurers were severely constrained in their ability to control medical costs. By 2019, Michigan’s auto insurance claim costs and premiums were the highest in the nation. This motivated the state’s legislature and governor to significantly reform its no-fault law and tighten its regulation of auto insurance. While these reforms and regulatory changes are relatively nascent, there is considerable interest in knowing their effects, including the consequences of allowing consumers to choose their level of no-fault coverage, instituting medical cost controls for no-fault coverage, and tightening the regulation of insurance companies. In this paper, we evaluate the no-fault reforms and their impacts. We find some initial evidence that claims costs and premiums for many drivers decreased substantially due to the reforms. However, medical providers and trial attorneys are advocating for legislation that tempers the cost controls, arguing that they are too harsh and arbitrary and that the adequacy and quality of care received by auto accident victims have suffered as a result. Fundamentally, there is the issue of whether it is possible to design a no-fault system that is superior to tort liability and is fair to all of a state’s residents in terms of the benefits it provides and its premium costs. Michigan could be viewed as an experiment on both the promises and pitfalls of a grand vision for no-fault auto insurance. Our paper contributes to an important debate on whether no-fault auto insurance can be saved and if it is worth saving.

Divorce Law in Kenya: In Support of a Uniform No-Fault Regime

In 2014, Kenya enacted the Marriage Act to amend and consolidate various laws on marriage and divorce. Among the amendments introduced was the irretrievable breakdown ground of divorce alongside more traditional fault-based grounds. The court in CWL v HN noted that the introduction of this ground had effectively done away with the need for petitioners to provide evidence of matrimonial fault in divorce proceedings. Despite this, the Act still maintains traditional fault grounds for divorce not only as independent grounds but also as factors to be considered when determining whether a marriage has irretrievably broken down. The author contends that this retention of fault-based requirements reflects an outdated position and contradicts the thinking behind the introduction of irretrievable breakdown as a divorce ground. This study, therefore, proposes adopting a uniform no-fault divorce system premised on irretrievable breakdown. To better align this system with the dual objective of protecting individual dignity while also safeguarding the dignity and sanctity of marriage, the study proposes a model that includes a mandatory requirement to attempt reconciliation before petitioning for divorce.

A survey of specialty choice among obstetrics and gynecology residents in Japan, Korea, and Taiwan.

The percentage of medicine graduates opting for residency in obstetrics and gynecology (OB/GYN) has been decreasing in developed countries, including in Taiwan, Japan, and Korea. This multicountry study surveyed the OB/GYN residents affiliated with the Taiwan Association of Obstetrics and Gynecology (TAOG), the Japanese Society of Obstetrics and Gynecology (JSOG), and the Korean Society of Obstetrics and Gynecology (KSOG) to evaluate the factors affecting the choice of pursing OB/GYN. A 17-item questionnaire surveying the factors influencing the choice of pursuing a major medical specialty was translated into Japanese, Korean, and Chinese and administered to postgraduate OB/GYN residents between July 1, 2020, and August 31, 2020. Data on the participants' sex, age, and level of residency were collected. Responses were compared between countries and sexes. Residents of all three countries chose OB/GYN based on personal interest, and a sense of accomplishment in saving people's life. Other positive factors include improved quality of life; higher salaries; and more opportunity for new techniques, research, and promotion. The negative factors included medical litigations, longer work hours, and unsafe working environments. Korean residents had lower ratings in several items, including "support from family," "safety of working environment," and "effectiveness of the alternative dispute resolution system," which, unlike Japan and Taiwan, is not a no-fault compensation system for childbirth accidents. The study findings can guide strategy making, such as decreasing workload and yet maintain training quality, to increase the number of medical students pursuing OB/GYN residency.

Response to the Letter to the Editor.

We thank Dr. calder for her response on behalf of the canadian Medical Protective Association (CMPA) to our article (Lee et al. 2021), and we appreciate the opportunity to address her comments. Dr. Calder claims that we did not undertake a full systematic review. Systematic reviews are distinct research undertakings beyond the objective of this manuscript. Importantly, bias and conflict of interest need to be avoided, and we propose that an organization with a vested interest in the topic is not the appropriate author of such a systematic review. If indeed CMPA has literature that supports their case, we ask them to release such information for critical review. Dr. Calder also critiques our article on the grounds that no-fault compensation would not improve patient safety. We disagree. Countries such as New Zealand and Sweden have had no-fault systems, which do not compromise patient safety, in place for over 40 years, and provide a model for how Canada can do this.

A Framework for Understanding How Variation in Health Care Service Delivery Affects Work Disability Management.

Introduction Differences in disability duration after work injury have been observed across jurisdictions, regions and urban and rural settings. A key aspect of effective disability management is the access and utilization of appropriate and high quality health care. This paper presents a framework for analyzing and thus understanding how health service spending and utilization vary across and within work disability management schemes and affect work disability management. Methods Our framework was developed through a literature review and policy analysis. Existing frameworks describing geographic variation in general health care systems identified factors believed to drive that variation. A review of policy and practice documents from Canada's no-fault cause-based work disability management system identified factors relevant to work disability systems. Results We expand on previous frameworks by taking a systems approach that centers on factors relevant to the work disability management system. We further highlight predisposing, enabling, workplace environment and need-based factors that could lead to variation in health care spending and utilization across and within jurisdictions. These factors are described as shaping the interactions between workers, health care providers, employers and work disability management system actors, and influencing work disability management health and employment outcomes. Conclusion Our systems-focused approach offers a guide for researchers and policymakers to analyze how various factors may influence spending and utilization across regions and to identify areas for improvement in health care delivery within work disability management systems. Next steps include testing the framework in an analysis looking at geographic variation in spending and utilization across and within Canadian work disability management systems.

How defensive medicine is defined in European medical literature: a systematic review

ObjectivesDefensive medicine has originally been defined as motivated by fear of malpractice litigation. However, the term is frequently used in Europe where most countries have a no-fault malpractice system. The...