Exploding the malpractice claims myth

Bakers keep notoriously unsociable hours. In order to have fresh bread ready on shop shelves each morning, the hard work of kneading and proving the dough must start while most of us are still firmly tucked up in bed. So it was nothing unusual for the staff of a particular bakery in Pudding Lane, London to be at work just after midnight on a Sunday morning.  It was probably nothing unusual when one of the staff reported that a small fire had broken out – baking in original wood-fired ovens will inevitably produce the occasional spark. 

This, however, was no usual fire; the year was 1666 and the flames from Farriner’s bakery would spread to become the Great Fire of London. When the firestorm subsided four days later, 13,500 properties had been destroyed, including St Paul’s Cathedral, the Royal Exchange, Customs House, and Bridewell Palace. 

From the ashes of this calamity rose some of the world’s first insurance companies, amidst smouldering monuments to the usefulness of fire insurance that lay in the debris of ruined homes stretching for miles in every direction. The newly-formed “Insurance Exchange for Houses” sold 5,000 policies in its first year of operation – a phenomenal take-up rate.  Their salespeople stoked fear in the hearts of Londoners by arguing that a recurrence of the Great Fire was almost inevitable. Suitably motivated, customers queued up to buy this new, relatively expensive, and as yet unproven financial product. 

Fast forward 360-odd years and, as anyone who has ever met a broker knows, generating fear of catastrophe remains the big hammer in most insurance salesperson’s toolkit. One exception to this, at least in Singapore, is malpractice insurance for doctors. While it is not mandatory under any law, every hospital here requires doctors who seek practising privileges to provide evidence of cover. As a result, the vast majority of Singapore’s private sector doctors and dentists routinely purchase malpractice insurance. Therefore, it is not necessary here to alarm doctors with doomsday scenarios about increasingly litigious patients, skyrocketing awards of damages and reputational destruction.

Or so you might think.

It turns out that there is an alternative use for invoking gloom and doom. For some years now a number of malpractice insurers in Singapore have been routinely applying rate increases at every renewal. The justification given for these price hikes is that malpractice actions in Singapore are on the rise so insurers are paying out more in claims and therefore are forced to adjust premiums.  When you think about it, this is quite a clever response as it simultaneously justifies premium increases and reinforces the importance of continuing to carry malpractice insurance. But just because it is clever does not mean it is accurate.

Investigating Malpractice Cases

Most patients wishing to bring an allegation of malpractice against their provider will start by making a complaint to the Singapore Medical Council or the Singapore Dental Council. There are sound reasons for this strategy; it is a low-cost means of testing the strength of your case, and a successful complaint gives the subsequent civil proceedings a strong chance of success. So, let’s look at the number of cases the SMC and SDC have referred to their tribunals over the past five years:

The first thing to note about these numbers is how small they are. The average number of annual tribunal hearings is only 16. Singapore has around 16,000 practising doctors and dentists, and so in any given year there is a one in one thousand chance of being brought before a tribunal. This is even more striking when you consider that not all of these hearings were for malpractice-related matters. What’s more, there is no evidence of any increase over time. For both doctors and dentists, 2019 was the worst year in the last five and otherwise the number of tribunal hearings is relatively stable. 

Further evidence for the very low claims level is found in a question to Singapore’s Minister for Health, Mr Ong Ye Kung, tabled on 23 September 2023 :

To ask the Minister for Health what is the (i) average number of complaints received per month for alleged medical negligence by hospital staff and (ii) average total patient intake per month, with a breakdown respectively for Sengkang Hospital, Singapore General Hospital, Tan Tock Seng Hospital and other regional hospitals. 

The response from the Minister is striking:

In 2022, the Singapore Medical Council (SMC) received an average of one complaint per month for alleged medical negligence by registered medical practitioners in the public sector hospitals. All these complaints were investigated, most of them involved complex cases, and the SMC was satisfied that there was no negligence on the part of healthcare workers. There were no such complaints received by other Professional Boards. 

The entire Singapore public healthcare sector, employing the majority of all doctors and dentists, generated only one complaint a month to the SMC and the vast majority of these complaints were found to be without merit. That is about as far from a malpractice claims crisis as you can get.

These figures do not consider the size of potential claims, and it is possible (although extremely unlikely) to have a year where claims volumes reduce but overall claims costs nevertheless increase. However, there is no evidence that malpractice awards are on the rise either. The largest malpractice judgment ever handed down in Singapore was the $5.3 million award against two doctors following the death of Mr Franklin Heng following a liposuction procedure. That finding was made in 2015 and has not been surpassed since. In any case, even if the average cost of smaller malpractice claims has risen, the very small claims volume we see in Singapore renders such increases immaterial.

Of course, none of these should be interpreted as a justification for not taking up malpractice insurance. The statistics indicate that the risk of claims is small, but this also means that doctors who are the subject of claims face greater scrutiny and a higher potential for loss of reputation. You should continue to purchase cover, but do so in the knowledge that the probability of ever having to use it is relatively small. More importantly, should your insurer tell you that premiums must increase due to the increasing claims trends in Singapore, invite them to present some evidence in support.

Authored by:

Mike Griffiths
Regional Director, Healthcare
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