at health, social and social-medical establishments in france

OVERVIEW OF
THE RISKS
AT HEALTH, SOCIAL AND
SOCIAL-MEDICAL
ESTABLISHMENTS IN FRANCE
REVIEW OF THE RISKS ENCOUNTERED
IN 2014
2015 UPDATE
CONTENTS
01. Objectifs and scope of the overview…………...……………… 3
02. How CL claims have evolved and are managed at French
health establishments…………………………………………………… 7
03. Claims figures for the French healthcare professionals…..… 24
04. How claims have evolved and are managed at French
social and medical –social establishments…………………………. 26
05. Personnel risks in French hospitals……………………………….. 28
06. New challenges…….…………………………………………….… 33
2
01
OBJECTIVES &
SCOPE OF THE OVERVIEW
3
OBJECTIVES
Objectives of the Sham risk overview
Provide information regarding how the main risks have evolved at
health, social and medical-social establishments and for the
healthcare profession: accident causes, follow-up of patient claims,
personnel risks.
Heighten awareness about the risks involved in the activity of
establishments and the healthcare profession, with concrete
examples.
Encourage risk prevention based on observations and
recommendations made during on-site risk visits.
4
SCOPE
Sham, No. 1 medical civil liability insurer in France with a 50% market share.
Sham insurers 9,467 members:
- 4,918 establishments, i.e. health, social and medical-social establishments
=> more than 60% of MCO* beds in France, with 70% of public health
establishments and 30% of private health establishments
- and 4,549 individuals (85% private and mixed practitioners vs 15% salaried
practitioners)
=> 50% market share among private gynaecologists/obstetricians and 7% among
private surgeons
Sham insurers 2 out of 3 childbirth deliveries in France
3,500 social and medical-social structures and close to 1,500 directors.
The 2015 Overview has been put together based on the analysis of 14,366 CL
claims against French health, social and medical-social establishments
- 12,546 at health establishments
- and 1,820 at SMS establishments
*MCO: Medicine - Surgery - Obstetrics
5
SCOPE – A CLOSER LOOK AT PERSONNEL RISKS
Sofaxis, specialised in the management of risks to the protection of personnel
employed in the FPH* and FPT* in France
Sofaxis insurers 1 in every 3 public establishments (health, social and medicalsocial)
The findings presented in the 2015 Overview relate to:
- 140,000 civil servants signed up to the CNRACL* (73% health / 27% SMS)
- across 911 establishments covered against all types of leave
(26% health / 74% SMS)
*FPH: public hospitals
FPT: local and regional civil service
CNRACL: national pension scheme for local authority civil servants
6
02
HOW CL CLAIMS HAVE
EVOLVED AND ARE
MANAGED AT FRENCH
HEALTH ESTABLISHMENTS
7
MANAGEMENT OF A CLAIM
CLAIMS
PROCEDURES
CCI (arbitration &
Amicable
Disputes
compensation board)
- Medical-legal analysis
- Opinion/Decision
Compensation
No compensation
20% to 30% of the medical civil liability claims filed with Sham lead to
compensation
8
INCREASE IN MEDICAL CIVIL LIABILITY CLAIMS
FREQUENCY INDEX
AAGR: +4.9% June
1998 – June 2015
AAGR: Annual average growth rate
The frequency index has doubled in the space of 16 years.
9
JUNE 15
JUNE 14
JUNE 13
JUNE 12
JUNE 11
JUNE 10
JUNE 09
JUNE 08
JUNE 07
JUNE 06
JUNE 05
JUNE 04
JUNE 03
JUNE 02
JUNE 01
JUNE 00
JUNE 99
JUNE 98
AAGR: +7% June
2010 – June 2015
BREAKDOWN OF CLAIMS RECEIVED BY HEALTH
ESTABLISHMENTS IN 2014
CLAIMS RELATING TO PHYSICAL INJURY OR MATERIAL DAMAGE
Physical
injury
46.4%
Physical
injury
98.1%
Cost
€205.7m
Number
12,546
Material
damage
53.6%
Claims relating to physical injury account for the largest proportion
of civil liability claims costs incurred by health establishments.
10
Material
damage
1.9%
PHYSICAL INJURY CLAIMS RECEIVED IN 2014
PHYSICAL INJURY CLAIMS BY TYPE OF CAUSE
Medical causes
92.2%
Medical causes
88%
Number
5,819
Other
1.4%
Hospital
routines
7.6%
Medical devices and
healthcare products
3%
Cost
€201.8m
Other
1.2%
Most of the claims were related to the core activity of the
establishments.
11
Hospital
routines
4.3%
Medical devices and
healthcare products
2.3%
CLAIMS RELATING TO PHYSICAL INJURY WITH MEDICAL CAUSES
RECEIVED IN 2014
CLAIMS RELATING TO ACCIDENTS LINKED TO MEDICAL MALPRACTICE
Care
50.2%
Infection
16.9%
Diagnosis
12.6%
Number
5,118
Half of claims
linked to care
Intubation
8.5%
Anaesthesia
3.7%
Misc.
