Claiming behaviour in a no-fault system of medical injury: a descriptive analysis of claimants and non-claimants.
OBJECTIVE
(i) To determine the proportion of patients in New Zealand who claim compensation from the national no-fault compensation program after experiencing a compensable injury; and (ii) to identify characteristics of injured patients who are least likely to claim despite having sustained a compensable injury.


METHODS
We estimated the percentage of eligible patients who claim no-fault compensation by linking a national claims database (Accident Compensation Corporation) to records reviewed in the New Zealand Quality of Healthcare Study (NZQHS). Bivariate and multivariate analyses were used to investigate socioeconomic and sociodemographic differences between claimants and injured non-claimants.


METHODS
Patients who experienced an adverse event associated with care in NZ public hospitals in 1998 and claimed compensation with the ACC, the national no-fault insurer (n = 741). Patients identified by the NZQHS as having sustained an adverse event associated with hospital care in the same year who did not file a compensation claim (n = 839).


METHODS
Adverse events, compensable adverse events, and compensation claims.


RESULTS
Among patients judged by NZQHS reviewers to be eligible for compensation, 2.9% (6/210) claimed. Odds of claiming after an adverse event were significantly lower for patients who were elderly (odds ratio [OR], 0.20; 95% CI, 0.14-0.28), from the most deprived areas (OR, 0.36; 95% CI, 0.23-0.57), or of Ma ori or Pacific ethnicity (OR, 0.47; 95% CI, 0.32-0.69 and OR, 0.26, 95% CI, 0.11-0.58).


CONCLUSIONS
Despite few apparent institutional or economic barriers, the proportion of injured patients in NZ who seek compensation after sustaining a compensable injury is very low. Hence, substantial underclaiming occurs in both negligence and no-fault systems. The disproportionately low propensity of elderly, poor and minority patients to seek compensation also appears to be pervasive.
Bismark
Marie M
MM
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.
Brennan
Troyen A
TA
Davis
Peter B
PB
Studdert
David M
DM
D000328:Adult; D035881:Compensation and Redress / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data*; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D016365:Liability, Legal; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand