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June 2024 
MPL Around the World


Table of Contents

Reveal Background
TOUCH
About Our Issue
About Our IssueRead More
TOCJuneInternational
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International Market Challenges
International Market ChallengesRead More
TOCJune2Europe
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Europe: Relyens/SHAM
Europe: Relyens/SHAMRead More
TOCJune4SouthAfrica
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South Africa: PPS and the Landscape
South Africa: PPS and the LandscapeRead More
TOCJune5Germany
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Germany: Established Market Opportunity
Germany: Established Market Opportunity Read More
TOCJuneSaudiArabia
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Saudi Arabia: An Emerging Market
Saudi Arabia: An Emerging MarketRead More
TOCJuneInova
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Your Captive Solution: Inova
Your Captive Solution: InovaRead More
TOCJuneMedmarc
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Insuring Non-U.S. Clinical Trials with Medmarc
Insuring Non-U.S. Clinical Trials with MedmarcRead More
TOC Ties That Bind
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Ties That Bind
Ties That Bind Read More
August Graphic13
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News & Updates
News & UpdatesRead More

About Our Issue

Last summer a select group of ProAssurance team members undertook significant research into different MPL environments outside the United States. They gathered perspectives from our Risk Management, Claims, and Underwriting teams, engaged in attorney and broker discussions, and read numerous industry trade articles and reports. From these efforts, the team identified key variables necessary for analyzing any new MPL market opportunity. These insights—including demographics and scope, regulation and legalities, claims processes, and values alignment—were then considered in light of ProAssurance’s vision to build trusted partnerships and provide effective insurance solutions for medical professionals.

Ultimately the team noted there was not an international market that aligns with ProAssurance’s current strategic goals. But their research into the international malpractice landscape was captivating. The team also provided an interesting spotlight on ProAssurance’s current and recent international activities.

In this issue we would like to share their findings with all of you as a resource. We have compiled a look at key issues impacting the malpractice landscape in different countries, as well as two spotlights on countries the team noted were of particular interest—Germany and Saudi Arabia. We also highlight the various ways in which ProAssurance has dipped its metaphorical toes into international waters in recent years, and the knowledge we gained as part of that work.

Team Responsible for These Findings:

JordanBurnsImage
Jordan Burns Director, SPC & IT Audit PMO
BriannaCreelImage
Brianna Creel Director, Hospital & Reinsurance Underwriting
AdamDraneyImage
Adam Draney Director, Claims
JoeKimichikImage
Joe Kimichik Production Standard Underwriter
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International Market Challenges

Navigating the complexities of malpractice insurance on a global scale presents a unique set of challenges, particularly for U.S. insurers seeking to expand their reach beyond domestic borders. While the demand for malpractice coverage exists worldwide, varying legal frameworks, cultural attitudes toward litigation, and healthcare systems add layers of intricacy to the process.

We have identified eight challenges of particular importance when considering selling medical malpractice insurance abroad.

1. Judicial Independence and the Rule of Law

Central to the challenges of selling malpractice insurance internationally is the issue of judicial independence and the rule of law. In many countries, particularly emerging markets, the concept of an independent judiciary and adherence to the rule of law may differ significantly from the standards observed in the United States. This variance can create uncertainty for insurers, as the consistency and predictability of legal outcomes play a crucial role in assessing risk and determining insurance premiums.

Additionally, concerns about corruption, political interference in legal proceedings, and the enforcement of contracts further complicate the landscape for insurers operating in foreign jurisdictions.
2. Underdeveloped Medical Malpractice Legal Compensation Systems

In contrast to the intricate legal compensation systems established in the U.S., many countries around the world grapple with underdeveloped or nascent frameworks for addressing medical malpractice. In these contexts, the absence of robust legal mechanisms often exacerbates the challenges associated with selling malpractice insurance internationally. Without clear guidelines for adjudicating malpractice claims and determining appropriate compensation, insurance providers face heightened uncertainty and risk. The lack of established precedents and case law can lead to inconsistency and unpredictability in the resolution of malpractice disputes, further complicating the assessment of potential liabilities and premiums.
3. Medical Malpractice as a Crime

In certain jurisdictions, medical malpractice is not only a civil matter but also a criminal offense. This adds another layer of complexity for insurers operating internationally. In countries where medical malpractice is considered a criminal act, the stakes for healthcare professionals and insurers are significantly higher. The potential for criminal liability can influence risk assessment, underwriting practices, and claims management strategies.

