Economic viability and sustainability of the Catalan medical professional liability insurance model

Abstract

In Catalonia, Spain, a singular and unique model of medical professional liability insurance has been developed. This model is regarded as highly beneficial, providing substantial benefits to professionals, the government, citizens, society, and patients. Its main feature is the delegation of the management of claims to the medical association by the insurer. In view of the difficulties in obtaining insurance coverage worldwide, the Council of Medical Colleges of Catalonia (CMCC) model has been examined. This analysis evaluates and contrasts the viability and economic sustainability of the model. A retrospective analysis was conducted on 4,832 medical malpractice claims and their compensation costs between 2002 and 2017, evaluating these against the premiums paid to the insurer. The technical return reached 6.39% (€7.78 million), with an estimated additional financial yield ranging between 3.61% and 33.39% depending on the investment scenario, confirming the overall economic viability and sustainability of the model. It is concluded that the delegation of claims management by the CMCC insurer to the CMCC enables the analysis of claims information, thereby facilitating the implementation of clinical safety initiatives that have a double positive impact. Firstly, these initiatives contribute to the viability and economic sustainability of the model by reducing the number and cost of claims. Secondly, they promote clinical safety through the knowledge and use of data, the modification of medical actions, the minimization of the risk of adverse events, the anticipation of claims, the improvement of clinical safety, and contribution to medical training.