Inégalités dans les parcours d’indemnisation des victimes d’accidents médicaux. Une enquête au sein du dispositif français de règlement amiable - HAL-SHS - Sciences de l'Homme et de la Société Accéder directement au contenu
Article Dans Une Revue Epidemiology and Public Health = Revue d'Epidémiologie et de Santé Publique Année : 2017

Inequity of compensation trajectories for victims of medical injuries. A survey in the French out-of-court settlement mechanism

Inégalités dans les parcours d’indemnisation des victimes d’accidents médicaux. Une enquête au sein du dispositif français de règlement amiable

Résumé

Background In France little is known about either the characteristics of people who take legal action because they believe themselves to be victims of harm caused by medical activity, or about their complaint trajectory. The law of 4th March 2002 created an out-of-court settlement mechanism which aims to reduce inequitable access to compensation experienced by victims faced with legal procedures that are both lengthy and costly. This mechanism now occupies a central position among the avenues of recourse available to patients and their families. Methods The study relates to the exhaustive database of 18,258 requests for compensation filed with the out-of-court settlement mechanism between 2003 and 2009. It takes 4 series of variables into account: (1) the characteristics of the people concerned by the request, (2) the recourse practices, (3) the result of the requests, (4) the characteristics of the commissions with whom they dealt. Univariate and multivariate analyses were performed, in particular to find factors relating to the different responses given to the requests. Results Of the requests filed with the out-of-court settlement mechanism, 34.5% led to compensation being awarded, 30.7% were deemed inadmissible and 34.8% were rejected on the basis of expert opinions. The risk of inadmissibility was greater when the victim was a woman, undeceased, or a minor aged between 1 and 17; it bore no relation to standard of living. Recourse to a lawyer (24%) depended on various characteristics, in particular the age and vital status of the victim. It is associated to the decrease of the risk of inadmissibility and to the increase of the chances of receiving compensation. There were significant differences in the ways requests were processed (depending on where they were filed), in the time it took to examine the case, and in the tendency to reject requests before or after expert medical opinion. Conclusion This study offers the first ever description of the population of patients and families who accessed the out-of-court settlement mechanism for medical claims in France. It looks at how, within the mechanism, the diversity of practices impacts inequity and experiences during the compensation process.
Position du problème En France, on connaît peu de choses tant sur les caractéristiques des personnes qui, s’estimant victimes de préjudices liés à l’activité médicale, forment des recours, que sur le parcours de leurs plaintes. La loi du 4 mars 2002 a créé un dispositif de règlement amiable qui vise à réduire les inégalités d’accès à l’indemnisation des victimes face à des procédures contentieuses réputées longues et coûteuses. Il occupe aujourd’hui une place centrale parmi les voies de recours des patients et de leurs familles. Méthodes Cette étude porte sur la base exhaustive des 18 258 demandes déposées dans le dispositif amiable entre 2003 et 2009. Elle prend en compte quatre séries de variables : (1) les caractéristiques des personnes impliquées dans la demande, (2) les pratiques de recours, (3) l’issue des demandes, (4) les caractéristiques des commissions qui les ont traitées. Des analyses univariées puis multivariées ont été conduites, notamment pour rechercher les facteurs associés aux différentes réponses apportées aux demandes. Résultats Sur l’ensemble des demandes déposées dans le dispositif de règlement amiable, 34,5 % ont reçu un avis positif d’indemnisation, 30,7 % ont été jugées irrecevables et 34,8 % ont été rejetées après expertise. Le risque d’irrecevabilité est plus élevé lorsque la victime est une femme, qu’il s’agit d’un mineur âgé de 1 à 17 ans ou d’une personne non décédée, mais ne dépend pas de son niveau de vie. Le recours à un avocat (24 %) est lié à différentes caractéristiques, notamment l’âge et le statut vital de la victime. Il est aussi lié à une baisse du risque d’irrecevabilité et à une augmentation des chances globales d’être indemnisé. D’importantes différences de pratiques de traitement des demandes existent selon le lieu où elles sont déposées, en termes de délai d’instruction et de tendance à rejeter les dossiers avant ou au contraire après expertise médicale. Conclusion L’étude fournit la première description de la population des patients et de leurs familles qui forment des recours en France. Elle interroge l’impact de la variabilité des pratiques au sein du dispositif sur les inégalités et les expériences vécues des parcours de la réparation. Background : In France little is known about either the characteristics of people who take legal action because they believe themselves to be victims of harm caused by medical activity, or about their complaint trajectory. The law of 4th March 2002 created an out-of-court settlement mechanism which Aims:to reduce inequitable access to compensation experienced by victims faced with legal procedures that are both lengthy and costly. This mechanism now occupies a central position among the avenues of recourse available to patients and their families. Methods The study relates to the exhaustive database of 18,258 requests for compensation filed with the out-of-court settlement mechanism between 2003 and 2009. It takes 4 series of variables into account: (1) the characteristics of the people concerned by the request, (2) the recourse practices, (3) the result of the requests, (4) the characteristics of the commissions with whom they dealt. Univariate and multivariate analyses were performed, in particular to find factors relating to the different responses given to the requests. Results Of the requests filed with the out-of-court settlement mechanism, 34.5% led to compensation being awarded, 30.7% were deemed inadmissible and 34.8% were rejected on the basis of expert opinions. The risk of inadmissibility was greater when the victim was a woman, undeceased, or a minor aged between 1 and 17; it bore no relation to standard of living. Recourse to a lawyer (24%) depended on various characteristics, in particular the age and vital status of the victim. It is associated to the decrease of the risk of inadmissibility and to the increase of the chances of receiving compensation. There were significant differences in the ways requests were processed (depending on where they were filed), in the time it took to examine the case, and in the tendency to reject requests before or after expert medical opinion. Conclusion This study offers the first ever description of the population of patients and families who accessed the out-of-court settlement mechanism for medical clAims:in France. It looks at how, within the mechanism, the diversity of practices impacts inequity and experiences during the compensation process.
Fichier non déposé

Dates et versions

hal-03480060 , version 1 (14-12-2021)

Identifiants

Citer

I Parizot, I Cailbault, Myriam Winance, Janine Barbot. Inégalités dans les parcours d’indemnisation des victimes d’accidents médicaux. Une enquête au sein du dispositif français de règlement amiable. Epidemiology and Public Health = Revue d'Epidémiologie et de Santé Publique, 2017, 65 (2), pp.99-108. ⟨10.1016/j.respe.2016.12.027⟩. ⟨hal-03480060⟩
27 Consultations
0 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More