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Education And Debate

Estimating the cost of compensating victims of medical negligence

BMJ 1994; 309 doi: (Published 06 August 1994) Cite this as: BMJ 1994;309:389
  1. P Fenn,
  2. D Hermans,
  3. R Dingwall
  1. School of Management and Finance, Nottingham University, Nottingham NG7 2RD
  2. School of Social Studies, Nottingham University Centre for Socio- Legal Studies, Oxford University, Oxford OX2 6UD
  1. Correspondence to: Professor Fenn.
  • Accepted 18 April 1994

The current system in Britain for compensating victims of medical injury depends on an assessment of negligence. Despite the sporadic pressure on the government to adopt a “no fault” approach, such as exists in Sweden, the negligence system will probably remain for the immediate future. The cost of this system was estimated to be £52.3m for England 1990-1. The problem for the future, however, is one of forecasting accuracy at provider level: too high a guess and current patient care will suffer; too low a guess and future patient care will suffer. The introduction of a mutual insurance scheme may not resolve these difficulties, as someone will have to set the rates. Moreover, the figures indicate that if a no fault scheme was introduced the cost might be four times that of the current system, depending on the type of scheme adopted.

In 1988 in a briefing paper for the King's Fund Institute1 we calculated both the approximate cost of the existing system of claims for medical negligence in Britain and the potential cost of replacing this with a system based on the Swedish model of “no fault.” We had to make assumptions about the extent to which the rate of claims would rise towards that experienced in Sweden, the likely level of payments under the putative scheme, and the costs of administering the scheme. Moreover, we based the estimated costs of the existing negligence system on a small scale postal survey of regional health authorities' solicitors. While the response was good, considerable diversity of approach existed to claims data across the country, and we acknowledged that a more comprehensive survey was needed.

We also acknowledged that the picture obtained at the time from the health authorities alone was in many ways incomplete because of the special position of …

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