Japan Obstetric Compensation System for Cerebral Palsy: Strategic system of data aggregation, investigation, amelioration and no‐fault compensation

Abstract

The Japan Obstetric Compensation System for Cerebral Palsy (JOCS-CP), which investigates, develops preventive mechanisms and awards monetary compensation, to cases of cerebral palsy was urgently introduced in 2009 in response to growing concern about Japan's deteriorating perinatal care and low birthrate. Under the political leadership, the Japan Council for Quality Health Care launched the JOCS-CP with support of various stakeholders. The JOCS-CP features of no-fault-based compensation which was discussed decades ago in the Japan Medical Association aiming at financial aid to patient and family and early settlement of dispute. As of 2017, 2233 petitions had been approved by the Review Committee for compensation. All the approved cases were consecutively put on analysis in the Investigation Committee which has compiled more than 1000 Investigative Reports. The reports were delivered not only to the childbirth facility but to the guardians/families. Survey revealed that most of childbirth facility and the guardians/families responded in favor of the reports. With regard to amelioration of profound cerebral palsy, the Prevention Report has been published on annual basis through analysis of all the Investigative Reports. The Prevention Reports and other educational materials were produced and distributed not only among medical professionals but among pregnant women. It is notable that the number of lawsuit filing related to obstetrics demonstrated rapid decrease compared to that of other medical specialties. The JOCS-CP could be described as a social experiment. It was overhauled in 2015 but deserves further discussion on reform for evolving into better system.

Current Status of the Obstetric Compensation System for Cases of Cerebral Palsy at a General Hospital in Tochigi, Japan

“…When parents of children with cerebral palsy wish to apply for the JOCSC, diagnosis by a registered physician (pediatric neurologist or certified physician for physical disability) is necessary. 4 Although 500 physicians are registered at present in Japan, an increase in the number of registered physicians may be preferable to expand the scope of the JOCSC. At our hospital, applications for the JOCSC were submitted for 11 cases (5 cases born at our hospital and 6 cases born at other childbirth facilities).…”

“…Children eligible for the JOCSC were defined as follows. 4 1. Gestational week at 33 weeks or later and birth weight of 2000 g or more, or 28 weeks or later with apparent asphyxia at birth for children born between January 1, 2009 and December 31, 2014.…”

“…US $280 000) were paid for each recipient of compensation. 3,4 In addition, after authorization of a recipient as being eligible for compensation, the causes of the cerebral palsy were analyzed from a clinical viewpoint. The analyses reports were provided to both the caregiver of the child and the childbirth facility.…”

“…Therefore, nationwide security of the perinatal medical system is required. 4 Under these circumstances, the Japan Obstetric Compensation System for Cerebral Palsy (JOCSC) was established in January 2009, as the first nationwide no-fault compensation system. [3][4][5][6] No-fault compensation system in medicine was precedingly introduced in New Zealand, Norway, and Sweden et al, so the JOCSC referred to the system of these countries when it was established.…”

“…4 Under these circumstances, the Japan Obstetric Compensation System for Cerebral Palsy (JOCSC) was established in January 2009, as the first nationwide no-fault compensation system. [3][4][5][6] No-fault compensation system in medicine was precedingly introduced in New Zealand, Norway, and Sweden et al, so the JOCSC referred to the system of these countries when it was established. 7,8 In our country, this system is managed by the Japan Council for Quality Health Care (JQ), which has major functions, including compensation for the economic burden faced by children with cerebral palsy and their families, analysis of the causes, and prevention of recurrence of similar cases.…”