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Compensation for Birth-Related Injury
No-Fault Programs Compared With Tort System
Kathryn Whetten-Goldstein, MPH, PhD;
Elizabeth Kulas, MA;
Frank Sloan, PhD;
Gerald Hickson, MD;
Stephen Entman, MD
Arch Pediatr Adolesc Med. 1999;153:41-48.
Objective To compare compensation systems for birth-related injuries.
Design Retrospective cohort study.
Setting Florida.
Participants Parents of children with birth-related injuries who filed claims that closed before August 1, 1995, with Florida's no-fault program (Neurological Injury Compensation Act [NICA]) or who filed tort claims that closed from January 1, 1986, to August 1, 1995.
Main Outcome Measure Compensation for medical and income losses due to birth-related injuries.
Results Families who received tort settlements were overcompensated for the injury, considering all sources of compensation. By contrast, NICA recipients broke even. Those who did not receive tort or NICA compensation lost nearly $75,000 in the first 5 years following the birth. In the subsample of families of children with cerebral palsy, overcompensation by tort claim was even greater, whereas NICA recipients were undercompensated. The cost of care for cerbral palsy in both groups was the same. The difference between tort and NICA compensation levels was attributable to payment for income loss. Overall, NICA recipients were satisfied with compensation received.
Conclusions Medical expenses were adequately covered under NICA, but not income loss. A universal health insurance program for children would not cover income losses. Similar costs incurred in NICA and tort systems suggests no rationing of care by NICA. Finally, absent some sort of targeted compensation, the losses experienced by families of children with birth-related injuries were substantial.
From the Center for Health Policy, Law, and Management (Drs Whetten-Goldstein and Sloan and Ms Kulas), the Sanford Institute of Public Policy (Dr Whetten-Goldstein), and the Department of Economics, Duke University (Ms Kulas and Dr Sloan), Durham, NC; and the Department of Economics, Vanderbilt University, Nashville, Tenn (Drs Hickson and Entman). Ms Kulas is now with Health Economics Research–Center for Health Economics Research, Boston, Mass.
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