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- Error Analysis
Journal Article > Study
Eappen S, Lane BH, Rosenberg B, et al. JAMA. 2013;309:1599-1606.
The business case for patient safety relies on the assumption that adverse events are financially harmful to hospitals over the long term, so up-front investment in safety improvement will eventually result in savings. However, this study cogently demonstrates that—at least for the specific case of surgical complications—hospitals actually profit when patients experience adverse events. Analysis of more than 30,000 surgical procedures revealed that hospitals received significantly greater net reimbursement for patients who experienced complications compared with those who had no complications. This disparity was particularly evident for patients with private insurance, although it was present to a lesser extent for patients with Medicare. This counterintuitive finding vividly demonstrates that, despite efforts such as the Centers for Medicare and Medicaid Services' policy of not paying for errors, payment incentives are not aligned to the extent that would truly encourage innovative approaches to improving safety. As the noted health economist Dr. Uwe Reinhart points out in his accompanying editorial, the findings of this study arise directly from a payment system that rewards providers for the volume rather than the quality of service provided.
Journal Article > Study
Who pays for medical errors? An analysis of adverse event costs, the medical liability system, and incentives for patient safety improvement.
Mello MM, Studdert DM, Thomas EJ, Yoon CS, Brennan TA. J Empirical Leg Stud. 2007;4:835–860.
Organizational costs associated with medical errors, and specifically adverse drug events, have been reported. This study analyzes such costs and also examines what proportion is absorbed by hospitals. Using claims data from a past study, investigators determined that hospitals assumed only 22% of costs associated with injuries. The authors advocate for continued efforts to improve the business case for safety interventions, partly by understanding the marginal costs associated with a given safety improvement. Legal reforms or market interventions are also suggested as mechanisms to deal with the externalization of injury costs.