Improving Patient Safety the Danish Way

Richard and Susan had no reason to believe that the doctor treating their child would make a mistake.  Yet, when Anna’s fever showed no signs of reducing, they went in for a second opinion, only to learn that Anna had been given the wrong medication.  It took just two days for Anna’s fever to subside with the new medication, but by then she had missed not only 10 days of school, but also her chance of making the cheerleader team, as she also missed out on the trials.  Looking at a distraught Anna, Susan wanted to file a medical malpractice case against the first doctor, but Richard explained that nothing would come out of it.  The cost of filing and pursuing the lawsuit would be more than the compensation, if any, that they would get.  At this point Anna looked up and said that it might have been better if they were living in New Zealand or Denmark.  Richard and Susan were both surprised at her remark and wanted to know why she felt that way.  Anna opened her laptop and showed them an article about Denmark’s approach to medical errors.

A Different Approach

Denmark has a comprehensive national program in place that compensates patients, who are harmed due to medical negligence or malpractice.  The primary focus of this program is to help patients who have been hurt by the health care system.  The compensation program in turn, makes available all data from these claims to hospitals and researchers.  However, this data is not used for rating healthcare facilities and personnel in the public domain, but allows the system to flag healthcare providers who have repeat errors and thus may pose a risk to the patient and the healthcare system.

Started in 1992, Denmark’s compensation program replaced the lawsuit-based approach, which was similar to the system followed in the US.  A series of high profile court cases, where the patients were unable to get compensation because it was too difficult to prove that the doctor did something wrong, triggered the change in the system.  Following the system used in Norway and Sweden, the Danish parliament took action and adopted the compensation program.  Under this system, medical injury claims are reviewed by medical and legal experts, where patients can participate in the review process and get answers, irrespective of whether they get the monetary compensation or not.  There are no charges for filing a compensation review claim and the patient’s are assigned a caseworker to help them through the process.  The detailed response, which the doctor or hospital have to file, can be rebutted by the patients, who have access to their medical records as well as the detailed explanation of the reviewer’s decision, through an online portal.

In case their claim is rejected, the patient may file an appeal, with no cost to the patient.   The appeal is reviewed by a seven member board comprising of doctors, two representatives of the Danish healthcare system, the patients representative and an attorney.  A patient may also request a district court review, although that has happened in just 2 percent of claims.  In case of medical negligence, a patient can file a report with a parallel system for professional discipline.

One of two criteria is most often applied by reviewers to patient claims of medical injury.  The first of these criteria’s is the “specialist rule” – which compares the treatment provided to that which an experienced specialist would provide.  Compensated if the treatment is found lacking, the patient can also be compensated despite the healthcare provider doing a good job, but not up to the specialist level.  The second criteria commonly applied by reviewers is the “fairness rule” –  where the patient is eligible for a compensation, if the patient has experienced a severe medical event that occurs less than 2 percent of the time.  Data shows that about one third of claims filed, result in compensation, paying out an average of $30,000.

The Advantages of this System

  • Although the average paid out is just about 15% of the average amount awarded in the US, more than 7 times as many claims are filed per capita in Denmark with 4 times as many patient’s per capita receiving some compensation.
  • Although the average compensation amounts may be low, the Government helps in cases of physical disabilities caused due to medical errors, by providing aides to help with the patient’s household chores.
  • Patients do not need to have claims running into millions of dollars.  Even claims of a few thousand dollars are worth filing, as there are no costs for pursuing such claims.
  • Information and compensation is provided to patients regardless of whether negligence is involved, resulting in providers being open about what took place.  This provides incentive for healthcare providers to apologize to patients, while also report errors that might show a pattern of mistakes.
  • About 10 percent of claims filed are by doctors on behalf of their patients.  With no threat of malpractice hanging over their heads, healthcare provides are very helpful to patients who have been harmed.
  • Danish healthcare providers are legally required to inform the patient if they have been harmed during their medical care.  The current system makes it possible for healthcare providers to do so, as there is no fear of being sued for monetary compensation.
  • Data collected and analyzed helps the healthcare providers to understand patterns of errors and take steps to rectify them.  With no threat of being sued or publicly humiliated, healthcare providers are forthcoming in providing data on mistakes committed by them.

The Danish system of pursuing medical claims is not foolproof, but it has resulted in a better and safer healthcare delivery system.  The program costs Denmark far less than the $10 billion that US providers spend on medical malpractice payouts and administrative costs.  The biggest advantage of the system is that patients and healthcare providers see themselves on the same side of the page, thus building a trust between them, which unfortunately is lacking in the US.

Richard and Susan could find no reason to disagree with Anne’s statement – at least in this case of Anne’s medical fiasco.


References

  1. Allen, O. P. (2016, January 03). How Denmark Dumped Medical Malpractice and Improved Patient Safety. Retrieved January 18, 2016, from http://www.truthdig.com: http://www.truthdig.com/report/item/how_denmark_dumped_medical_malpractice_and_improved_patient_safety_20160103
  2. Budryk, Z. (2016, January 11). Medical malpractice overhaul could save millions of dollars and improve patient safety. Retrieved January 18, 2016, from http://www.fiercehealthcare.com: http://www.fiercehealthcare.com/story/medical-malpractice-overhaul-could-save-millions-dollars-and-improve-patien/2016-01-11
  3. Transcript: January 25, 2013. (2013, January 25). Retrieved January 18, 2016, from http://www.pbs.org: http://www.pbs.org/wnet/need-to-know/transcripts-full-episode/transcript-january-25-2013/16159/
  4. Ulrich, A. (1994). An Evaluation of the Danish No-Fault System for Compensating Medical Injuries. Annals of Health Law , 1-40.
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