What do we want to know?
At present in the UK, compensation for medical injuries can be sought through tort litigation, with payouts made through court or out-of-court settlements. No-fault compensation schemes (NFCSs) can provide an alternative method to redress claims resulting from medical injury. To inform consideration of an administrative compensation scheme relevant to birth injuries, we sought to develop preliminary theoretical frameworks describing the mechanisms that might influence engagement in such schemes and lead to improvements in outcomes for affected individuals and families. We conducted the first part of a realist review, which seeks to identify empirically and theoretically-based contextual, mechanism and outcome (CMO) configurations. We did not test the CMO configurations, so no causal claims are made. Thus, the findings should be read in this light, and should not be interpreted as definitive evidence that the CMO configurations presented below do influence engagement or outcomes.
What did we find?
We drew on 44 papers relating to medical and non-medical injury, to present a summary of possible mechanisms entailed in no-fault compensation and tort reform that are thought to lead to patient and clinical practice outcomes.
- Overall, we found varied conceptualisations of NFCSs in different geographical contexts, and papers that discussed the effects of tort reform with comparable effects.
- Liability was the key variable in schemes, with the concept of ‘blame’ shaping those schemes within certain countries.
- There is evidence to suggest that the schemes were a product of their jurisdictions.
- The empirical research attempted to test the effect of no-fault schemes and tort reform as outlined in Table A. The findings from this research underpinned propositions to explain the observed effects of no-fault schemes and tort reform.
- However, the schemes should not be considered a panacea, as doubts remained as to their contribution to patient safety and provider accountability (Wallis 2013).
What are the implications?
The CMO configurations generated from the studies contribute to our understanding of how compensation schemes can benefit patients and health professionals. Benefits of schemes include improved targeting of compensation to those most deserving of it, and speedier physical recovery after injury. However, the complexity of the interactions between compensation processes, individual circumstances and context-specific health systems make it difficult to establish strong potential causal pathways, most notably regarding health outcomes. Overall, the shape of compensation schemes will be highly influenced by the health system context and the prevailing political opinion about the role of the state in health care.
How did we get these results?
Papers were sought via iterative searching and included if they focused on compensation schemes relevant to iatrogenic injuries occurring at birth or in the early years (under five years of age), or sought to compensate injuries in two out of three of the following cases: i) resulted high-value claims; ii) had high long-term costs; iii) were highly emotive to victims. Papers were assessed for their relevance: the quality of the research reports lies in the richness of the descriptions of CMO interactions. Descriptive and empirical data were extracted and analysed from individual reports by two reviewers. They met to discuss the findings and agree the final set of CMO configurations, and text to justify them, as presented.
This report should be cited as:
Dickson K, Hinds K, Burchett H, Brunton G, Stansfield C, Thomas J (2016) No-fault compensation schemes: A rapid realist review. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.
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