The Swedish Patient Compensation System: Myths And Realities'
InkmaliondReview of Law and Economics (1994) 14, 453-466The Swedish Patient CompensationMyths and Realities’PATRICIAM.System:DANZONThe Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USAI. IntroductionThe Swedish compensation system for medical injuries has been suggested as a possiblemodel for medical malpractice reform in the United States and in other countries.2Patient compensationin Sweden is provided by the Patient CompensationInsurance(PCI), a voluntary, contractual administrative mechanism that provides compensationwithout proof of provider fault. The discipline of medical providers is handled by aseparate Medical ResponsibilityBoard (MRB). The frequency of claims filed perphysician is at least 50% higher under the PC1 than under the U.S. medical malpracticesystem, but the PC1 is widely accepted by the medical profession. The PC1 costsroughly 2.38 per capita, or 0.16% of health care costs in Sweden, whereas U.S.medical malpractice insurance premiums account for l-2% of (higher) health careexpenditures,more than a lo-fold difference. Administrative overhead is 18% of totalPC1 premiums, compared to roughly 60% in the United States. Recent proposals inthe United States for a rule of no-fault (strict) enterprise liability for medical injuriescite the PCI’s low overhead rate as evidence of the potential savings from switchingfrom a negligence rule to a causation-basedrule of liability.” In this regard, the PC1has also been compared to strict enterprise liability under workers’ compensation,which also has a lower overhead percentage than tort liability.4The purposes of this paper are three. First, it provides a brief description of thestructure and experience of the PC1 and the MRB. Second, it explains the PCI’s lowoverhead, using a simple model of optimal litigation effort. This model challengesthe conventional wisdom that the PCI’s low overhead derives from a no-fault rule ofliability. More generally, any analogy between no-fault as applied in the PC1 and nofault systems of strict liability-eitherworkers’ compensationor strict enterprise liability for medical injuries-ismisplaced. On the contrary, the PC1 experience illustratesthat a causation-only test for compensability is neither necessary nor sufftcient for lowoverhead costs. Rather, the PC1 achieves low overhead costs by foregoing any attemptat deterrence.The MRB, which is totally decoupled from the PCI, is ineffectual. Ingeneral, low overhead is a very misleading indicator of the efficiency of any insurance system.A third purpose of this paper is to examine lessons from the PC1 for a proposedcontractualalternative for medical injuries. 5 The fact that patients and providersoverwhelminglyopt into the PC1 rather than tort suggests that it offers a Paretosuperior alternative. However, contractualoptions are constrainedby transactions0 1994 Butterworth-Heinemann
454The Swedish Patient CompensationSystem: Myths and Realitiescosts and by the distribution of income, which depend on the status quo tort regimeand other institutional factors. Thus other countries with very different tort and healthcare institutions could not expect to adopt the PC1 model with similar results. Ingeneral, statutory tort reform and voluntary contracting are complements,not substitutes. Moreover, whether the PC1 will survive the opening up of Swedish insuranceand health care markets to greater competition remains an open question.Parts II and III of this paper outline the structure of the PC1 and MRB andsummarize claims experience.‘j Part IV presents a simple model of litigation effort toexplain the PCI’s low overhead rate. Part V uses a bargaining model to explain whypatients and providers may have opted for this type of compensationsystem, despiteits apparent inconsistency with theories of optimal liability regimes. Part VI concludesthe article. Where possible, the PC1 is compared to the U.S. medical malpracticesystem, as the most extreme tort regime.II. Structure of the Swedish Patient Compensation InsuranceThe PC1 is a supplementaryinsurance for medical injuries that is added to compensation provided through other social and collective insurances. The basic Swedish socialinsurance scheme covers all citizens for medical expense and wage loss due to illnessor injury, regardless of cause. Medical care is organized and largely financed at thecounty council level, with services provided through public hospitals and clinics. Thereis a small but growing network of private practitioners.Sweden’s fault-based system of tort liability for medical providers resembles medicalmalpractice liability in the United States in its basic structure, but the Swedish tortsystem has changed little during the last century’ and is much less favorable to plaintiffsin several respects. Contingentfees, which shift risk from plaintiffs to attorneys, areillegal. The custom-based standard of care has allegedly acted as an obstacle to plaintiffs, because of difficulty in obtaining expert testimony.” The standard of proof(roughly a 75-85% threshold probability) is higher than the “preponderanceof theevidence” standard applied in the United States. Swedish tort benefits are subject tofull collateral source offset, and payments for pain and suffering are at relativelymodest levels, based on a schedule.’ Trial is by judge, whereas given the choice inthe United States, most litigants opt for a jury.The PC1 was established in 1975 by voluntary contract between the county councilsand a consortium of insurers, in order to preempt the threat of statutory expansionenteredof tort liability, possibly to a form of strict liability. ‘O Private practitionersinto similar contracts and a voluntary contractual PharmaceuticalInsurance (PI) wasestablished in 1978. The motivating political concern was lack of patient access to tortcompensation:Only about 10 patients per year received compensationfor medicalformalpractice. ‘I The PC1 provides a simple, administrative source of compensationa subset of medical injuries. Although patients retain the right to sue in tort undertraditional negligence rules, tort claims have been extremely rare until recently.DefinitionAn injuryof a CompensableInjuqis compensableif (1) by “the preponderanceof the evidence” it was causedby medical care, and (2) either the treatment was not medically justified or the injurycould have been avoided, given customary care. The PC1 requires no proof of fault
PATRICIAM. DANZON455or negligence of an individual provider. Thus from the physician’s perspective, thePC1 is truly no fault. From the patient’s perspective, however, the criteria ofcompensability are quite similar to traditional custom-based tort standards.‘* Medical causationis a necessary but not a sufficient condition. Normal, and even most abnormal, risksof standard medical care are explicitly not compensable. The criteria for compensability are defined in some detail in writing and are revised periodically, balancing pressures for compensationagainst cost control.CompensationThe PC1 offers benefits comparable to those available through tort in order to deflecttort claims. Compensationfollows tort principles of full compensationfor economicloss with scheduled payments for noneconomicloss based on the claimant’s age andinjury severity. As in the Swedish tort system, there is full offset ofbenefits payable fromother public and mandatory insurances, which in Sweden provide very comprehensivecoverage of wage loss and medical expense. Payment levels for noneconomicloss areand are payable only if there ismodest by U.S. and even most European standardsia physical injury.AdministrationTo file a claim, the patient completes a simple form, often with the assistance ofhospital or clinic personnel. Claims are administered by the monopoly consortium ofinsurers.i4 Patients may appeal from the insurer’s decision to a Patient Claims Panelthat includes two patient representatives and two provider representatives.The panel’sdecisions are merely advisory but have been followed by the insurer consortium inthe relatively few cases (roughly 107)o in which the panel rules against the consortium.The patient may further appeal to binding arbitration under the general Swedisharbitration system. Proceedings of the panel and arbitration are closed to the publicand the pressi and the evidence is usually submitted in writing, with oral presentationrequiring special permission.Medical experts are used as independentadvisers tothe insurer or panel, at their discretion, rather than as representativesin an adversarialprocess. Patients typically do not have attorney representationunless the case goesto arbitration. Contingent fees are banned.FinancingThe PC1 is financed by premiums paid by county councils and by private physiciansand other professionals.Premiums are assessed on a flat per-capita basis for eachcounty council, regardless ofclaims experience. These assessments are adjusted retroactively as costs are incurred, including full pass-throughof the insurers’ expenses.Thus the functions of the insurer consortiumare purely administrative:It retainsnone of the underwriting and risk-bearing functions that are fundamental to liabilityinsurance in competitive insurance markets.DeterrenceThe PC1 was designed to provide compensation without regard to deterrence. Individual providers suffer no moral blame, financial loss, or reputation loss as a result of
456The SwedishPatient CompensationSystem: Myths and Realitiessuccessful claims. Although clinics and hospitals are informed about their claimsexperience,the responsible individuals and the causes of the avoidable injury are notidentified. The PC1 database so far lacks sufficiently detailed information to be usedfor risk management.Patients can file claims with the MRB, which, following investigation, may result in a reprimand or a warning to the provider. This has no financialconsequence for the physician or the patient. No information flows between the MRBand the PCI. This decoupling of compensationand deterrence is said to be necessaryto maintain physician cooperationin patient compensationthrough the PCI.III.Claims ExperienceClaim FrequencyThe number of claims filed per year increased steadily from 682 in 1975 to 4799 in1985,‘” then dropped to an average of 3317 per year for 1986-1991.Espersson (1992)estimates that about 5500 claims were filed in 1992.” This is a huge increase relativeto 10 paid claims a year under the pre-1975 tort system, and much more than the1000-1500annual filings initially projected for the PCI.