Medical malpractice and legal resolution systems in Japan

Medical malpractice claims and dispute resolution systems have been examine d in Western societies for their impact on the quality of: care and efficie nt compensation for injured patients. However, little is known about the Ja panese malpractice environment because claim information has been closely g uarded. Based on data from the Japanese Supreme Court, the Ministry of Heal th, Labor, and Welfare (formerly the Ministry of Health and Welfare), and t he Japan Medical Association (JMA), which provides malpractice insurance to 43.5% of Japan's 250 000 physicians, we review Japanese malpractice liabil ity systems and the frequency of claims during the last 30 years. Annual pr emiums for physician professional liability insurance are relatively low ($ 454-$491). Although the frequency of claims in Japan is lower than that rep orted in the United States, England, and Germany, the number of claims is i ncreasing in Japan. According to publicly available data from the Japanese Supreme Court, the annual number of medical malpractice suits filed in dist rict courts has increased from 102 in 1970 to 629 in 1998 (from 0.09 to 0.2 5 per 100 physicians). The proportion of awards greater than $89 300 increa sed from 13.6% in 1976 to 65.4% in 1987, Among JMA members, claims increase d 31% from 1987 to 1999, but the frequency of claims has remained at approx imately 0.3 per 100 JMA members. The JMA's professional liability program o ffers a nonbinding out-of-court review of claims that is faster and less ex pensive than judicial resolution (a few months with no attorney required vs 35 months and attorney fees), but is a poor means of deterrence or discipl ine. Since JMA data represent only 43.5% of Japanese physicians, generaliza tions cannot be made about all Japanese physicians and institutions. The la ck of data on all claims hinders adequate evaluation of dispute resolution methods, development of appropriate risk management activities, and proacti ve education for Japanese physicians.