0.9%
Prescription
1.2%
Diagnosis examination
1.2%
Procreation, obstetrics
3.6%
Information,
consent
1.2%
Medical and paramedical care account for the majority of claims
12
MANAGEMENT OF A CLAIM
CLAIMS
PROCEDURES
CCI (arbitration &
compensation board)
Amicable
Disputes
- Medical-legal analysis
- Opinion/Decision
Compensation
13
No compensation
FOCUS ON CASES BROUGHT BEFORE THE CCI
Increase in the number of claims brought before the CCI
concerning healthcare establishments covered by Sham
2,130
2,147
2,138
2,134
2,172
1,782
1,789
1,799
1,279
The increase in the number of cases brought before the CCI
has remained steady
14
2,130 claims
brought
before the
CCI in 2014
FOCUS ON CASES BROUGHT BEFORE THE CCI
Trend in the proportion of claims brought before the CCI
63.4%
36.6%
38.7%
42%
41%
38%
35%
32%
32%
26%
The number of
cases brought
before the CCI
has remained
stable in recent
years
61.3%
58%
59%
62%
65%
68%
68%
Other claims
channels
74%
Cases brought before
the CCI
A third of the claims presented by the establishments go though
the CCI
15
BASES FOR THE OPINIONS ISSUED BY THE CCI IN 2014
No malpractice
or hazard
36.7%
Rejection (not
competent,
inadmissible)
30.9%
Sham
15.8%
Other
1.6%
Shared CL
2.3%
Compensation
by ONIAM
12.7%
18.1% of the opinions issued by the CCI provide for compensation
(in full or part) by Sham (versus 18.8% in 2013).
16
18.1%
MANAGEMENT OF A CLAIM
CLAIMS
PROCEDURES
CCI (arbitration &
compensation board)
Amicable
Disputes
- Medical-legal analysis
- Opinion/Decision
Compensation
17
No compensation
DISPUTED CLAIMS IN 2014
Number of decisions made by administrative
and judicial courts
Breakdown of decisions made by
administrative and judicial courts
1,110
1,096
1,111
Liable
57.2%
1,074
1,021
Non-liable
42.8%
Non-liable
Liable
The number of decisions in which establishments are deemed
liable (635) exceeds those in which they are cleared of
responsibility (475), confirming the trend observed since 2012.
18
MANAGEMENT OF A CLAIM
CLAIMS
PROCEDURES
CCI (arbitration &
compensation board)
Amicable
Disputes
- Medical-legal analysis
- Opinion/Decision
Compensation
19
No compensation
CLOSED CASES RELATING TO PHYSICAL AND MATERIAL DAMAGE
Rejection of amicable
claim, no further
proceedings
53.1%
Amicable settlements
40%
40% of the cases
closed in 2014 were
settled amicably
Litigation
with liability
3.8%
Litigation
With no liability
3.1%
Half of the cases closed did not result in any compensation
Less than 7% of the cases were closed after a litigation procedure
20
COST OF ORDERS TO PAY COMPENSATION
Average cost (in euros) of orders issued by
administrative courts as at 31 December in
the year of the decision
Breakdown of decisions handed down by
administrative courts
272,845
256,746
164,728
Liable
55.9%
195,130
194,010
232,439
178,600
179,000
218,200
180,800
133,000
The average cost of orders to pay compensation remains very high
21
Non-liable
44.1%
SETTLEMENTS IN 2014
METHOD OF COMPENSATION FOR CLOSED CLAIMS IN RELATION TO
PHYSICAL INJURY OR MATERIAL DAMAGE
5,056 settlements worth less than €15,000
704 settlements of more than €15,000
Amicable
settlements
90.1%
Amicable
settlements
50.7%
Disputed
settlements
9.9%
Disputed
settlements
49.3%
For the first time, the number of claims for large amounts settled amicably has
exceeded the number of disputed cases
22
SETTLEMENT TIMES FOR PHYSICAL INJURY CLAIMS
Average settlement times:
Amicable: 11 months
CCI: 1 year and 7 months
Disputed claims: 3 years and 6 months
23
03
CLAIMS FIGURES FOR
THE FRENCH
HEALTHCARE
PROFESSIONALS
24
FOCUS ON THE FRENCH HEALTHCARE PROFESSIONALS: 418 CLAIMS
PHYSICAL INJURY CLAIMS AGAINST HEALTH PRACTITIONERS
OPERATING IN PRIVATE PRACTICES
Breakdown in terms of number
Surgery
65%
Obstretics
25%
Breakdown in terms of cost
Obstretics
56%
Surgery
39%
Medicine
and other
10%
Medicine and other
5%
Surgery is the specialist field that accounts for the highest number
of claims against health practitioners, while obstetrics is the most
costly
25
04
HOW CLAIMS HAVE
EVOLVED AND ARE
MANAGED AT FRENCH
SOCIAL AND MEDICALSOCIAL ESTABLISHMENTS
26
FOCUS ON FRENCH SMS ESTABLISHMENTS: 1,820 CLAIMS
CLAIMS AGAINST SOCIAL AND MEDICAL-SOCIAL ESTABLISHMENTS
Breakdown in terms of number
Breakdown in terms of cost
Material
damage
94.9%
Physical
injury
5.1%
Most of the claims relate to material damage often to items of
everyday life
27
Physical
injury
66.5%
Material
damage
33.5%
05
PERSONNEL RISKS IN
FRENCH HOSPITALS
28
FOCUS ON PERSONNEL RISKS: MEASUREMENT OF LEAVE
FROM WORK FOR HEALTH-RELATED REASONS
RATE OF ABSENTEEISM: 12.9% in 2014
Breakdown by nature of the absence:
Nature of absence
Rate of absenteeism
Ordinary illness
5.8
Long illness 1/long-term
3.9
Maternity
1.7
Accident in the workplace
1.5
TOTAL
Ordinary illness
45%
12.9
Long illness/
Long-term
30%
Maternity
13%
Accident in the
workplace
12%
29
Leave volumes have risen by 19% across all types of leave
(accidents in the workplace, ordinary illness, long illness/long
term), resulting in a steady increase in the overall absentee rate in
the past five years.
