• Title/Summary/Keyword: Insurance Claim Failure

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The NHS litigation scheme related to Maternity Services in UK: its experiences and implications (영국 NHS의 모성서비스 관련 의료과오보상제도의 경험과 그 함의)

  • Han, Dong-Woon;Hwang, Jung-Hye
    • The Korean Society of Law and Medicine
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    • v.11 no.2
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    • pp.181-208
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    • 2010
  • Maternity services is often perceived as a troublesome business and obstetric litigation is on the increase in Western countries. Overall, the number of claim and cost of litigation to the NHS Litigation Authority (NHSLA) from maternity services in the UK is increasing every year. Maternity services account for 60-70% of the total sum paid. This has widespread implications for both the individual practitioners and the institutions where they work, due to increasing malpractice insurance premiums. Fear of litigation is also attracting fewer medical graduates into the specialty, leading to a recruitment crisis in obstetrics and gynaecology. The litigation process can cause pain, suffering and distress to clinicians as well as to the patients and their families. Litigation in maternity services is the result of a complex of events when malpractice (presumed or real) impacts on the attitude of pregnant women and their environment. In such complexity, information is mandatory but may often be misinterpreted. If messages are not tailored to the receiver's capacity, communicating well with the pregnant patient becomes crucial. Therefore, to reduce medicallegal issues in obstetrics, increasing attention and an applicable standard of obstetric care to avoid negligence and medical errors should go along with other measures. Considering UK's experiences, NHS redress scheme make it easier to pursue small claims and birth related claims, without necessarily reducing the number of claims processed through the conventional legal system and perhaps encouraging even more of them. The task of dealing with the greater number of inquiries into their practice would inevitably create an added burden for clinicians and hospital managers. Thus further proposals are required to limit the cost of processing inflated claims and to consider whether clinicians should be given some protection from litigation alleging a failure to prevent birth related impairment.

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Class duplication prescriptions in patients taking fixed-dose combination antihypertensives (고혈압 복합제 복용환자에서 동일계열약물 중복 현황)

  • Koo, Hyunji;Lee, Ji Won;Choi, Ha Eun;Je, Nam Kyung;Jeong, Kyeong Hye
    • Korean Journal of Clinical Pharmacy
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    • v.32 no.2
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    • pp.125-132
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    • 2022
  • Background: Fixed-dose combinations have the advantage of improving patient compliance, but may increase the risk of duplicate prescriptions. As the use of fixed-dose combination antihypertensives increases, it is necessary to investigate the current status of class duplication prescriptions (CDP) in patients taking fixed-dose combination antihypertensives in Korea and to identify factors associated with CDP. Methods: We conducted a retrospective observational study using nationally representative claim data. Hypertensive patients aged 20 years or older taking fixed-dose combination antihypertensives were extracted. Among these patients, patients with CDP were identified. A chi-square test was applied to determine the differences between patients with CDP and non-CDP. The associated factors of CDP were identified through multiple logistic regression. Results: Of the 74,165 patients who were prescribed fixed-dose combination antihypertensives, 426 patients (0.6%) with CDP were identified. The most common antihypertensive class associated with CDP was calcium channel blockers (194 patients, 45.5%), followed by angiotensin II receptor blockers (136 patients, 31.9%). Patients aged 75 years or older (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.02-3.52), chronic kidney disease (OR 4.45, 95% CI 2.15-8.25), chronic heart failure (OR 2.71, 95% CI 1.93-3.72), coronary artery disease (OR 2.22, 95% CI 1.60-3.03) and Medical Aid/Patriots and Veterans Insurance (OR 1.49, 95% CI 1.04-2.07) were significantly associated with increased CDP. Conclusions: The factors associated with CDP were the elderly, comorbidities, and low socioeconomic status. Since CDP can result in negative clinical outcomes, active intervention by the pharmacist is warranted.

