The incidence of medical disputes and litigation is growing rapidly in Korea(6), and a similar trend has been observed worldwide(9–11). Most medical disputes usually occur when a patient perceives or is affected by an adverse event(12), although adverse events may not always result from medical negligence. Postoperative complications are inevitable. Failure or delay in identifying these complications is considered as medical negligence; however, despite a prompt diagnosis and appropriate management, there could be a possibility of medical disputes being raised. An extensive study carried out in the United States revealed that adverse events occurred in 3.7% of hospitalizations, and among them, only 27.6% were attributed to negligence(13).
The results of our study showed that 19 cases of medical disputes (95.0%) resulted from adverse events, and among these, five (26.3%) were consequences of medical negligence. There were other cases where unexpected complications occurred without any evidence of negligence; nevertheless, the medical staff may be held responsible for such results and suffer deleterious economic consequences(14). Our results also demonstrated that the absence of medical negligence was not associated with less compensation.
Morbidity (p = 0.004, U = 1.0) and length of hospital stay (p = 0.009, rho = 0.571) were factors associated with the amount of compensation. This may result from the higher total medical costs that patients with morbidity and longer hospital stay had to bear, but unfortunately data on patients’ medical costs were unavailable due to the retrospective nature of the study.
The mean compensation awarded was USD 7,502 ± 2,534. The Korean Medical Dispute Mediation and Arbitration Agency year book(6) stated that the average cost of mediation in 2016 was USD 7,964 with an annual increase of 7%. Although these data were based on disputes raised in all fields of medicine including Korean medicine and dentistry, the mean total cost was comparable to that of our study, while it was far different from that of data from the US, where an average compensation of USD 485,348 was paid(15). This disparity is due to the difference in patient medical costs. The average overall healthcare cost for gastric cancer was USD 149,900 in Western countries(16) whereas it was USD 12,577 in South Korea(17).
This study has several limitations. This study was a retrospective review and the information on disputes we could receive from the legal affairs team was limited only to cases that involved payment of compensation from the hospital for settlement of the disputes; information on the total medical costs of the patients was unavailable. In addition, this study is based on data from a single large-volume center in Korea; therefore, it may not reflect the situations in care centers of different settings or other countries.