This intersection of civil and criminal proceedings in malpractice cases requires insurers to have a nuanced understanding of both legal frameworks to effectively navigate the complexities of international markets. Insurers must carefully evaluate the legal landscape of each jurisdiction they operate in to ensure compliance with local regulations and mitigate the risk of criminal liability.
4. No Fault Patient Compensation Systems

Some regions are designed to streamline the process of compensating patients for medical injuries without the need for litigation or proving fault, significantly altering the dynamics of malpractice insurance. While they aim to expedite compensation and reduce legal costs, they also introduce challenges for insurers in assessing risk and pricing policies. The absence of fault determination can blur the lines between insurable and uninsurable risks, potentially impacting the viability of traditional malpractice insurance models. The effectiveness of these systems in providing timely and equitable compensation varies across regions. As such, insurers must carefully evaluate the implications of no-fault patient compensation systems on their business strategies and adapt their approaches accordingly.
5. Government-Subsidized Malpractice Coverage

Government-subsidized malpractice coverage represents a significant factor in the international malpractice insurance arena. In some jurisdictions, like the U.K., governments directly provide or heavily subsidize malpractice insurance for healthcare professionals. While intended to ensure widespread access to healthcare services and manage costs, these arrangements can pose challenges for private insurers entering the market. Government-subsidized coverage may alter the competitive landscape by offering lower premiums or more comprehensive coverage than private insurers can provide. The involvement of government agencies in underwriting and regulating malpractice insurance also introduces layers of bureaucracy and compliance requirements for private insurers to navigate.
6. Obtaining Quality Legal Representation

Another significant challenge in the realm of international malpractice insurance is ensuring healthcare professionals have access to quality legal representation. In some jurisdictions, particularly those with underdeveloped legal systems or limited access to legal services, healthcare providers may struggle to secure adequate defense in malpractice claims. This lack of representation can exacerbate the financial and reputational risks for both healthcare professionals and insurers alike.

The differences in legal cultures and language barriers further complicate the process of obtaining quality legal support outside the U.S. Insurers must proactively address this challenge by establishing networks of experienced legal professionals in each jurisdiction where they operate, ensuring that healthcare providers have access to the expertise needed to effectively defend against malpractice claims.
7. Contractual Liability of the Physician

Unlike in some domestic settings where liability is primarily determined by malpractice laws and regulations, international contracts often play a significant role in delineating the responsibilities and liabilities of healthcare providers. These contractual agreements can vary widely in scope and complexity, depending on factors such as the nature of the healthcare system, the involvement of third-party payers, and the preferences of the contracting parties. For insurers, understanding and assessing the contractual obligations of physicians is essential for accurately underwriting policies and managing risks. The variations in contractual arrangements across different jurisdictions can complicate claims management and dispute resolution processes, particularly when conflicts arise between contractual provisions and local malpractice laws.
8. Regulatory Compliance

Navigating regulatory compliance is paramount for insurers venturing into the international malpractice insurance market. Each jurisdiction boasts its own set of regulations governing insurance practices, malpractice laws, and healthcare standards, necessitating a comprehensive understanding of local legal frameworks. Failure to adhere to regulatory requirements can result in severe penalties, reputational damage, and even suspension of operations in certain jurisdictions.

The challenges of selling medical liability insurance internationally are multifaceted, encompassing diverse legal, regulatory, cultural, and market factors. From navigating differences in judicial independence and compensation systems to addressing contractual liabilities and regulatory compliance, insurers face a complex landscape that demands agility, expertise, and a nuanced understanding of local dynamics.

