Igiene e Sanità Pubblica 2024; 90 (3): 59-71
Enrico Burato1, Enrico Trombetta1, Chiara Picchetti1, Liviana Scotti1, Paola Colombo1, Maria Paola Garancini1, Luciana Bevilacqua1, Enrico Comberti1, Paola Goretti1, Maristella Moscheni1, Cristina Oppezzo1, Anna Paiano1, Chiara Signori1, Paolo Trucco1, Simona Amato1
Affiliation
1 Working Group for the designing of risk management activities in health structures in Lombardy
Keywords: risk management, claims
ABSTRACT
The monitoring of litigation (i.e., claims received by the public healthcare system of the Lombardy Region) is started following the implementation of the “Circolare 46/SAN/2004” by evaluating the risk management activities carried out over a five-year period (2016-2021) and following a systematic approach by the regional risk management coordination group. The paper presents a risks analyzed belong to the following 4 categories: Clinical Risk, Worker Risk Facility Accidental Damage.
The trend of the Average Settled (cash analysis) shows an increase of the amounts over the years. The average amount paid is from about €45k in 2017 to over €71k in 2021, with a 16% decrease in the average amount paid in 2021 compared to the previous year (2020).
The trend of the average amounts paid (analysis by accrual) shows a significant natural decrease over the years. The average amount settled is from about €74K in 2016 to almost 30K in 2021, recording a 30% decrease in the average amount liquidated in 2021 compared to the previous year (2020).
As presented in the paper, the analysis shows a decrease in the magnitude of claims over time, as a positive factor that could be explained by the centralization and continuous monitoring of financial statement data, and the presence of claims evaluation committees (CVS) that includes different skills, such as: broker, loss adjuster, risk manager, medical examiner, lawyers, company management , etc., and the insurance expertise that works in the revaluation of reserves linked to the budget reform.