History of the Norwegian patient injury system
The Norwegian System of Patient Injury Compensation (NPE) was established in 1988 and celebrates its 30th anniversary in 2018. To mark our anniversary, we have looked at some statistics covering our 30 years of patient injury compensation, and present some milestones from the beginning through to 2017 here.
NPE was established as an interim scheme in 1988, pending adoption of the Patient Injury Act. The intention was for NPR to be in existence for just three years. It was not until 1998 that the government put forward a bill, followed by an additional proposition in 1999, before the Patient Injury Act was finally passed in 2001. In 2003, the new Patient Injury Act entered into force, but only in respect of the public health service. Until then, the system had been administered by KLP forsikring.
The aims of the system
The system was set up in order to process claims for compensation from patients who believed that they had sustained injuries as a result of treatment at a public somatic hospital in Norway. More and more patient groups have been included in the system over the years. Today, we process compensation claims from patients who believe they have sustained injuries following a failure of care by either the private or the public health service.
NPE as an interim scheme 1988 – 2003
In 1988, NPE received 231 applications, and we paid out a total of NOK 62,348 in compensation.
In 1989, we were tasked with processing drug cases on behalf of the Norwegian Legemiddelforsikring drug insurance pool, and we received the first two drug cases relating to adverse reactions. In 1989, we paid out a total of NOK 1 million in compensation.
1993 saw NPE’s first serial injury case. We received the first “Boneloc” case, which concerned a type of bone cement used in hip replacement surgery. Over the next few years, a total of 390 cases were reported relating to this cement. 84 percent of these cases were upheld.
In 1996, we arranged the first contact meeting with the country’s patient and user ombudsman. The last time we arranged the meeting was as recently as autumn 2017.
In 1999, we paid out a total of more than NOK 1 billion in compensation.
In 2001, the Patient Injury Act was adopted, and 2002 saw the launch of our website: npe.no.
NPE became a state administrative body
In 2003, the new Patient Injury Act entered into force. As a result, all public health services were now included in the system. At the same time, NPE was formally established as a state administrative body under the Ministry of Health and Care Services. By then, NPE had, as a three-year interim system, celebrated its 15th anniversary. In the same year, we paid out a total of NOK 388 million in compensation – over NOK 100 million more than the previous year.
In 2004, we received the first cases about the drug Vioxx, which was withdrawn from the market because it produced adverse reactions in the form of an increase in the risk of stroke and heart attack. Vioxx was a painkilling and anti-inflammatory drug, which was primarily used by patients with arthritis or osteoarthritis. By 1 January 2018, we had dealt with 277 cases concerning Vioxx.
By the end of 2007, we had received a thousand cases concerning drug injuries since the first case was reported in 1989. This year, we will pay out over half a billion kroner in compensation for the first time.
In the same year that we celebrated our 20th anniversary – 2008 – 400 participants gathered for Norway's first national conference on patient safety at Oslo University Hospital. It was NPE which took the initiative to arrange the conference, by inviting key stakeholders in the health service to a meeting.
The private health service is included
In 2009, the private health service was included under the patient injury system. During the first year, 265 compensation claims were received relating to private treatment. By the year-end 2017/2018, we had received a total of 4,490 cases. This year, we also started transferring medical records electronically with certain treatment providers. The annual compensation payout has increased to over NOK 750 million.
NPE had both its own board and a separate council from the outset. The council was disbanded with effect from 1 January 2009. The council was disbanded partly because its role was unclear and partly because its duties overlapped with those of NPE’s board.
In 2010, we received the first compensation cases concerning the swine flu vaccine, Pandemrix. By the end of 2017, we had received 734 cases linked to the vaccine.
In 2014, we paid out more than NOK 1 billion in compensation in a single year for the first time, the highest annual amount of compensation we have paid out to date.
NPE’s board was disbanded in 2016. The board was disbanded because management of the agency was successfully being handled through the dialogue between the Ministry of Health and Care Services and NPE.
By the end of 2017, we had received 88,512 claims for compensation and paid out a total of NOK 12.7 billion in compensation, since we were set up as an interim scheme in 1988.