Beyond negligence: Avoidability and medical injury compensation
Beyond negligence: Avoidability and medical injury compensation
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DOI：
10.1016/j.socscimed.2007.08.020
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发表时间：
2008-01-01
影响因子：
5.4
通讯作者：
Studdert, David M.
中科院分区：
文献类型：
--
作者：
Kachalia, Allen B.;Mello, Michelle M.;Studdert, David M.
在美国，对侵权制度和过失标准的失望激起了人们对医疗伤害替代赔偿制度的兴趣。一种可能性是试行行政“健康法院”，由专门的裁决人员利用中立的专家作出赔偿决定。赔偿将不是基于过失，而是基于更广泛的可避免医疗伤害（可避免性）标准。尽管对健康法院存在相当大的兴趣，但利益相关者经常对可避免性标准的含义和操作表示不确定。瑞典、丹麦和新西兰这三个国家长期以来一直实行行政管理制度。我们对这些系统中的管理员和涉众进行了采访。我们的目标是就如何运作健康法院，特别是如何制定和应用替代性赔偿标准，如可避免性，获得经验教训。这篇文章报告了我们关于系统的起源和运作的发现，他们的补偿标准的演变，以及这些标准是如何实际应用的。我们发现，这三种制度都有其主要的起源，即确保对受害者的赔偿，而不是制裁提供者。他们都放弃了过失标准。北欧系统使用可避免性标准，主要定义为不会发生在最佳医生手中的伤害。他们的经验表明，这一定义是可行的。新西兰最近向无过错制度的转变，揭示了各种赔偿标准的利弊。成功应用可避免性等替代标准的主要经验教训包括严格遵守国家先例，使用中立和经验丰富的专家，以及阻止将信息从赔偿调查部门例行移交给纪律当局。重要的是，这三个国家都在利用其系统的力量来改善患者安全，而可避免性标准似乎非常适合这项任务。(c) 2007 Elsevier Ltd.版权所有。
Disenchantment with the tort system and negligence standard in the United States is fueling interest in alternate compensation systems for medical injury. One possibility is experimentation with administrative "health courts," through which specialized adjudicators would utilize neutral experts to render compensability determinations. Compensation would be based not on negligence, but rather on a broader avoidable medical injury (avoidability) standard. Although considerable interest in health courts exists, stakeholders frequently express uncertainty about the meaning and operation of an avoidability standard.Three nations-Sweden, Denmark, and New Zealand-have long operated administrative schemes. We conducted interviews with administrators and stakeholders in these systems. Our goal was to garner lessons on how to operate a health court, and specifically, how to develop and apply alternate compensation criteria such as avoidability. This article reports our findings on the origins and operations of the systems, the evolution of their compensation criteria, and how these criteria are actually applied.We found that all three systems had their primary genesis in ensuring compensation for the injured, as opposed to sanctioning providers. All have abandoned the negligence standard. The Nordic systems use an avoidability standard, principally defined as injury that would not occur in the hands of the best practitioner. Their experience demonstrates that this definition is feasible to apply. New Zealand's recent move to a no-fault system sheds light on the benefits and drawbacks of a variety of compensation standards.Key lessons for successfully applying an alternate standard, such as avoidability, include a strict adherence to national precedent, the use of neutral and experienced experts, and a block on routine transfer of information from compensation investigations to disciplinary authorities. Importantly, all three nations are harnessing their systems' power to improve patient safety, and the avoidability standard appears to be well suited for this task. (c) 2007 Elsevier Ltd. All rights reserved.