Who pays for medical mistakes?

We know what can happen when a medical provider makes a mistake. When treatment goes wrong, it usually results in more treatment such as more surgery, medication, therapy and care. The question is, who pays for that extra treatment?

The answer is depends on many factors. According to a 2013 estimate published in the Journal of Patient Safety, more than 400,000 Americans die annually in part because of avoidable medical errors. This is after 2010 health law aimed to increase quality of care. In 2008, the most recent year studied, medical errors cost the country $19.5 billion, most of which was spent on extra care and medication, according to another report.

If a medical mistake stems from negligence, a medical malpractice lawsuit may be an option.  However, in a state like Michigan, it must be exceptionally clear that the doctor or hospital was at fault to bring a lawsuit.  “That creates a Catch-22”, John Goldberg told the Washington Post (Mr. Goldberg is a professor at Harvard Law School and an expert in tort law). “We’ll never know if something has happened because of malpractice” because it’s not clear from the patient’s position to bring the lawsuit.

The cost of medical mistakes often falls on the patient.   A medical mistake can not only cost the patient their health, but their job and health insurance, leaving the patient to pay out of pocket for .  (See this Washington Post article for a patient’s story about the devastating consequences of  a medical error).

Some hospitals have policies in place to cover medical mistakes- when they find they’ve errd, they cover follow-up care.  Unfortunately, this is not the norm.

For Medicare patients, Federal law dictates that the costs for extra care for certain errors must be covered by the hospital. These are called “never events” and include such things as leaving instruments in a patient’s body during surgery or operating on the wrong body part.

On average, a privately insured patient cost about $39,000 more — $56,000 vs. $17,000 — in hospital bills when surgery led to complications than when it did not, according to a 2013 study in the Journal of the American Medical Association. Private insurers work with hospitals, contracting to prevent errors with hospitals they consider “in network.”

Another study showed that hospitals find ways to distribute the costs of medical errors, bearing as low as 22 percent of the cost.