Risk Management and Healthcare Policy (Sep 2021)
The Association Between Medical Liability Insurance Coverage and Medical Disturbances in Tertiary Psychiatric Hospitals in China: A National Survey
Abstract
Jin Luo,1 Huanzhong Liu,2 Yuanli Liu,3 Feng Jiang,1 Yi-Lang Tang4,5 1Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 2Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People’s Republic of China; 3School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China; 4Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA; 5Atlanta VA Medical Center, Atlanta, Ga, USACorrespondence: Feng JiangInstitute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, People’s Republic of ChinaEmail [email protected] TangDepartment of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USAEmail [email protected]: Medical disturbances (MD), a severe type of medical disputes, are common in Chinese hospitals. Medical liability insurances were introduced to establish a new system of conflict resolution and risk management. However, data are scarce on the effects of medical liability insurance coverage and MD in psychiatric hospitals. This study was set to address it based on a nationwide survey.Methods: A national cross-sectional survey was conducted in March 2019. Physicians in 41 tertiary psychiatric hospitals participated in a smartphone based anonymous questionnaire. Experience of MD, sociodemographic and occupational characteristics, and job satisfaction information were reported by physicians. The hospital medical liability insurance status was reported by participating hospitals. Multi-level logistic regression analysis was used to examine the association between medical liability insurance coverage and MD.Results: In total, 4511 physicians completed the survey, 3760/4511 (83.35%) physicians in 32 hospitals had medical liability insurance coverage, and 1401/4511 (31.06%) physicians had encountered medical disturbances in the previous year. After adjusting for confounding factors, medical liability insurance coverage was not significantly associated with MD (OR=1.28, 95% CI: 0.93– 1.76). Female gender, working in West China, and higher job satisfaction were protective factors for MD. Higher outpatient volume/week (> 50 patients/week) and longer working hours/week were risk factors for MD.Conclusion: Nearly one-third of physicians in Chinese top-tier psychiatric hospitals reported experience of MD. There was no significant association between medical liability insurance coverage and MD experienced among physicians in Chinese psychiatric hospitals. Policymakers and hospital administrators need to tailor the scope of medical liability insurance and to focus on other factors to reduce MD, including reducing workload and improving the doctor–patient relationship.Keywords: medical disturbance, medical liability insurance, physicians, public psychiatric hospitals, China
