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Compensation for birth-related injury: no-fault programs compared with tort system
K Whetten-Goldstein1, E Kulas, F Sloan
1Center for Health Policy, Law, and Management, Sanford Institute of Public Policy, Duke University, Durham, NC 27708, USA. kwg@hpolicy.duke.edu
Objective:
To compare compensation systems for birth-related injuries.
Design:
Retrospective cohort study.
Setting:
Florida.
Participants:
Parents of children with birth-related injuries who filed claims that closed before August 1, 1995, with Florida's no-fault program (Neurological Injury Compensation Act [NICA]) or who filed tort claims that closed from January 1, 1986, to August 1, 1995.
Main Outcome Measures:
Compensation for medical and income losses due to birth-related injuries.
Results:
Families who received tort settlements were overcompensated for the injury, considering all sources of compensation. By contrast, NICA recipients broke even. Those who did not receive tort or NICA compensation lost nearly $75000 in the first 5 years following the birth. In the subsample of families of children with cerebral palsy, overcompensation by tort claim was even greater, whereas NICA recipients were undercompensated. The cost of care for cerebral palsy in both groups was the same. The difference between tort and NICA compensation levels was attributable to payment for income loss. Overall, NICA recipients were satisfied with compensation received.
Conclusions:
Medical expenses were adequately covered under NICA, but not income loss. A universal health insurance program for children would not cover income losses. Similar costs incurred in NICA and tort systems suggests no rationing of care by NICA. Finally, absent some sort of targeted compensation, the losses experienced by families of children with birth-related injuries were substantial.