MEDICAL IMPLICATIONS AND INSURANCE – The rain of complaints against doctors knocks out the companies

For years, Italy has witnessed a worrying increase in complaints connected with medical malpractice, with important negative repercussions on the expenditure incurred by the National Health Service, on the technical balance of the health liability branch and, ultimately, on doctors and structures. The reasons for the trend of increased risk are well known: the expansion of the definition of the doctor's responsibility, the increase in the amount of compensation and greater litigation. The phenomenon is common to all developed countries but elsewhere (USA, Great Britain, New Zealand, Ireland, France) reform laws have been introduced in the first years of the new century to contain its economic effects.

In Italy, nothing has been done by offloading the burden of a situation that has become unsustainable onto the economic agents. For over a decade, the health insurance branch has been systematically recording huge losses. Between 2001 and 2012 the cost of claims in the class exceeded the premiums collected by an average of 50% in coverage for doctors and 72% in those for facilities. For a large part of the specializations, the costs of coverage for doctors remain affordable (below 1.000 euros for employed doctors) with some peaks for some high-risk freelance activities. The cost of claims for healthcare facilities is substantial: in 2013 this was equal, on average, to 107 euros per hospitalization. Due to the uncertainty of determining the final cost of claims, the insurance offer to cover the risks of medical facilities has gradually become rarefied. Many regions have decided to manage the risk of malpractice by resorting to so-called self-insurance. However, in the absence of adequate funds to cover the future cost of claims (characterized by a long latency) it is already possible to predict the emergence of a new hole in public finance. The policy solutions to be followed to mitigate the impact of the phenomenon should aim at a drastic reduction in claims by intervening on several fronts. In the field of prevention, it would be advisable to prepare measures aimed at spreading a greater culture of risk, encouraging the adoption of risk management protocols in the structures and professionals.

It is also believed by many that the underlying juridical system needs a profound revision starting from a revisiting of the concept of liability, the expansion of which has contributed not a little in recent years to the increase in the costs of medical malpractice. Lastly, to reduce the high degree of uncertainty about the extent of the claims, it would be desirable to introduce limits and standardize non-pecuniary damages, as well as encouraging the use of alternative forms of dispute resolution. The recent Balduzzi law (2012) addresses part of these issues, albeit only on a programmatic level. Almost three years later, the related implementing provision has yet to be issued. In particular, the rule with which the law had established, for the compensation of biological damages, the recourse to the same tables envisaged for the payment of damages consequent to serious injuries in motor liability insurance remains unapplied. Moreover, it is a fulfillment which the insurance sector awaits execution now ten years after its regulatory provision.

The full text of the speech by Dario Focarelli al convention “Healthcare responsibility: problems and prospects” is available on the page: http://www.ania.it/it/pubblicazioni/monografie-ed-interventi/Danni/Responsabilita-sanitaria-e-assicurazioni-proposte-e-criticita-Intervento-Focarelli-19.03.2015.pdf