Influence of Accreditation on Malpractice Insurance (MI): The Experience of Orthorisq (10 Years)
Seance of wednesday 06 march 2019 (Bilan de 10 ans d'Accréditation gestion des risques)
DOI number : 10.26299/ah05-sy44/emem.2018.1.013
Abstract
In 2001, some of the leading health insurers not wanting to continue performing PL on a 30-year guarantee basis, influenced the legislator to change the MI from 2002 onward with coverage over 10 years after stabilization.
Overnight health professionals, and especially the most exposed being orthopedic surgeons, have been involved with problems of unknown past and the cessation of their activity, and warranty problems over time. The law, moreover, left warranty holes, partially covered in 2012 on the guarantee ceilings, but still sufficiently unclear on some legal positions.
Another immediate consequence, because of the unknown past, was the doubling of the MI premiums in a market then in a state of Oligopoly and with fees blocked by the agreement with the health insurer, itself monopolistic.
An agreement was reached in 2006 with the State, so that, subject to the adhesion of
professionals to a risk management system, which also carries accreditation, (ORTHORISQ for orthopedics) surgeons would then see their MI premium offset by a subsidy ranging from 55% to 66% of its amount (paid by the health insurance).
Orthorisq, a risk management organization of the French Orthopedic Society, was involved in the realization of programs designed to awaken Orthopedists to surgical risk, its knowledge and its prevention.
At the same time, partnerships were forged with leading insurers for the same purpose.
10 years later, the MI market seems to have become attractive with at least 5 offers from insurance companies, stabilized tariffs, but coverage with still problems of guarantee holes because of the lack of clarity of certain texts of law.
These partnerships make us work with insurers, and we find that only 20% of claims are at fault.
A claim occurs on average one year out of two except for the spine which is once a year and this has been the case for several years, which also stabilizes insurance premiums.
The outcome is quite positive. Unfortunately, 4% of orthopedic surgeons have a degraded insurability profile.
This notion of insurability is a parameter that has become essential for a good and serene practice. Legislative instability, which is the victim side of the socio-economic environment, requires ongoing work to support orthopedists through its partnerships and beyond the most extensive relationships with insurers, public authorities and patient representatives.
Overnight health professionals, and especially the most exposed being orthopedic surgeons, have been involved with problems of unknown past and the cessation of their activity, and warranty problems over time. The law, moreover, left warranty holes, partially covered in 2012 on the guarantee ceilings, but still sufficiently unclear on some legal positions.
Another immediate consequence, because of the unknown past, was the doubling of the MI premiums in a market then in a state of Oligopoly and with fees blocked by the agreement with the health insurer, itself monopolistic.
An agreement was reached in 2006 with the State, so that, subject to the adhesion of
professionals to a risk management system, which also carries accreditation, (ORTHORISQ for orthopedics) surgeons would then see their MI premium offset by a subsidy ranging from 55% to 66% of its amount (paid by the health insurance).
Orthorisq, a risk management organization of the French Orthopedic Society, was involved in the realization of programs designed to awaken Orthopedists to surgical risk, its knowledge and its prevention.
At the same time, partnerships were forged with leading insurers for the same purpose.
10 years later, the MI market seems to have become attractive with at least 5 offers from insurance companies, stabilized tariffs, but coverage with still problems of guarantee holes because of the lack of clarity of certain texts of law.
These partnerships make us work with insurers, and we find that only 20% of claims are at fault.
A claim occurs on average one year out of two except for the spine which is once a year and this has been the case for several years, which also stabilizes insurance premiums.
The outcome is quite positive. Unfortunately, 4% of orthopedic surgeons have a degraded insurability profile.
This notion of insurability is a parameter that has become essential for a good and serene practice. Legislative instability, which is the victim side of the socio-economic environment, requires ongoing work to support orthopedists through its partnerships and beyond the most extensive relationships with insurers, public authorities and patient representatives.