FOCUS ON PERSONNEL RISKS: MEASUREMENT OF HEALTHRELATED ABSENCES FROM WORK
FREQUENCY: 72 periods of leave for 100 members of personnel
employed in 2014
Breakdown by nature of leave:
Ordinary illness
76%
Accident in the
workplace
10%
Long illness/
Long-term
7%
Maternity
7%
30
FOCUS ON PERSONNEL RISKS: MEASUREMENT OF HEALTHRELATED ABSENCES FROM WORK
EXPOSURE: 50% of personnel absent at least once in 2014
Breakdown by nature of leave:
Ordinary illness
68%
Accident in the
workplace
14%
Maternity
10%
Long illness/Long-term
8%
31
FOCUS ON PERSONNEL RISKS: MEASUREMENT OF HEALTHRELATED ABSENCES FROM WORK
SEVERITY: 54 days leave on average in 2014
Breakdown by nature of leave:
Nature of leave
32
Average number of
days leave
Long illness/long-term
222
Maternity
101
Accident in the workplace
58
Ordinary illness
29
ALL RISKS COMBINED
54
06
NEW CHALLENGES
33
DRAWING ON INSURER-COMPILED DATA TO MANAGE RISKS
In terms of risk management, much of Sham’s credibility stems from the
documentation it has compiled (12,000 claims a year and a thousand or
so court decisions annually, barring amicable settlements and cases
brought before the CCI).
This documentation contains a wealth of information, grouping together
clinical situations, expertise reports and rulings.
Sham has long analysed this data to prepare and update a framework for
risk analysis visits. This data can also be used in the work of the Medical
Council.
34
STRENGTHENING TIES WITH SOCIETIES IN HEALTHCARE FIELDS
Sham is working more closely with societies in healthcare fields – both
medical and non-medical – (CEPPRAL*, Lyon Biopôle, members of the
SFAR* and the SFHH*) to further its understanding of claims rates at
healthcare establishments and better inform practitioners.
The contribution of methodologies and specialised medical expertise has
helped in the preparation of a number of scientific abstracts and
publications based on data compiled by Sham (operating theatres,
outpatient surgery, obstetrics and the study of infectious diseases).
35
* CEPPRAL: task force to assess professional healthcare practices in the Rhône-Alpes region in
France
SFAR: society for anaesthesia and resuscitation in France
SFHH: society for hygiene in hospital environments in France
MEASUREMENT OF RISK EXPOSURE AND PROSPECTS
The data is not based solely on claims figures. Since 2006, Sham has been
carrying out approx. 150 risk visits annually at establishments. In 2014, its risk
exposure measurement activity became fully computerised.
Insurer audits are more detailed and, more importantly, the data
gathered can be used for new analysis purposes, e.g. to map risky
situations or set benchmarks among establishments.
Ultimately, by drawing on this data, the healthcare profession can
develop ever more appropriate risk management programmes… and
gauge the benefits.
36
EMERGING RISKS
Risks tied to the increasing complexity of patient care (care network,
involvement of home-care and e-health solutions)
Risks tied to the information system
Accidents relating to the risk of fire, malfunction, difficult weather
conditions, flooding, etc.
Risk of error (in design, configuration, information transfer, input)
Malevolence, bearing in mind that the hardware and the data may have
a market value
Risks tied to increasing patient involvement in the mechanism (online
consultations, Internet of Things (IoT), etc.) and risk to image
Class action lawsuits in healthcare
37
OVERVIEW OF
THE RISKS
AT HEALTH, SOCIAL AND
SOCIAL-MEDICAL
ESTABLISHMENTS IN FRANCE
REVIEW OF THE RISKS ENCOUNTERED
IN 2014
2015 UPDATE