 
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Europe: Relyens/SHAM

Société Hospitalière d'Assurances Mutuelles (SHAM), a Relyens Group company, is a mutual insurance company providing medical malpractice insurance based in Lyon, France. The company is a prevalent medical malpractice insurance provider in France and, while SHAM has operated primarily in France in the past, there has been some expansion into Italy and Spain. ProAssurance and SHAM explored opportunities to collaborate and develop a relationship based on expertise exchange and focus on risk management ideas.

Throughout the relationship, we frequently discussed topics of interests with Dr. Frederic Fuz, the Head of Risk Management Services for SHAM, and Louise Collet, an attorney (juriste) who worked in SHAM’s Risk Management department. ProAssurance hosted a delegation from SHAM at ProAssurance Headquarters in Birmingham, Alabama, in July 2015. ProAssurance’s team showed the delegates one of our insured hospitals, showcased the Birmingham office, and held information sessions with various departments. In September 2015, SHAM hosted a group from ProAssurance to visit their office in Lyon. The group included ProAssurance’s former chief medical officer and medical director, and Aaron Hamming, Director of Risk Management Data Analytics and Technology. The visit was similar to the trip in July with SHAM discussing services and providing a tour of a hospital SHAM insured.

Throughout the collaboration, Dr. Fuz attended several ProAssurance Risk Management conferences. A ProAssurance team met with SHAM in Barcelona, Spain in October 2018, and Risk Management leadership toured a Barcelona hospital. ProAssurance’s team presented on risk management strategies used by our organization as well as resources we offer to our insureds.

Joint Studies

The collaboration between the two entities led to a Key Consideration Report on two studies jointly conducted by ProAssurance and SHAM, “Addressing and Preventing Physician Burnout in France and the United States” and “Closed Claims Retrospective Study of Diagnostic Error Claims.”

The first report was developed through reviewing literature that did not find a definitive relationship between physician burnout and professional liability claims but identified signs and symptoms associated with burnout. Those symptoms included inattentiveness, lethargy, and lack of follow-through in some patient care situations. The study of literature found that burnout can affect any professional, but physicians are particularly susceptible to it. Healthcare systems can assist physicians by providing physical, mental, and healthy lifestyle resources.

The other study focused on two objectives: furthering support of ProAssurance’s and SHAM’s current patient safety strategies and identifying the needs of physicians and hospital staff. The claims they reviewed occurred in the hospital setting, included allegations of diagnostic error, and closed in 2014 with an indemnity payment. Some factors considered include the incident date, the location of the injury, the medical specialty, and others. Investigators identified common contributing factors: SHAM’s study showed significant patient health and medical histories were present in a fifth of the claims studied. ProAssurance’s study showed that the patients’ medical histories were clinically pertinent in approximately 24% of claims but not always considered in the diagnostic process. Between both studies, nearly three-fourths of cases involved emergency or unforeseen, unplanned care, and most of the cases involved emergency department care. SHAM and ProAssurance discovered different main causes of the diagnostic errors. SHAM found the contributing factors included failure to order additional tests, poor clinical examination, lack of review of medical background, misinterpretation of tests, and no requirement of specialists. ProAssurance found failure to order additional testing, improper interpretation of a study, inadequate physical exams, and failure to seek consultation of a specialist to be the main factors in diagnostic error.

The collaborative relationship between SHAM and ProAssurance allowed for an opportunity to expand each other’s ability to understand different factors impacting the medical malpractice insurance field.

 

 

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South Africa: PPS and the Landscape

Professional Provident Society

Since 2018, ProAssurance has nurtured a reinsurance relationship with the Professional Provident Society (PPS), a financial services institution headquartered in Johannesburg, South Africa. Operating since 1941, PPS offers custom insurance solutions for health, life, disability, auto, and investments to its approximately 150,000 professional members. Their Health Professions Indemnity product was developed for private physicians and healthcare professionals in private groups or facilities in response to rising defense costs and an increasing severity of claims.

PPS has modeled their program on ProAssurance’s claims and underwriting processes and uses a modified version of ProAssurance’s policy form, with adoption of a similar approach to reserving claim files. Like ProAssurance, PPS endorses the values of integrity, fair treatment, and collaborative relationships, offering affordable, quality coverage aimed at protecting provider autonomy and reducing liability risk.

The Claims Environment

The number and frequency of medical malpractice claims in South Africa have risen dramatically in recent years. So have premium costs, putting a strain on both providers and public health. The nation experienced a 23% growth in the number of medico-legal claims (claims based on medical negligence or malpractice) in the public sector from 2014 to 2019, and over US$350 million in awards were issued in 2020/2021.

Healthcare in South Africa

South Africa’s healthcare system has a complex history, impacted and shaped by disease, poverty, and discriminatory laws promoting racial segregation. A rise in the Black population in the 1920s and 1930s, combined with policies favoring White citizens in urban areas, led to healthcare disparities. Apartheid policy imposed further restrictions on education, land ownership, and housing for Black citizens. South Africa has also suffered under the weight of life-threatening epidemics like malaria and smallpox in the 17th century and, more recently, HIV/AIDS. After an initial delay in government response to HIV/AIDS, robust initiatives including an antiretroviral program and an increase in dedicated spending for HIV in the early 2000s helped further South Africa’s approach to public health.

The first public health department was established in South Africa in 1919, with community health centers emerging in 1945, marking the beginning of community-based primary care and promotion of broader access to care for citizens. Private healthcare, available since the 19th century, was funded out of pocket until 1889 and was followed by medical schemes, which were introduced to benefit White mine workers. These became available to Black citizens in the 1970s, though at significant cost. The private sector continued to experience growth in South Africa in the 1980s and 1990s, with medical schemes the main source of health insurance in private care.

Today there are about 200 private hospitals in the nation, and 79% of physicians work in the private sector. The South African constitution currently guarantees either public or private health services to every individual citizen. Each of the country’s nine provinces has a Department of Health that provides healthcare delivery and promotes health and preventive services. The public health system is funded by a National Revenue Fund and provides free “low-quality” care for all citizens without formal insurance coverage. Care is tiered and available based on treatment need through primary care facilities as well as district and tertiary hospitals.

The Legal Landscape

Practitioners in South Africa are subject to established laws and principles that regulate medicine and medical practice, such as the Health Professions Act and National Health Act. Medical malpractice or negligence in South Africa refers to a situation where the treatment provided by a physician or other healthcare provider did not meet the standard of care and resulted in an adverse outcome or harm to the patient. The Health Professions Council of South Africa (HPCSA) is the governing body that handles patient complaints and investigates claims made against medical providers.

As in the U.S., a medical liability insurance policy protects the provider, helping to cover litigation and defense costs, and safeguarding the insured against potential damages. PPS claims-made policies, for example, cover advocate (attorney) costs, as well as the costs of criminal prosecution. Insureds also have access to 24/7 medical and legal advice and have the option of extended coverage.

The patient/claimant has a right to pursue legal action against a healthcare provider and seek financial compensation (what they refer to as “quantum of damages”) for what is believed to be negligence. It is the duty of the court to institute a fair proceeding, weigh evidence (e.g., medical records, expert testimony), and determine if negligence occurred. The legal framework for these cases is as follows:

  • Duty of Care: The provider is legally obligated to provide the care that a reasonable healthcare professional would demonstrate in a similar circumstance.
  • Informed Consent: A provider must discuss with the patient the risks, benefits, and alternatives to treatment and obtain informed consent before proceeding with treatment and procedures.
  • Standard of Care: Expert testimony helps determine the standard of care in each particular case, and a breach in standard can lead to a ruling of negligence.
  • Causation: For a finding of malpractice, it must be proven that the provider’s actions or omission of actions directly caused harm or injury to the patient.

If negligence is proven, the court will determine the appropriate level of compensation. Medical expenses, loss of earnings, pain and suffering, or loss of financial support due to the death of a patient are examples for which financial damages may be awarded to the claimant.

