Case study 6: No-fault maternity compensation schemes
Global State of Patient Safety 2023
Country where the case study originated highlighted in red. Where relevant, additional countries where this programme has been implemented are highlighted in blue.
What is it?
The Japan Obstetric Compensation System for Cerebral Palsy (JOCS-CP) consists of a monetary compensation scheme, and an investigation and prevention programme, for cases of cerebral palsy. By the end of 2022, 99.9% of health care facilities had voluntarily signed up to take part in the scheme, and 3,807 cases had been awarded compensation. The Japan Council (JC) for Quality Health Care oversees the scheme.
A key element of the scheme is the publication of an investigation report for each case, which is provided to the facility and the family involved. Families are contacted at the beginning of the process to hear their perspective and clarify their expectations from the process. Reports are analysed to produce and disseminate an overarching prevention report. An annual conference is also held to share the learning from investigations.
Other countries have adopted, or are in the process of adopting the approach, including Malaysia, Italy, Thailand and China. Sweden also operates a similar system.
Why was it developed?
The JOCS-CP was introduced in 2009 in response to:
- a growing concern about Japan’s deteriorating perinatal outcomes
- a high number of lawsuits filed in obstetrics and gynaecology, and
- shortages of obstetricians, due to an increasingly litigious culture.
The scheme reduces the time that is spent putting families through lengthy court processes, which can take 2-3 years due to the challenge and complexity of establishing negligence in court.
How can it be adopted?
Some clinicians initially cautioned against the introduction of the scheme, suspecting that some families would use the financial compensation to initiate a lawsuit. However, this has not been the case. Patient groups were involved in the launch of the scheme, and they continue to advise on its operation. There is an acceptance that the primary wishes of families who have been affected by cerebral palsy are:
- restoration,
- sincere reflection and apology,
- a clear investigation,
- learning and prevention, and
- monetary compensation.
“So our system was designed around these five elements, and that’s one of the reasons why the system was welcomed in our society – it was rooted in our society”.
Consideration needs to be given to the social system of each country when implementing the scheme. For example, in Japan people with disabilities receive a pension from the age of 20 from the social security system, and the compensation payments are made in annual increments up to this age. Consideration also needs to be given to which body is suitable to operate the system:
“…the government cannot operate [the system] because people don’t necessarily like the government, because they have the ability to penalise us. JQ is seen as a neutral body, an authoritative body, and has worked with patients and families for a very long time.”
How can the measurement of patient safety be improved?
The number of cases compensated are declining. By gathering similar cases into one national system, and by standardising the wording of investigation reports, it is possible to identify key themes which can be addressed to prevent future incidents. For example, it was found that foetal monitoring was a recurring theme, and slowly there has been a reduction in these cases, suggesting foetal monitoring practices are improving.
Key resources and contact details
Professor Shin Ushiro - ushiro.shin.161@m.kyushu-u.ac.jp
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