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The issues of patient safety and quality of care have gained policy attention with a growing appreciation of the scale and impact of medical injury in health systems. While the focus is clearly on the prevention of iatrogenic injury, the question of patient compensation is now also considered important, if only because in fault-based tort systems the fear of litigation may itself be a barrier to the disclosure and open discussion of medical error. No-fault systems, by contrast, do not require proof of culpability, and thus may both reduce barriers to compensation and increase disclosure of error. Little evidence, however, is available on the performance of such systems. This article reports on the analysis of two data sources-a sample of hospital admissions and a complete set of compensation claims for medical injury. Both are for the same year and region of New Zealand, a country that has maintained a no-fault system of accident compensation for a quarter of a century. Just over 2 percent of hospital admissions were associated with an adverse event that was potentially compensable under scheme criteria. While the claims process was well targeted, the level of claims making and receipt was low, with the ratio of successful claims to potentially compensable events being approximately 1:30. Comparison of social and clinical characteristics of the two data sets revealed a degree of selectivity. Compared with the hospital events, the typical successful claimant was younger and female and was much more likely to have experienced a surgical adverse event that, while unexpected, was not due to substandard care. It is concluded that, in interpreting these results, account needs to be taken of a number of features unique to the New Zealand system. These include: the limited payoff for a compensation claim (no pain and suffering or lump sum, free hospital care); the relative complexity of the grounds for claim (either rarity and severity or practitioner error); and a history of limited litigation for medical error. This suggests that, while the New Zealand system is well targeted, cheap, and free of financial and legal barriers, a change in legal doctrine alone has not in itself been sufficient to remove completely the selective and low level of claims making traditionally associated with patient compensation under tort.

The optimal serum concentration of theophylline for the management of acute airways obstruction was evaluated by comparing the response to target concentrations at the extremes of the usual therapeutic range. 174 patients requiring intravenous theophylline were randomly assigned to a target concentration of 10 or 20 mg/L. Control of theophylline dosage using measured theophylline concentrations and evaluation of efficacy and toxicity was performed under double-blind conditions. 87 patients (50%) required hospital admission. Of these, 54 patients (62%) were followed throughout their hospital admission and reviewed at an outpatient clinic approximately 1 week after discharge. The duration of hospital stay, and rate and extent of improvement in peak expiratory flow rate were not different between the groups. There was significantly more toxicity in the 20 mg/L group. The initial target concentration for theophylline in the management of acute airway obstruction should be 10 mg/L under circumstances where concentration is used to control theophylline dosages.

Adverse events lead to a significant use of health care resources in New Zealand. These findings suggest that substantial resources could be saved by eliminating preventable adverse events.

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