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Germany: Established Market Opportunity

Germany has one of the largest insurance industries in Europe and is home to some of the largest insurers globally, including Allianz Group and Munich Re. The market is structured with individuals purchasing insurance from primary insurers, which retain around 86% of the risk on the policies they sell, with the remainder passed on to reinsurers.1

Medical Liability: Germany vs. United States

The German medical liability system is in some ways similar to that of the U.S. system. There are, however, a number of critical differences between Germany’s system and ours.

Lawyers’ and Court Fees

While a contingency fee arrangement is used in most U.S. medical liability actions, the charging of contingency fees by German lawyers is permissible only in limited circumstances. Instead statutory rates dictate both court fees and lawyers’ fees based on the “amount in dispute and the procedural stages covered” in the case. An agreement made by a party in the litigation to pay higher lawyer fees (an hourly rate, for example) is permissible, but the party usually is responsible for the additional costs regardless of the court’s decision in the case “unless the fees in excess of the statutory rates constitute recoverable damages.”2

Damage Awards

In contrast to the judicial system in America, German medical malpractice trials are decided by the judge only. There is no option to have a jury decide the case. Damages, too, differ from the U.S. in that they, like attorney fees, are calculated using legally established guidelines. Damages in the German system (including pain and suffering) are compensatory only. Punitive damages are not awarded at all. Additionally, in the German socialized medicine system, expenses due to injury are mostly paid by the social security system.3

Expert Witnesses

In both Germany and America, medical experts have an important role in medical liability lawsuits. The countries differ slightly on which party employs them. In the U.S., the defense and the plaintiff generally employ their own witnesses to inform their cases. Germany, however, takes a slightly different approach. While plaintiffs and defendants may still hire their own expert witnesses, the judges in cases routinely pick their own expert witnesses. While U.S. judges may appoint their own witnesses, the practice is the exception rather than the rule.4

Loser Pays

Another major difference between the U.S. and German systems is which party pays. In the U.S, plaintiffs and defendants are responsible for their own legal costs, with medical liability insurance paying the covered costs of the defendant. In Germany, the loser of a medical liability case pays the winner’s legal costs. Plaintiffs in Germany do, however, have some protection available in that they can buy special insurance that will cover what they'll owe a defendant if their suit fails.4

German Brokerage Market: Current Trends

The commercial insurance brokerage market in Germany “is at the beginning of a consolidation phase similar to those that started in the U.S. and U.K. around 20 years ago.” Acquisitions of brokerage firms as well as new (often private-equity-backed) consolidators are becoming a regular occurrence, and the leading players are increasing their M&A activities.5

References
  1. Jennifer Rudden, “Insurance Industry in Germany - Statistics & Facts.” Statista. December 21, 2023, https://www.statista.com/topics/9049/insurance-industry-germany/.
  2. “A Concise Guide to Insurance Litigation in Germany,” Clyde & Co LLP, March 3, 2020, https://www.lexology.com/library/detail.aspx?g=169cd652-813f-4687-a2e4-63de9e64ddf1.
  3. Edith Palmer, “Germany: Medical Liability in a Universal Health Care System.” Medical Liability: Canada • England and Wales • Germany • India, June 2009, https://tile.loc.gov/storage-services/service/ll/llglrd/2015372201/2015372201.pdf.
  4. Robert Lowes, “Malpractice: Do Other Countries Hold the Key?” Medical Economics, July 25, 2003, https://www.medicaleconomics.com/view/malpractice-do-other-countries-hold-key.
  5. Tim Braasch, Ainsley Mayhew Seers, and Christopher Sur, “The Consolidators’ Moment Has Arrived: Germany’s Commercial Insurance Brokerage Market.” Strategy&, April 4, 2023, https://www.strategyand.pwc.com/de/en/industries/financial-services/germanys-commercial-insurance-brokerage-market.html.
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Saudi Arabia: An Emerging Market

Diving into the Business Environment

Saudi Arabia’s government is working to build a city in the northwest area of the kingdom that will rely on renewable energy and house more than nine million residents. The project, named the Line, will have a mirror-façade that goes from the Red Sea eastward across the desert into a mountain range. The government also has Project 2030, which is a framework to reduce Saudi Arabia’s dependence on oil as well as expand its economy and develop public service sectors like health, infrastructure, recreation, education, and tourism. Saudi Arabia’s Crown Prince Mohammed bin Salman bin Abdulaziz inaugurated the Saudi Genome Program, aimed to reduce genetic diseases using advanced genomic technologies.