Review of 2013 Major Medical Decisions (2013년 주요 의료 판결 분석)

  • Lee, Dong Pil;Jeong, Hye Seung;Lee, Jung Sun;Yoo, Hyun Jung
    • The Korean Society of Law and Medicine
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    • v.15 no.1
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    • pp.263-302
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    • 2014
  • The court handed down meaningful rulings related to medical sectors in 2013. This paper presents the ruling that the care workers could be the performance assistants of the care-giving service although the duties of care worker are not included in the liability stipulated in the medical contract signed with the hospital for reason of clear distinction of duties between care workers and nurses within the hospital in connection with the contract which was entered into between the hospital and patients. In relation to negligence and causal relationship, the court recognized medical negligence associated with the failure to detect the brain tumor due to the negligent interpretation of MRI findings while rejecting the causal relationship with consequential cerebral hemorrhage. The court also recognized negligence based on the observation on the grounds of inadequate medical records in a case involving the hypoxic brain damage caused during the cosmetic surgery. In terms of the scope of compensation for damages, this paper presents the ruling that the compensation should be estimated based on causal relationship only in case the breach of the 'obligation of explanation' is recognized, however rejecting the reparation for de factor property damages in the form of compensation, and the ruling that the lawsuit could be instituted in case that the damages exceeded the agreed scope despite the agreement that the hospital would not be held responsible for any aftereffects of surgery from the standpoint of lawsuit, along with the ruling that recognized the daily net income by reflecting the unique circumstances faced by individual students of Korean National Police University and artists of Western painting. Many rulings were handed down with respect to medical certificate, prescription, etc., in 2013. This paper introduced the ruling which mentioned the scope of medical certificate, the ruling that related to whether the diagnosis over the phone at the issuance of prescription could constitute the direct diagnosis of patient, along with the ruling that required the medical certificate to be generated in the name of doctor who diagnosed the patients, and the ruling which proclaimed that it would constitute the breach of Medical Act if the prescription was issued to the patients who were not diagnosed. Moreover, this paper also introduced the ruling that related to whether the National Health Insurance Service could make claim to the hospitals for the reimbursement of the health insurance money paid to pharmacies based on the prescription in the event that the hospitals provided prescription of drugs to outpatients in violation of the laws and regulations.

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A Study on the Liability for Damage caused by Space Activity - With reference to Relevant Cases - (우주활동에 의하여 발생한 손해배상책임에 관한 연구 - 관련 사례를 중심으로 -)

  • Lee, Kang-Bin
    • The Korean Journal of Air & Space Law and Policy
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    • v.26 no.1
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    • pp.177-213
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    • 2011
  • The purpose of this paper is to research on the liability and cases for space damage with reference to the space activity under the international space treaty and national space law of major countries. The United Nations has adopted two treaties relating to the liability for space damage as follows: the Outer Space Treaty of 1967 and the Liability Convention of 1972. Korea has enacted the Outer Space Damage Compensation Act of 2008 relating to the liability for space damages. The Outer Space Treaty of 1967 regulates the international responsibility for national activities in outer space, and the national tort liability for damage by space launching object. The Liability Convention of 1972 regulates the absolute liability by a launching state, the faulty liability by a launching state, the joint and several liability by a launching state, the person claiming for compensation, the claim method for compensation, the claim period of compensation, the claim for compensation and local remedy, the compensation amount for damage by a launching state, and the establishment of the Claims Commission. The Outer Space Damage Compensation Act of 2008 in Korea regulates the definition of space damage, the relation of the Outer Space Damage Compensation Act and the international treaty, the non-faulty liability for damage by a launching person, the concentration of liability and recourse by a launching person, the exclusion of application of the Product Liability Act, the limit amount of the liability for damage by a launching person, the cover of the liability insurance by a launching person, the measures and assistance by the government in case of occurring the space damage, and the exercise period of the claim right of compensation for damage. There are several cases with reference to the liability for damage caused by space accidents as follows: the Collision between Iridium 33 and Cosmos 2251, the Disintegration of Cosmos 954 over Canadian Territory, the Failure of Satellite Launching by Martin Marietta, and the Malfunctioning of Westar VI Satellite. In the disputes and lawsuits due to such space accidents, the problems relating to the liability for space damage have been settled by the application of absolute(strict) liability principle or faulty liability principle. The Liability Convention of 1972 should be improved as follows: the clear definition in respect of the claimer of compensation for damage, the measure in respect of the enforcement of decision by the Claims Commission. The Outer Space Damage Compensation Act of 2008 in Korea should be improved as follows: the inclusion of indirect damage into the definition of space damage, the change of the currency unit of the limit amount of liability for damage, the establishment of joint and several liability and recourse right for damage by space joint launching person, and the establishment of the Space Damage Compensation Review Commission. Korea has built the space center at Oinarodo, Goheung Province in June 2009. Korea has launched the first small launch vehicle KSLV-1 at the Naro Space Center in August 2009 and June 2010. In Korea, it will be the possibility to be occurred the problems relating to the international responsibility and the liability for space damage in the course of space activity. Accordingly the Korean government and launching organization should make the legal and systematic policy to cope with such problems.

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