‘” The proportion receivingpayment declined from 55% for the period 1975-1986to 18% for claims filed during1986-1991(Table 1) but is estimated at 40% for 1992.” The decline in claim filingsand in percent compensated during the late 1980s suggests that standards of compensability were significantly tightened. ” The 1992 estimates imply some relaxation.Claim frequency is roughly 2 1 claims per 100 physicians per year, or 50% higher thanthe U.S. figure of 13-16 claims per 100 physicians. *’ These estimates are approximatebecause the Swedish system does not allocate claims to specific personnel, and figuresfor the United States differ across regions and over time.Claim SeverityThe average payment per paid claim (claim severity) and its rate of growth cannotbe calculated from the available data. 22 However, reports for specific years indicatemuch lower payment levels than in the United States. For 1987 Rosen et al. (1992)TABLE 1. Number and cost of claims under the PC1Jan. I975July 1986Total claimsResolvedNumber compensated(% of resolved)Denied compensation(% of resolved)Total cost of payout” (SEK)Cost per paid claim y 1986Dec. 199118,24318,6663,35418.015,31282.0380m113,298Jan. 1975Dec. ces: Oldertz (1986, p. 655-656) footnote 11; Espersson (1992, p. 23-24) footnote 19.“Ibtal cost and total cost per paid claim are summations of current SEK. Without conversion to constant SEK,they understate the current value of total payout since 1974.
PATRICIA M. DANZON457report an average cost per paid claim of SEK 38,000 (US 5,429), and SEK 680,000(US 97,143) for the most severe disability category (over 30% disability).‘J For theUnited States, the mean payment per paid claim was roughly 120,000in 1986,although the median was much lower.24Pain and suffering accounts for 74% of total payments made by the PC1 and thePI (Table 2). This reflects the comprehensivecoverage of economic loss through othersocial insurance. The great majority of claims are minor. Only 4% of paid claimsinvolved permanent disability of more than 30% or death,2” but these cases accountedfor 4 1.6% of compensation paid for injuries that occurred in 1987. This concentrationof payments in a very small percentage of severe injury cases is comparableto theUnited States, where 5% of paid claims receive 49% of dollars paid.2GAppeals and Tort ClaimsThe number of appeals to the Advisory Panel increased from 2.5% of claims resolvedprior to 1986 to 4.1% ofclaims resolved through 1991 (Table 3). Over the same periodthe number appealed to arbitration increased sixfold but is still very low in absoluteterms (33 of the 58,972 resolved claims). Of the 990 appeals to the panel, the panelconcurredwith the consortiumin about 90% of cases and reversed in 10%. Thispercentagehas remained stable over time. The plaintiff’s chances of winning atarbitration have remained roughly 20%. The number of tort claims has also increased,from 5 through 1986 to 35 through 1992. 27 The plaintiff has won in three cases, lostin seven, and the remainder are still undecided.28TABLE 2. Percentage distribution of cumulative payout under PC1 and PI by category of lossJan. 1975July 1986Pain and sufferingIncome lossMedical costsDeathTotalJan. 1975Dec. 199168151521007413112100Sources: Oldertz (1986) footnote 11; Espersson (1992) footnote 19.TABLE 3. Appeals, arbitration, and tort claims: cumulativeJun. 1975July 1986Appeals to panel(Percent of resolved claims)Arbitration(Patient win)Tort claims9902.46%Sources: Oldertr (1986) footnote 1 I; Espersson (1992) footnote 19.(I?5Jan. 1975Dec. 19912,4404.14%(36;35
458The Swedish Patient Compensation System: Myths and RealitiesPremiumsPC1 premiums were roughly SEK 16.7 (US 2.38) p er capita, or 0.16% of health carespending, which was SEK 11,000 (US 1,57 1) p er capita in 1989.2g By contrast, medicalmalpractice insurance premiums in the United States are l-2% of total health carespending, or roughly a IO-fold difference as a proportionof health expenditures,which are larger in the United States.‘” The higher claim frequency in Sweden is thusmore than offset by lower claim severity, due to collateral source offset (which iscost shifting, not real cost reduction),lower payments for pain and suffering, andlower overhead.MRBClaimsThe number of complaints filed with the MRB-roughly1,400 per year”‘-isaboutone fourth of the 5,500 annual filings with the PCI. Of these MRB claims, roughly60% are deemed to have sufficient substance to be taken up by the board, and lo-15%receive some sanction.Comparingthe number of paid PC1 claims with the number of patient-initiatedMRB filings provides a very rough measure of the loss in deterrencethat resultsfrom decoupling compensationfrom deterrence.If all cases compensated by the PC1involved some medical error, and noting that 25% of MRB claims were not potentiallycompensable,since the only allegation was impolite treatment, there is a large gapbetween the roughly 2,200 compensatedPC1 claims per year, 600 cases reviewed bythe MRB (with allegations beyond impolite treatment),and 80-120 that result in areprimandor warning. This discrepancy, roughly 1 sanctioned MRB case per 20compensatedPC1 claims, provides a measure of the loss in potential deterrencethatresults from separating discipline and compensationin Sweden.%Comparing the number of sanctioned MRB claims in Sweden with the number ofpaid malpractice claims in the United States (assuming that 50% of the 16 malpracticeclaims per 100 physicians in the United States result in payment to the plaintiff), thefrequency of MRB claims per 100 physicians in Sweden is about one third of thefrequency of malpractice claims per 100 physicians in the United States. The numberof sanctioned MRB claims is about 11% of the number of paid malpractice claims perphysician in the United States. This contrasts with a rate of PC1 claims for compensationthat is 50% higher in Sweden than in the United States. Of course, these comparisonsdo not indicate the success of either system in sanctioning or deterring true negligence,because the number of negligent injuries is not known and cannot be inferred directlyfrom the number of claims.33IF Overhead CostsThe administrativecost of the PC1 was 18% of premium in 1992; this implies thatover 80% of PC1 insurance premiums reaches patients as compensation,comparedto roughly 40% of the U.S. malpractice insurance premium.34 The Swedish figurewould probably be even lower if costs and benefits paid under social insurance wereincluded. However, these figures are misleading because they focus on compensationand omit the deterrence functions of the tort system. The information generated anddeterrencesignals sent by the PC1 and MRB combined are surely less than in theU.S. tort system, although whether these deterrencebenefits outweigh the highercosts is an open question.
PATRICIAM. DANZON459More fundamentally, overhead cost as a percentage of premiums is meaningless asan indicator of the efficiency of an insurance system that is subject to moral hazard,that is, where the availability of insurance affects behavior and hence the frequencyof injuries and claims. In competitive insurance markets, insurers have incentives toinvest in loss prevention and claims control if the marginal savings (in injuries prevented or unwarrantedpayments averted) justifies the marginal overhead cost.95 Forexample, if a liability insurer simply pays every claim filed at the amount requestedby the plaintiff, overhead expense is minimal, benefit payments are high, and theoverhead ratio is very low. Conversely, if an insurer provides loss prevention and riskmanagementservices to insureds and litigates claims that appear frivolous, this resultsin higher overhead, lower loss payments, and a higher overhead percentage. Efftciencymay nevertheless increase (real social costs are lower) ifthese investments in loss controlreduce the frequency of injuries and invalid claims. Thus the overhead percentage isa very misleading measure of the true social overhead, which includes the unobserveddeadweight loss due to nonoptimal rates of injuries and claims.96As argued earlier, the PC1 does not owe its low overhead percentageto use of acausation-onlytest for compensability.A more plausible explanationderives from asimple model of expenditureon litigation as a rational investment by the litigants.The magnitude of this investment reflects expected costs and benefits. For the defense,the objective function may be writtenMin p(x)A wx,Xwhere x is the input of litigation effort, w is the cost per unit, p is the probability ofa plaintiff verdict, with pX 0, and A is the expected award at verdict. Minimizingwith respect to x and rearrangingyieldswx---g -E,,x.In equilibrium,the ratio of litigation expense to benefit payments is equal to theelasticity of expected payout with respect to effort, E,,,. A similar relationship can bederived for the plaintiff, assuming that the objective is to maximize the expectedpayoff, net of attorneys’ fees. 37 Thus, the key to reducing litigation expense is toreduce the parties’ expected payoff on these investments, E,,,.Applying this simple model, the PC1 owes its low overhead rate to the followingseveral factors that reduce all parties’ incentives to invest in litigation:a. Written rules of compensability and damages. The use of written rules reduces uncertainty and the ability to influence the outcome, thereby reducing incentives to investin litigation. 3xThe contractual basis of the PC1 may permit it to be both more specificthan common law and more flexible in adapting to change than statutory schemes.Administrationby a single consortium may result in more consistent decisions thanoccurs with heterogeneousjudges and juries.b. Elimination of provider-specific liability. Eliminationof provider-specificliability,including financial responsibility and the terminology of fault, are probably the mostcritical features leading to prompt and nonlitigious claim resolution. Under the PCI,providers have no incentive to oppose compensation;indeed, by supporting ratherthan opposing the patient’s case, they may actually reduce the likelihood that thepatient files a disciplinary charge against them with the MRB.
460The SwedishPatient CompensationSystem:Myths and RealitiesEqually important is the absence of experience-ratedpremiums. Provider cooperation would surely be less complete and litigation more extensive if the negligencerule had been replaced by strict provider liability with experience-ratedpremiums,as in enterprise liability proposals. The elimination of all feedback about individualphysicians from the PC1 to either their employers or to the MRB eliminates indirectsanctions or reputation costs. Lack of public access to decisions or deliberationsofthe panel or arbitration also reduces the risk of adverse publicity for providers, makingthem more willing to cooperate.Thus on the defense side, the key to low litigation expense is that individual providers have no personal stake in the outcome. They therefore invest nothing themselvesand put no pressure on insurers to oppose patient compensation.c. Simplified procedures/limitedpatient tights. The reduced factual inquiry to determinecompensability, the simple administrative procedures for filing and adjudication, andrelying on written rather than oral evidence reduce costs relative to formal tort proceedings.However, these simple rules reduce litigation expense by providing patients verylittle opportunity for redress against the insurers’ decisions. Dejure patients can appealto the Advisory Panel and to arbitration, or file a tort claim. But de facto they probablywould have difficulty obtaining a medical expert; they would bear their own legalcosts (unless covered by homeowners’ insurance or legal aid); the lack of public accessto PC1 decisions and decision making probably reduces patients’ informationandability to influence the system, as does the fact that oral representationis generallynot permitted. Thus, the minimal litigation expense incurred by patients and lowappeal rates may reflect low expected payoff from appeal, rather than a high levelof satisfaction with the insurers’ decisions.However, any dissatisfaction with the PC1 rarely spills over into tort litigation becausethe PC1 is structured to offer patients a higher expected net payoff (higher probabilityof compensationand lower costs) than does Swedish tort. Thus Swedish patientsvoluntarily opt for the PCI, although their rights are very limited compared to thoseof a U.S. tort plaintiff.d. Noncompetitive liability insurance. Operationof the PC1 by a monopoly insurerconsortium weakens competitive pressures to control costs by claims control and lossprevention services, underwriting, and experience rating of premiums. These servicesraise measured overhead costs, but total social costs should be lower due to morethan offsetting reduction in injuries and invalid claim payments, and incentives forefficient administration.”e. Lack of competition in health care markets. Providers’ acceptance of flat-rated premiums is facilitated by the lack of campetition in the health care market that prevailedin Sweden until recently. The 1992 health care reforms introduce greater freedomof choice for patients, prospective payment of hospitals, and capitation of primarycare physicians, all of which increase the incentives of providers to control their owncosts and to compete for patients. Cost-sensitive providers are more likely to demandexperience-ratedpremiums and to resist the payment of claims that they deem unwarranted. The reforms are too recent to evaluate full effects. In any case, demand forexperiencerating may remain muted as long as PC1 premiums remain low and arepassed through directly in county council taxes, rather than being allocated as a costto individual hospitals and clinics. The point here is that if other countries seek toretain deterrence and operate competitive health care and liability insurance markets,they cannot expect to match the PCI’s low overhead rate.