Medical Professional Liability Environment in Saudi Arabia

Saudi Arabia has a medical malpractice policy that mandates the minimum terms regarding medical malpractice errors, the coverage, exclusions, and limits of indemnity. This policy was influenced by an increase in malpractice claims brought against practitioners within the kingdom. More than 3,500 cases have been filed in the medical malpractice area between 2016 and 2018 in Saudi Arabia, which marks a 73% increase in cases over a five-year period. The medical malpractice policy provides indemnity for malpractice and for defense costs, including all costs, fees, and expenses in connection with the settlement of a claim or for defending the insured against the claim. Traditional Islamic law, also known as Sharia law, determines the limits available.

What to Expect If Entering Saudi Arabian Business Market

If a company were to enter the MPL market in the Kingdom of Saudi Arabia, it would be crucial to understand the role of the hierarchy, workweek, prayer times, Sharia law, and Islamic holidays. To build beneficial business relationships in Saudi Arabia, one must take the time to establish personal relationships with those in the kingdom.

If there is a business dispute, Saudi Arabia created the Saudi Center for Commercial Arbitration to help businesses resolve disputes. This program is available to both local and foreign businesses. A portion of Saudi Arabian businesses have incorporated the program into contracts since the creation of the center. Local courts can enforce arbitration awards made with the Saudi Center for Commercial Arbitration, if the laws comply with Sharia law. Companies in Saudi Arabia are not allowed to agree to international arbitration unless they have received approval from the Council of Ministers. Prospective businesses could expect delays in payments from companies that have government contracts. It is also key to understand that Sharia law will impact how legal proceedings function in Saudi Arabia.

References

“About Saudi Arabia,” The Embassy of the Kingdom of Saudi Arabia, accessed May 9, 2024, https://www.saudiembassy.net/legal-and-judicial-structure-0.

“Individual Insurance Solution,” Gulf General Cooperative Insurance, accessed May 9, 2024, https://www.ggi-sa.com/en/detail/individual/medical-malpractice-insurance.

“Medical Malpractice Takaful Coverage,” Al Rajhi Takaful, accessed May 9, 2024, https://www.alrajhitakaful.com/en/personal/medical-malpractice-insurance.

Raed Almannie et al., “The Status of Medical Malpractice Litigations in Saudi Arabia Analysis of Annual Report,” Saudi Journal of Anesthesia 15, no. 2 (Apr-June 2021): 97-10, https://journals.lww.com/sjan/Fulltext/2021/15020/The_status_of_medical_malpractice_litigations_in.4.aspx.

John Barlow and Salma Achour Khouaja, “Saudi Arabia’s Standard Insurance Policy for Medical Malpractice,” HFW, Nov 2021, https://www.hfw.com/Saudi-Arabias-Standard-Insurance-Policy-for-Medical-Malpractice.

Bill Chappell, “A 105-Mile-Long City Will Snake Through the Saudi Desert. Is that a Good Idea?” NPR, July 26, 2022, https://www.npr.org/2022/07/26/1113670047/saudi-arabia-new-city-the-mirror-line-desert.

Abdulhamid Hassan Al-Saeed, “Medical Liability Litigation in Saudi Arabia,” Saudi Journal of Anaesthesia 4, No. 3 (Sep-Dec 2010): 122-126, DOI: 10.4103/1658-354X.71133.

Abdulhamid Samarkandi, “Status of Medical Liability Claims in Saudi Arabia,” Annals of Saudi Medicine 26. No 2 (Mar-Apr 2006): 87-91. DOI: 10.5144/0256-4947.2006.87.

Your Captive Solution: Inova

Inova_logo_websafeAs healthcare evolves, it’s critical to understand alternative solutions for risk financing. Consider Inova® to form a workers’ compensation or medical professional liability insurance program with a single source, bundled alternative for complex and large exposures.

