Identifying the precise number of clinical negligence claims raised each year in every country throughout the world is by no means an easy task. Understanding how such claims relate to the countries' respective health care systems is even more of a challenge. In fact, it is almost impossible to accurately quantify in context the number and scope of clinical negligence claims made throughout the world.
There are many different reasons as to why one country will experience lower or higher numbers of clinical negligence claims that another and it is difficult to draw any concrete comparisons at the supranational level. Indeed, a relatively poor record of clinical negligence in one country might suggest a heavily litigious society, whilst an extremely positive record of clinical negligence claims in another may point to a legal system that does not robustly defend the public interest. In short, the number of clinical negligence claims brought will naturally vary from one country to the next, but the inevitable differences observed between nations is not usually helpful in understanding how their health care and legal systems interact.
Rather than look at the specific number of clinical negligence claims brought in a given country, it is sometimes more revealing to examine the percentage of total health care costs that can be attributed to clinical negligence compensation. In the US, which is widely regarded as an extremely litigious country, only 0.6 per cent of health care costs are spent on medical malpractice lawsuits – the lowest figure since the early 1990's. The reduction in US clinical negligence costs, however, does not necessarily indicate that doctors have suddenly determined to perform their duties more carefully. In fact, state level tort reform has meant that claimants must establish a higher burden of proof in medical malpractice or clinical negligence actions.
The 0.6 per cent that is spent on clinical negligence costs could also merely highlight just how significant the private sector expenditure on health care is in the US. Although the number of medical malpractice claims brought in the US has been on the decline for the past two decades, the Journal of the American Medical Association (JAMA) recently published statistics that suggest around 225,000 patients die every year in the US due to the negative effects of medication, complications from hospital-acquired infections, unnecessary surgery or hospital errors. Given the scale of the US and the maturity of its legal system, it is therefore reasonable to assume that it will have one of the highest numbers of clinical negligence cases globally.
In the UK, the number of clinical negligence claims has risen modestly during recent years, despite the fact that compensation payouts have risen sharply. Such a discrepancy further dilutes the benefits of looking at the number of clinical negligence claims made as a model of accurately assessing a country's health care system. The largest clinical negligence compensation payout awarded in 2009 was for £7.6 million excluding legal costs.
Many clinical negligence cases involve substantially higher legal costs than actual compensation awarded, which further distorts the statistics. In 2000, the World Health Organisation (WHO) published a list of the best and worst countries for health care. France headed the rankings, with Italy, San Marino, Andorra, Malta, Singapore, Spain, Oman, Austria and Japan filling out the top ten. The UK was ranked 18th and the US 37th.