Although there have been numerous strategies to prevent motor vehicle collisions and their subsequent injuries, few have been effective in preventing motor vehicle injury claims. In this paper, we examine the role of legislation and compensation system in altering injury claim incidence.
The population base for our natural experiment was all Saskatchewan, Manitoba, British Columbia and Quebec residents who submitted personal injury claims to their respective motor vehicle insurance provider from 1990 to 1999. The provinces of Saskatchewan and Manitoba switched from Tort to pure No-Fault insurance on January 1, 1995 and on March 1, 1994 respectively. British Columbia maintained tort insurance and Quebec maintained pure no-fault insurance throughout the entire 10-year period.
The conversion from tort insurance to pure no-fault motor vehicle insurance resulted in a five-year 31% (RR = 0.69; 95% CI 0.68-0.70) reduction in total injury claims per 100,000 residents in Saskatchewan and a five-year 43% (RR = 0.57; 95% CI 0.56-0.58) reduction in Manitoba. At the same time, the province of British Columbia retained tort insurance and had a five-year 5% reduction (RR = 0.95; 95% CI 0.94-0.99). Quebec, which retained pure no-fault throughout the entire 10-year period, had less than one third of the injury claims per 100,000 residents than the tort province of British Columbia.
The conversion from tort to pure no-fault legislation has a large influence in reducing motor vehicle injury claim incidence in Canada. Legislative system and injury compensation scheme have an observable impact on injury claim incidence and can therefore have significant impact on the health care system.
A survey has been carried out of court rulings during the last decade in cases regarding patients' complaints about alleged medical malpractice. The character of the cases is described, both penal code/disciplinary cases and cases regarding compensation. A number of main themes is evaluated: the availability of case records to the patient; the possibility for patients to choose medical advisers; the lessening of the burden on patients to prove that physicians have been negligent; and the relaxation of the burden on patients to prove causality between the injury and the medical treatment given. These main themes are evaluated over time. The investigation should be seen in the light of the fact that Denmark has recently introduced a patient insurance scheme, and the study will be the starting point for a later evaluation of the importance of this scheme, with particular reference to an improvement in patients' rights.
Voluntary insurance for the compensation of patients for damage sustained in health care was introduced in Sweden 20 years ago and similar systems exist in Finland, Denmark and Norway. This type of insurance is, or is in the process of becoming, statutory. The basic principle is that the apportioning of blame to any individual(s) is not a prerequisite for compensation to be paid out for injury sustained by a patient. Owing to hospital proprietors and care givers having taken out patient insurance policies with approved insurance companies, it has been possible for damages to be compensated in accordance with current insurance norms and the frequency of lawsuits arising from injury sustained in health care has been minimised. This type of insurance is universally accepted, and has often enabled unfortunate confrontations between doctors and patients to be avoided.
Injuries sustained by patients in connection with health care or medical treatment in Finland are compensated for as provided in the Patient Injuries Act, which came into force on 1 May 1987. Between 1987 and 2003, a total of 95,411 claims were made to the Finnish Patient Insurance Centre, the body in charge of the claims handling. Every third claim qualified as a patient injury. In my presentation I will focus on examining how the 17 years' claims statistics are used for the prevention of patient injuries and for the improvement of health care quality control. While the Finnish Patient Insurance Centre considers injury prevention as an important issue, the significance of this work has also been widely discussed in public. Injury prevention is a common cause and a goal sought by all providers of health care and medical treatment. This preventive work is clearly linked to the development and management of the policyholders' quality control systems. Successful prevention work requires the creation of feedback systems, cooperation networks and increased interaction to ensure that all parties will be able to participate and commit themselves to the targets. The Finnish Patient Insurance Centre has upgraded information services and increased training e.g. by launching a wide training programme tailored to individual policyholders. By using the experience gained over the years, patient injuries can be prevented. This in turn reduces human suffering and results in increased patient satisfaction in the long run. Taking up issues in the workplace with an open and thorough approach also helps foster a positive workplace climate. From an economical point of view, insurance premiums are thus kept under better control, because premiums charged on public sector policies are fully experience-rated.