Inova provides a smart alternative to traditional insurance for large entities that desire a more customized risk financing approach. As an established Segregated Portfolio Company (SPC), Inova offers a fully bundled captive solution.

You may consider an Inova program if you are interested in assuming meaningful risk and meet the following criteria:

  • Your current premiums exceed $1.5 million (primary coverage).
  • You seek an alternative insurance solution for complex medical professional liability or workers’ compensation risks.
  • You have an established risk management program and a single insurance “buying decision.”
  • While you are interested in taking on risk, you desire a risk partner that can help support a sustainable program.

Inova’s alternative insurance solution—commonly referred to as captives, or “protected cells”—is part of an SPC structure. Assets and liabilities reside securely within your own cell, providing you with better control over insurance costs and outcomes. However, the broader SPC also enjoys economies of scale that can be leveraged more holistically.

Inova’s “soup to nuts” approach makes it easy to create, participate, and benefit from your own program:

  • Fully bundled offering: Inova is vertically integrated, providing specialized expertise in program formation, underwriting, risk management, and claims administration.
  • Strategic partnerships: Inova has structured, solid partnerships with globally respected reinsurance partners, as well as highly respected financial, investment, and audit firms.
  • Alternative insurance expertise: Inova’s Eastern Re was the first SPC to be authorized by the Cayman Islands Monetary Authority. It also was the first SPC to be assigned a financial strength rating by AM Best Company.

You can be confident knowing that Inova’s SPC structure can help to mitigate fluctuations of traditional insurance pricing cycles—providing you with greater peace of mind. 

Insuring Non-U.S. Clinical Trials with Medmarc

Medmarc-Logo-RGBThrough Medmarc’s international partner, Allianz Global Corporate & Specialty (AGCS), we can arrange tailor-made, locally admitted, clinical trial insurance solutions in more than 160 countries worldwide.


Local Insurance Requirements

In the vast majority of foreign jurisdictions, companies conducting human clinical trials need to demonstrate to local regulators that they have fully admitted, legally compliant clinical trial insurance in place. AGCS has an established reputation and proven capabilities for meeting these regulatory requirements.

AGCS is the center of expertise for global business insurance and large corporate and specialty risks. 

With a worldwide network in more than 160 countries, they are one of the very few global insurers with an exclusive focus on the needs of global corporate and specialty clients.

Solutions Showcase

Get an overview on what you need to know to insure international clinical trials from the Medmarc team.

Medmarc utilizes an open-market distribution network. This means that any properly licensed broker may place coverage with us. You can place business with us and our strategic international partners—without specific appointments, unless required by state law.

For more information, visit the Medmarc website. https://medmarc.com/broker-resources/

ProAssurance Welcomes Risk Managers

BarbaraHunyady-2We are pleased to announce Barbara Hunyady, JD, as our new Midwest Regional Risk Manager.

Barbara is a licensed attorney with experience litigating medical malpractice cases and has defended a number of physicians and hospitals over the course of her career. She joined ProAssurance in 2018 as a member of the Claims department. She managed medical malpractice claims across the state of Michigan and all Michigan interlocutory appeals and was a member of the national appellate team.

You can reach Barbara directly at 517-347-6287 or BarbaraHunyady@ProAssurance.com.

BradBWe also congratulate Bradley E. Byrne Jr., JD, as our new Southeast Regional Risk Manager.

Bradley is a licensed attorney with a background in civil litigation, business development, and professional athlete representation. He has been a member of the Risk Management team since 2020, advising physicians and healthcare professionals on healthcare risk management and professional liability issues. He earned his bachelor’s and juris doctorate degrees from the University of Alabama and is a member of the Alabama Bar Association, the Birmingham Bar Association, the American Society for Healthcare Risk Management, and the Alabama Society for Healthcare Risk Management.

You can reach Bradley directly at 205-776-3048 or BradleyByrne@ProAssurance.com.

 

Please join us in wishing Barbara and Bradley success in their new roles.

