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Welcome to Vegas Lawyer. This site is for people who were hurt in Nevada. Contact us for a free consultation. You may want to read the Las Vegas Personal Injury Law introduction on our home page. Also, you can get an overview of other claims like Wrongful Death, Auto Accidents, Slip & Fall, and Products Liability before you explore the Article below.

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Evidence of Medical Errors

Millions of Americans receive health care services every day, and a very high percentage of those services are of high quality and delivered in a timely fashion. Even in the best systems, however, mistakes are made. Some patients are injured during the course of their treatment. A small number of others suffer adverse consequences as a result of inappropriate benefit coverage decisions that impinge on or limit the delivery of necessary care. In health care, even a small number of mistakes made by individuals, groups of individuals, or organizations can have serious, costly, or fatal consequences. Such injuries can result in additional health expenses, increased disability, lost wages, and lost productivity. These costs are borne by individuals, families, the health care system, and society as a whole. A system of continuous quality improvement committed to preventing errors and correcting them when they do occur is a vital step in improving the quality of care in the United States. Studies estimating the number of Americans injured in the course of treatment have tended to focus on inpatient or hospital settings. For example:

    Adverse drug events in hospitalized patients lead to excess length of stay, extra costs, and mortality. Such costs totaled $8.4 million in 1 year alone for a 700-bed teaching hospital.

    From 1983 to 1993, deaths due to medication errors have risen more than twofold, with 7,391 deaths attributed to medication errors in 1993.

    A 1991 study of medical records from acute care hospitals in New York State found that adverse events occurred in 3.7 percent of hospitalizations and that 27.6 percent of those errors were due to negligence.

    A study of errors in a medical intensive care unit revealed an average of 1.7 errors per day per patient, of which 29 percent had the potential for serious or fatal injury.

Much less is known about the incidence of injuries that occur as a result of inappropriate decisions by health plans to deny coverage for health care services. One reason we know so little is that there is no systematic mechanism for gathering information about such injuries. Concern about the impact of inappropriate coverage decisions has grown as managed care arrangements have become more widespread.

In traditional fee-for-service insurance, decisions to deny coverage of a benefit usually occurred after the benefit had been provided. Over the last 20 years, however, both public and private health insurance plans increasingly have employed utilization review techniques that serve to deny coverage before a service is provided in an attempt to reduce unnecessary care, reduce costs, and inform patients in advance of decisions to deny coverage of unnecessary, inappropriate, or uncovered services.

There is ample empirical evidence to substantiate the existence of significant overutilization of services, which some have estimated to be as high as 30 percent of total health care delivered in the United States. The Commission has identified ensuring the appropriate use of health care as one of its six national aims for improvement.

Efforts by health plans to reduce overutilization, when based upon evidence showing that certain procedures or services are unnecessary, may have a positive impact on cost and quality. Yet, inappropriate decisions do occur. An inappropriate decision not to authorize insurance coverage is one where it is ultimately determined that a needed service was covered by the plan. Such decisions can have enormous health consequences for those individuals in need of services, especially expensive services for which it would be difficult or impossible to pay out of pocket.

The majority of inappropriate decisions to deny coverage probably are resolved by patients, providers, and health plans through discussions and appeals processes. The goal of the health care system should be to do everything possible to see that the right decisions are made in the first place and to promptly correct any inappropriate decisions. A small but growing number of cases are, however, ending up in the courts.



This information came from a
HCQC online article.

*** Any law, statute, regulation or other precedent is subject to change at any time ***

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