Consultation on Recommendations for No-Fault Compensation in Scotland for Injuries Resulting from Clinical Treatment

Annex A Swedish Compensation Scheme for Medical Accidents

Extracts from Chapter 3 of Volume II - No fault Compensation Schemes for Medical Injury: A Review¹⁷

"Sweden

Administration

3.8 The Swedish Patient Insurance Association (Patientforsakringsforeningen or PFF) is a public company which administers the scheme. It is financially supported through contributions made by county councils which are responsible for the scheme. It is financially supported through contributions made by county councils which are responsible for the provision of health care."

"3.11 The scheme was originally established as a voluntary scheme in 1975. The scheme was placed on a statutory footing as a result of the Patient Injury Act 1996 (PIA 1996). The legislation came into effect on 1 January 1997. While many of the provisions contained in the PIA 1996 draw on the earlier voluntary scheme, there were certain important changes governing the right to compensation as a result of medical injury and the obligation of both public and private health care providers to hold what is called 'patient insurance' to provide for such compensation."

"Funding

3.12 Under the provisions of the PIA 1996, health care providers are required to obtain insurance that covers claims being made in respect of medical injuries. Insurers that provide such insurance belong to the Patient Insurance Association.

3.13 There are 21 regions in Sweden each with their own directly-elected Parliaments. Each region is responsible for the provision of healthcare within their 40 boundaries. Health care is financed by regional income tax, which represents 10% of the income of those resident within regions. A small proportion of health care (1-2%) is financed by private means or through private health insurance. Doctors are employed by regional hospitals. GPs are either employed by regions or operate as independent contractors paid by regions.

3.14 The regions mutually own and operate a medical injury insurance company (LOF). The insurance policy for medical injury is held by regions rather than by doctors or hospitals. The LOF covers medical injuries in regional hospitals and primary care centres, as well as for all private care (through contracts signed by private health providers). The premiums paid to LOF by the regions are drawn from regional income tax. They are not risk-based and are instead based on the number of inhabitants per region. It is estimated that LOF covers 90% of health care provision in Sweden. The remaining 10% is covered by private insurance companies which provide cover for doctors and dentists operating in private practice, chiropractors, physiotherapists and nursing homes."

"3.26 Under the Patient Torts Act 1996, a claimant is entitled to bring tort-based claims in the courts arising out of medical injury. Health care providers are required to carry liability insurance to cover such claims. The claimant must show with reasonable certainty that the health care provider's conduct caused the alleged injury.

3.27 Where a claimant has sustained an injury due to the alleged negligent failure to provide information or obtain consent in relation to the provision of medical treatment, then a claim must be brought under tort law principles in the courts (Espersson 2000a; 2006; 2009).

Review and appeal mechanisms

3.28 If claimants are unhappy with the decision made regarding their eligibility and/or entitlements under the scheme, they may apply to the Patient Claims Panel. This Panel consists of a chairperson who is, or has served as, a judge, and six other members who are appointed for three year terms. The members bring differing areas of relevant expertise to the work of the Panel. The Panel aims to promote fair and consistent application of the terms of the PIA 1996 and issues opinions at the request of claimants, health care providers, insurers or the courts. The Panel is an advisory body and therefore its opinions operate as recommendations only, but there is a high level of compliance. It is estimated that in 10% of claims brought before the Panel their recommendation was that cover be granted by the PFF (Espersson 2000a; Hellbacher et al. 2007; Essinger 2009), with 70% of claims being settled in 6 months.

3.29 Bringing a claim before the Panel is free of charge for the claimant, who benefits from being able to have the matter heard by experts in the field before making a decision on whether to bring a tort-based claim in the courts. The claimant is entitled to choose whether to bring their claim before the Panel or to proceed directly to court (Espersson 2000a).

Complaints process and professional accountability

3.30 Independent Patients' Advisory Committees operate in every region in Sweden. The Committee assists patients who experience difficulties in their relationship with health practitioners. The Committee does not have any decision making powers but aim to take a practical approach to resolving complaints.

3.31 The Medical Responsibility Board (HSAN) deals with complaints where patients allege incompetence on the part of health practitioners. HSAN has the power to issue 'soft' warnings (reprimands) to health practitioners as well as bring disciplinary proceedings. Disciplinary action is kept entirely separate from the no-fault scheme (Essinger 2009).

Medical error and patient safety

3.32 The analysis of medical error with a view to enhancing patient safety is encouraged in Sweden through the use of root cause analysis of events which led to claims for medical injury under the no-fault scheme. This is economically incentivised by LOF (the national medical injury insurance company). Senior medical figures at regional hospitals receive regular updates providing details on all claims for medical injury under the no-fault scheme that originated in their hospitals. The reasons for such claims are followed on a regular basis through visits by LOF representatives to the hospitals. Discussions are held on the data, as well as what can be done to avoid such medical injuries in the future. National Patient Safety conferences are also held on a regular basis and are attended by representatives from the Hospital Federation, the National Board of Health and Welfare and the medical profession. It is expected that new patient safety legislation will come into force in 2010 which will implement a range of specific initiatives to bring about quality and safety improvement in the provision of health care in Sweden (Essinger 2009: 5-7)."