Analysis Of The Claims Submitted To The Patient Insurance (Pi) Scheme In Sweden During 1975–1979 In Obstetrical And Gynaecological Cases
Authors: Ryde‐Blomqvist Elsa 
Published: December 2009

The Patient Insurance (PI) scheme in Sweden was instituted on 1 January 1975. From the PI it is possible for a patient to obtain acknowledgement of an injury sustained in connection with medical treatment or operation—and receive financial compensation therefor—without having to prove that the injury was the result of fault or neglect. Special conditions of undertaking are laid down for the guidance of PI assessors which, if fulfilled, will entitle the patient to indemnity from the respective county council (via the PI) for injury sustained in connection with medical care received from county institutions or staff.

As the Swedish PI scheme was the first of its kind in the world, an evaluation of its application during the first 5 years seemed justified. the present work constitutes the obstetrical‐gynaecological part of that project.

The objectives of the study were: to analyse and group according to injury all claims concerning obstetrical or gynaecological intervention submitted to the PI during 1975–79; to evaluate available literature on such injuries in relation to the present findings; to make recommendations for changes in the treatment routines of frequently occurring or serious injuries; and to study the working procedures of the PI, especially regarding its assessment of patient claims.

Chapter I sets out the historical background of the PI. the extent of a patient's right to indemnity from the PI is discussed, covering the conditions of undertaking that must be fulfilled on the patient's part, and the Pi's obligations. the Patient Injuries Committee is presented, to which injured parties can appeal against decisions of the PI.

Chapters II—X. During the period studied, altogether 275 claims concerning obstetrical and gynaecological treatment were submitted to the PI, i.e. 2.5% of all claims received by the PI during that period. Most of the injuries resulted from surgical intervention. the claims have been grouped into six gynaecological and three obstetrical chapters. the reporting frequency to the PI was low during this period and therefore no statistical information can be derived from the analysis.

A review of the current literature revealed a similar pattern of severe complications as that found among claims to the PI. in one respect, however, the present study is unique, since complications resulting from certain types of intervention, though performed under so varying circumstances, have never before been compiled and evaluated. the reported injuries were fairly evenly distributed among the 26 counties and the three different sizes of hospital.

The six gynaecological chapters include: complications associated with elective abortions (40 claims, of which 70% due to uterine perforation); sterilization associated complications (29 claims, of which 45% dealing with technical error, including incomplete closure of Fallopian tubes, one tube incorrectly treated, and recanalization); IUD associated complications (18 claims, in which 78% reported uterine perforation); complications to hysterectomy (94 cases—the largest group—of which 62% were associated with trauma to the urinary tract and/or the intestines and of which 8.5% resulted in peripheral nerve injury); complications (mostly infections) to treatment for urinary incontinence (10 claims) and for genital prolapse (advanced surgical complications) (11 claims); complications to miscellaneous gynaecological treatment (13 claims) including 7 cases of extra‐uterine pregnancy and 4 cases of miscarriage. Claims concerning elective abortion, miscarriage and extra‐uterine pregnancy are included in these chapters as treatments had been given in a gynaecological department.

The three obstetrical chapters include: complications to vaginal delivery (19 claims, of which 72% were rejected by the PI as they were caused by infection or defective healing of a perineotomy); complications to Caesarean section (CS) (32 claims, of which 69% reported after emergency CS); birth injuries (9 claims, of which 5 concerned traumatic complications to breech presentation).

Chapter XI. Description of the Swedish public health service generally, and the PI in particular. the need for more careful recording of case histories and improved training in gynaecological surgery is emphasized. A revision of the Pi's computer variables is suggested. A revision of the Pi's conditions of undertaking is also called for, as the present rules are difficult to understand, for both medical staff and claimants.

The PI scheme has rapidly been accepted and increasingly utilized by the Swedish public. the PI has also narrowed the previous rather wide gap between the medical staff and the patients, which is an encouraging development.