PATRICIAM. DANZON461V. Is the PC1 an Efficient Contractual Alternative?Since patients and providers overwhelminglyopt into the PCI, it presumably offersa Pareto-improvingalternative relative to the tort system. More generally, some features of the PC1 are consistent with theoretical predictions of efficient contracts forinjury compensation.For example,the written criteria of compensabilityreduceuncertainty and incentives for litigation. The structure of damage payments is generally consistent with theories of optimal compensation.Payments for pain and sufferingare determinedby a schedule based on the plaintiff’s age and injury severity. Theamount of payment for future damages is determined at the time of claim disposition4”but is paid as an annuity if the award is a significant fraction of the injured person’ssupport, with adjustment if circumstanceschange. However, this cannot be attributedsolely to efficient contractual choice, since Swedish tort benefits follow a similar structure, and the PC1 must match tort benefits in order to preempt tort claims.Other features of the PC1 are inconsistent with theoretical predictions about contractual choices for compensabilityand damages. Economic analyses generally concludethat compensationfor pain and suffering is of relatively low or zero value.4’ Suchtheories cannot readily explain the choice to operate a system whose primary functionis to pay compensationfor pain and suffering. The PC1 structure is also inconsistentwith the prediction that the contractual choice of liability rule would be either noliability (and no compensationexcept from private or social insurance) or liability forwillful harm or gross negligence.42Moreover, providing compensationconditional on medical causation but with nolink to deterrence is contrary to the conclusion that ifcompensationis the sole objectiveit is more efficiently provided through first-party private insurance or social insurance(Danzon, 1985, footnote 26). Indeed, since the PC1 is supplementaryto a generalsocial insurance system and is financed by a per-capita premium that is ultimatelyfunded largely through the income tax, a more efftcient solution would appear to beto expand the social insurance program, thereby eliminating the cost of operatingthe PCI. The PC1 selects for additional compensationinjuries that are caused byinappropriatemedical care, whereas the unlucky outcomes of disease or appropriatemedical care receive only the basic social insurance. The theory of optimal compensation-andthe PC1 is solely a compensationmechanism-providesno justification forhigher compensation,including payments for pain and suffering, depending solelyon the cause of the injury.These predictionsarise in a Coasian world, with perfect informationand zerotransactionscosts, in which the contractualalternative to tort liability would bedesigned to minimize the real social costs of medical injuries, including the utilitycosts of injuries, preventive measures, litigation, and other overhead. In reality, contracting is constrained by the income distribution implied by the prevailing tort regime,by other institutional constraints, and by transactions costs.The PC1 contractual choice can be modelled by modifying the standard model ofout-of-court settlement, since settlement is a case-specific contractual choice. Assumeinitially that intermediariesare perfect agents and that patients and providers arehomogeneousand risk neutral, with state-independentutility, so we can model thebargain as between a representativerisk-neutral patient and physician. Assume fullinternalizationof all costs and benefits. The patient’s minimum ask is defined by thepatient’s expected tort benefits, including expected net gain from statutory expansion,minus any net change in litigation costs, plus any net change in expected future injury
462The Swedish Patient Compensation System: Myths and Realitiescosts (deterrence):X’ PiA!! pi& - (Cl- Cl) (D: - D!!),(1)where Xi is the patient’s minimum ask, p is the probability of payment conditionalon an iatrogenic injury, A is the expected award, C is litigation costs, and D is expectedfuture deterrencebenefits net of prevention costs. Subscripts a and t denote thecontractual and tort alternatives, respectively, and superscripts i and j denote patientand physician, respectively. The physician’s maximum offer XJ is equal to the physician’s expected costs of tort, plus the expected change in monetary and nonmonetarycosts of litigation,XJ p!A’g piAi (Ci - C;) (D{ - DJd),where D is the physician’sbargaining range isxj-xi p&i- p;&psychological ( 4 -cl)or nonmonetary (Cl -costs of litigation.C:) (Dl - DB) (D: - D:).(2)The(3)If the parties have equal expectationsof the tort outcome, the bargaining range isthe sum of the net reduction in litigation expenditureto both sides, plus the reductionin the physician’s psychological costs, minus any reduction in expected deterrencebenefits to patients:Xj - Xi AC’ ACJ ADJ AD’.(3’)Although the potential gain from contracting out AC’ ACJ ADJ AD’ is assumedhere to be fixed, a more complete model would treat this as endogenous. In the absenceof constraints, the parties would select the contractua
I. Introduction The Swedish compensation system for medical injuries has been suggested as a possible model for medical malpractice reform in the United States and in other countries.2 Patient compensation in Sweden is provided by the Patient Compensation Insurance . of tort liability, possibly to a form of strict liability. 'O Private .
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