Changing experience of adverse medical events in the National Health Service: Comparison of two population surveys in 2001 and 2013

The objective of the study was to examine changes in the frequency and severity of adverse events associated with medical care in Great Britain over a 12-year period during which resources made available by government initially expanded and were subsequently constrained by the consequences of the global financial crash. Data on perceived adverse events arising from health care, collected from two population surveys representative of Great Britain’s general population in 2001 and 2013, were analysed and compared. The samples consisted of 8,202 adults aged 15 and over in 2001 and 19,746 adults aged 15 and over in 2013, and the main outcome measures were self-reported illness, injury or impairment caused in the opinion of the respondent by medical treatment or care. Respondents were also asked about the perceived severity of harm in terms of health and work, and any actions taken in response to perceived harm. The proportion of all respondents reporting that over the last three years they had suffered some illness, injury or impairment that in their opinion was caused by their medical treatment or care was 2.5% (497/19746) in 2013, compared with 4.8% (391/8202) in 2001, a reduction of 33% after adjusting for age, gender, income and social class differences between the two surveys. Perceived impact on health and work of these events was similar in both surveys, as was the proportion of injured respondents who pursued a legal claim for financial compensation, at 11% (53/497) in 2013 and 10.5% (41/391) in 2001. We also report multivariate analyses of perceived harm rates and severity, and propensity to seek, and accept, compensation. The results of these surveys conducted with a 12-year interval suggest that the NHS became significantly safer when measured by patient perceived harm from medical care, after controlling for the impact of demographic and socio-economic change

The Impact of Risk Management Standards on Patient Safety: The Determinants of MRSA Infections in Acute NHS Hospitals, 2001-08

We study a key part of National Health Service (NHS) policy to ensure high-quality health care: failure to supply such care cost the NHS £787m in clinical negligence payouts during 2009–10. The NHS uses risk management standards to incentivize care, and we examine their effects on methicillin resistant Staphylococcus aureus (MRSA) infections. Using a specially assembled data set, ourGMMresults suggest that improvements in the risk management standards attained by some hospitals are correlated with reductions in theirMRSA infection rates. Moreover, the exogeneity of this relationship cannot be rejected for higher risk management levels, suggesting attainment of higher standards was instrumental in reducing infection rates

Legislative History: Joint Order, Recalling LD 268, LD 558 and LD 1813 from the Legislative Files to the Senate (SP680)

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Enterprise liability, risk pooling, and diagnostic care

The safety of patients is an important responsibility of health care providers, and significant compensation costs may arise if providers are negligent. A widely debated option involves liability for such compensation being placed with the hospital rather than the individual clinician, a system known as “enterprise liability.” In the United States, partial adoption of enterprise liability and proposals for its universal introduction have accompanied high-profile “malpractice insurance crises” in the last two decades. Hospitals in England and Wales have been subject to this system since 1990, and risk-pooling arrangements have emerged subsequently allowing hospitals to transfer their liability risk to an agency known as the National Health Service Litigation Authority. We explore some of the mechanisms used by this agency to provide hospital management with financial incentives to take care. We estimate the influence of these arrangements on the use of diagnostic imaging tests within hospitals, using a panel data set covering the period 2000–04, during which period a policy shift took place leading to a form of “natural experiment.” Our results suggest that the use of diagnostic tests did not respond to the incentives created during this period. We speculate that certain types of patient care activity, including the use of diagnostic tests, may be less responsive to incentives placed at the level of the hospital by comparison with incentives placed at the level of the clinician. Our findings may have implications for jurisdictions contemplating a move to enterprise liability as well as wider implications for public-sector organizations faced with financial incentives to improve service quality