No-fault compensation for medical injuries - The prospect for error prevention

Leading patient safety proposals promote the design and implementation of e rror prevention strategies that target systems used to deliver care and esc hew individual blame, They also call for candor among practitioners about t he causes and consequences of medical injury. Both goals collide with funda mental tenets of the medical malpractice system. Thus, the challenge of add ressing error in medicine demands a thorough reconsideration of the legal m echanisms currently used to deal with harms in health care. In this article , we describe an alternative to litigation that does not predicate compensa tion on proof of practitioner fault, suggest how it might be operationalize d, and argue that there is a pressing need to test its promise. We tackle t raditional criticisms of "no-fault" compensation systems for medical injury -specifically, concerns about their cost and the presumption that eliminati ng liability will dilute incentives to deliver high-quality care. Our recen t empirical work suggests that a model designed around avoidable or prevent able injuries, as opposed to negligent ones, would not exceed the costs of current malpractice systems in the United States. Implementation of such a model promises to promote quality by harmonizing injury compensation with p atient safety objectives, especially if it is linked to reforms that make i nstitutions, rather than individuals, primarily answerable for injuries.