Author Affiliations: Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan (Drs Nakajima and Tatara); Risk Management Foundation, Harvard Medical Institutions, Boston, Mass (Dr Keyes); and law office of Kaneko & Iwamatsu, Tokyo, Japan (Dr Kuroyanagi).
Section Editor: Annette Flanagin, RN, MA,
Managing Senior Editor.
Medical malpractice claims and dispute resolution systems have been
examined in Western societies for their impact on the quality of care and
efficient compensation for injured patients. However, little is known about
the Japanese malpractice environment because claim information has been closely
guarded. Based on data from the Japanese Supreme Court, the Ministry of Health,
Labor, and Welfare (formerly the Ministry of Health and Welfare), and the
Japan Medical Association (JMA), which provides malpractice insurance to 43.5%
of Japan's 250 000 physicians, we review Japanese malpractice liability
systems and the frequency of claims during the last 30 years. Annual premiums
for physician professional liability insurance are relatively low ($454-$491).
Although the frequency of claims in Japan is lower than that reported in the
United States, England, and Germany, the number of claims is increasing in
Japan. According to publicly available data from the Japanese Supreme Court,
the annual number of medical malpractice suits filed in district courts has
increased from 102 in 1970 to 629 in 1998 (from 0.09 to 0.25 per 100 physicians).
The proportion of awards greater than $89 300 increased from 13.6% in
1976 to 65.4% in 1987. Among JMA members, claims increased 31% from 1987 to
1999, but the frequency of claims has remained at approximately 0.3 per 100
JMA members. The JMA's professional liability program offers a nonbinding
out-of-court review of claims that is faster and less expensive than judicial
resolution (a few months with no attorney required vs 35 months and attorney
fees), but is a poor means of deterrence or discipline. Since JMA data represent
only 43.5% of Japanese physicians, generalizations cannot be made about all
Japanese physicians and institutions. The lack of data on all claims hinders
adequate evaluation of dispute resolution methods, development of appropriate
risk management activities, and proactive education for Japanese physicians.
Nakajima K, Keyes C, Kuroyanagi T, Tatara K. Medical Malpractice and Legal Resolution Systems in Japan. JAMA. 2001;285(12):1632-1640. doi:10.1001/jama.285.12.1632