Article Text

Download PDFPDF
Analysis of 23 364 patient-generated, physician-reviewed malpractice claims from a non-tort, blame-free, national patient insurance system: lessons learned from Sweden
  1. K Pukk-Härenstam1,
  2. J Ask2,
  3. M Brommels1,3,
  4. J Thor1,4,
  5. R V Penaloza5,
  6. F A Gaffney6
  1. 1
    Medical Management Center, Karolinska Institutet, Stockholm, Sweden
  2. 2
    Mutual Insurance Company of Swedish County Councils, Stockholm, Sweden
  3. 3
    Department of Public Health, University of Helsinki, Helsinki, Finland
  4. 4
    The Karolinska University Hospital, Stockholm, Sweden
  5. 5
    Vanderbilt University’s National Center on School Choice, Nashville, Tennessee, USA
  6. 6
    Vanderbilt University’s School of Medicine, Nashville, Tennessee, USA
  1. Dr F A Gaffney, Vanderbilt University School of Medicine, 2100 West End Ave. Suite 700, TN 37203, USA; drew.gaffney{at}


Context: In Sweden, patient malpractice claims are handled administratively and compensated if an independent physician review confirms patient injury resulting from medical error. Full access to all malpractice claims and hospital discharge data for the country provided a unique opportunity to assess the validity of patient claims as indicators of medical error and patient injury.

Objective: To determine: (1) the percentage of patient malpractice claims validated by independent physician review, (2) actual malpractice claims rates (claims frequency ÷ clinical volume) and (3) differences between Swedish and other national malpractice claims rates.

Design, setting and material: Swedish national malpractice claims and hospital discharge data were combined, and malpractice claims rates were determined by county, hospital, hospital department, surgical procedure, patient age and sex and compared with published studies on medical error and malpractice.

Results: From 1997 to 2004, there were 23 364 inpatient malpractice claims filed by Swedish patients treated at hospitals reporting 11 514 798 discharges. The overall claims rate, 0.20%, was stable over the period of study and was similar to that found in other tort and administrative compensation systems. Over this 8-year period, 49.5% (range 47.0–52.6%) of filed claims were judged valid and eligible for compensation. Claims rates varied significantly across hospitals; surgical specialties accounted for 46% of discharges, but 88% of claims. There were also large differences in claims rates for procedures.

Conclusions: Patient-generated malpractice claims, as collected in the Swedish malpractice insurance system and adjusted for clinical volumes, have a high validity, as assessed by standardised physician review, and provide unique new information on malpractice risks, preventable medical errors and patient injuries. Systematic collection and analysis of patient-generated quality of care complaints should be encouraged, regardless of the malpractice compensation system in use.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests: None.

  • Ethics approval: The Stockholm Regional Ethical Review Board approved this study.

Linked Articles

  • Quality lines
    David P Stevens