title: The Claims Management Committees trial: experience of an Italian hospital of the National Health System.
abstract: BACKGROUND
  In Italy, health care is mainly financed by earmarked central and regional taxes, with regions receiving their allocated share of resources from the National Health Fund. The Council of the Tuscany Region in 2009 began an experimentation aimed to enforce the extrajudicial conciliation. The Council established the Claims Management Committees (CMC) for civil liability in the Tuscan Health Service. The CMC trial provides that the damages are compensated directly by the hospital, removing the cost of liability insurance. The aim of this study is to collect and compare the liability-insurance-period and the CMC trial-period.
  
  
  METHODS
  Data were derived from the management claims database of the Health Directorate of the Careggi Hospital in Florence between 2006 and 2012. Two main periods are considered for the comparison of data: 2006-2007-2008 during the insurance management and 2010-2011-2012 during the CMC trial.
  
  
  RESULTS
  During the insurance management period, the total expenditure was equal to the €14,846,334.44 paid in the 3-year period. The total expenditure during the CMC trial 3-years period was equal to €7.076.370,75. Under the CMC management, we observed a marked decrease in the recourse to legal action in the face of a substantial maintenance of the number of claims opened for each year. The CMC trial showed a greater speed in setting claims for damages.
  
  
  CONCLUSIONS
  Under CMC management, a greater and more diligent efficiency is matched by a lower economic outlay. The use of the direct management of damage compensation may be an important tool for risk management, thus guaranteeing the recourse to targeted and appropriate interventions.
authors.affiliation: Forensic Medicine Sciences Section, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Italy.
authors.forename: Gian-Aristide
authors.initials: GA
authors.lastname: Norelli
authors.affiliation: Forensic Medicine Sciences Section, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Italy. Electronic address: dott.ssadeluca@gmail.com.
authors.forename: Federica
authors.initials: F
authors.lastname: De Luca
authors.affiliation: Forensic Medicine Sciences Section, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Focardi
authors.affiliation: Legal Department and Human Resources Management, Careggi Hospital, Florence, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Giardiello
authors.affiliation: Forensic Medicine Sciences Section, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Italy.
authors.forename: Vilma
authors.initials: V
authors.lastname: Pinchi
mesh_terms: D035881:Compensation and Redress; D016208:Databases, Factual; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006748:Hospital Departments / Q000706:statistics & numerical data; D006801:Humans; D007351:Insurance, Liability / Q000191:economics*; D007558:Italy; D008318:Malpractice / Q000191:economics* / Q000706:statistics & numerical data; D009313:National Health Programs; D011331:Private Practice
keywords: Claims analysis; Medical malpractice; National health service costs