Health Affairs: Medical errors cost U.S. $17 billion in 2008
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Pressure ulcers were the most common measurable medical error, followed by postoperative infections and by postlaminectomy syndrome, a condition characterized by persistent pain following back surgery, according to Jill Van Den Bos, study author and consultant with the Denver Health practice of actuarial and consulting firm Milliman, and colleagues.
“We wanted to separate additional costs due to medical injuries to quantify those costs,” Van Den Bos said in an interview. The researchers defined a medical injury as medical care with an adverse outcome. Medical injuries differ from medical errors, which may or may not result in a medical injury. “A medical error is a preventable adverse outcome that results from improper medical management rather than from a progression of an illness resulting from lack of care,” Van Den Bos noted.
The study specifically focused on measurable medical errors that harm patients—a subset of medical injuries—and examined direct medical costs, rather than indirect costs, such as malpractice insurance premiums.
Using medical claims from Jan. 1, 2000, to Sept. 30, 2008 from the Thomson Reuters MarketScan databases (which provided medical and prescription drug claim data), the researchers used 2008 population estimates from the Census Bureau to extrapolate the findings from their sample to the U.S. population.
Van Den Bos and colleagues identified approximately 564,000 inpatient injuries (1.5 percent of all inpatient admissions in the U.S.) and 1.8 million outpatient injuries (0.15 percent of the estimated outpatient encounters nationwide) and matched them to control groups of approximately 2 million inpatient and 6.7 million outpatient encounters with the healthcare system that did not result in injuries.
The most common medical injury was side effects from adverse drug reactions; pressure ulcers were the most common medical error, according to the study.
“Together, 10 errors are accountable for 69 percent of the total medical cost for measurable medical errors,” the researchers noted. Postoperative infections were the most costly error, totalling $3.3 billion in medical costs, followed by pressure ulcers at $3.2 billion total medical cost.
The other eight errors included:
- Mechanical complications of noncardiac device implant or graft—$1 billion total medical cost;
- Postlaminectomy syndrome—$995 million total medical cost;
- Hemorrhage complicating a procedure—$678 million total medical cost;
- Infection due to central venous catheter—$589 million total medical cost;
- Pneumothorax (collapsed lung)—$569 million total medical cost;
- Infection following infusion, injection, transfusion or vaccination—$566 million total medical cost;
- Other complications of internal prosthetic device, implant and graft—$398 million total medical cost; and
- Ventral (abdominal) hernia without mention of obstruction or gangrene—$342 million total medical cost.
“Counting the numbers of medical errors and estimating their costs is comparatively straightforward,” the researchers concluded. “The next step, reducing these costs, can be a daunting challenge. However, our study shows that 10 types of error account for more than two-thirds of the total cost of errors. Efforts to reduce costs should focus on these types of errors.”
The study was funded by the Society of Actuaries.