November ProVisions Webpage Graphics14-1

Wisconsin Hospitals and Facilities Rate Change

We are committed to responsible pricing that reflects the current risk environment. Upon recent review of our rate plan and rating factors, we have updated the rate strategy for Hospitals and Healthcare Facilities in Wisconsin. A 5% base rate increase, which has been filed and approved, may impact ProAssurance insureds. These changes go into effect July 1, 2024, and are applicable to new and renewal accounts.

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The pandemic wiped out nearly a decade of progress in improving life expectancy within just two years. Between 2019 and 2021, global life expectancy dropped by 1.8 years to 71.4 years (back to the level of 2012). Similarly, global healthy life expectancy dropped by 1.5 years to 61.9 years in 2021 (back to the level of 2012). (World Health Organization)

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Tokio Marine Forecasts ¥1 Trillion 2024 Profit: “Drastic” Growth Ahead

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Global Immunization Efforts Have Saved at Least 154 Million Lives Over the Past 50 Years

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“Breaking Point”: How Australia's Hospital Crisis Is Impacting Each State and Territory

Australia's peak medical body is calling for urgent action and funding to help hospitals mitigate a crisis as wait times for planned surgeries hit record highs.

The Australian Medical Association's latest annual Public Hospital Report Card showed the national median waiting time for planned surgery was 49 days in the 2022-23 financial year. It's an increase of nine days on the previous 12 months, and 13 days longer than 10 years ago. (SBS News)

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Cameroon Doctors Flee to Europe, North America for Lucrative Jobs

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The number of people, including doctors, acquiring passports and applying for visas has increased by 70%, officials say. In addition, 75% of the 1,000 doctors that Cameroon’s government trains each year are leaving. (VOA News)

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Senior Doctors in South Korea Submit Resignations, Deepening Dispute Over Medical School Plan

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Selling Deep Before Selling Wide

TTBJune

One morning, I got a call from Mike, my sales manager. "How about adding the Florida Keys to your territory?" he asked. Apparently, Bob, who had it for years, rarely ventured there. "Only three hospitals, a handful of surgeons, but if anyone can squeeze some sales out of it, it's you."

This proposition came six months after I'd assumed the most extensive geographical territory in the distributorship, spanning 120 miles from Boca Raton to Sebastian. I was already busier than I ever imagined. Still, more territory meant more commissions, and there are worse things than driving around the beautiful Florida Keys while feasting on the world's best key lime pie (my favorite).

"Sure, Mike. It's not exactly next door, but I'll figure it out."

The closest account was in Key Largo, a 2.5-hour drive from my home in Jupiter. Key West, with the most potential, was a whopping 5.5-hour drive.

Fast-forward to six months later, I only called on The Keys twice, as I stayed busy in my main territory. The Keys accounts were too far away, and both times I went there, the surgeon I hoped to see had gone fishing. I was already spending more time behind the wheel than with prospects.

Mining the Gold Closer to Home

Analyzing my territory, I discovered that most of my business flowed from customers within a 15-mile radius. Digging deeper to identify hospitals with the most growth potential, I realized they were the same accounts.

Going through each account in this relatively small part of my territory, it became apparent why business had slowed. I had done a fair job of calling on key surgeons, but my follow-up attempts were random and sporadic. Additionally, there were surgeons and other decision-makers I had never met.

It was time to narrow my focus.

Prioritizing Follow-up Over Searching for New

Success in healthcare sales hinges on a solid follow-up strategy. My best accounts were those where I had built relationships, so I adjusted my follow-up approach to prioritize this over solely pursuing immediate sales.

Doctors and other HCPs are more likely to do business with sales professionals who sustain a consistent and reliable presence. Focusing more on targeted accounts and tailoring solutions and support based on each stakeholder's needs paid off. I was closing more deals while burning less gasoline!

Please ... Cut My Territory!

These are words you'll rarely hear from a salesperson. Still, after significant growth working just a small part of my territory, it made sense. I had too much on my plate. I asked Mike to reassign my accounts in The Keys and gave up five additional hospital accounts at the far reaches of my territory. This freed up my time for a comprehensive approach to each account before moving on to the next.

Sometimes, Less Is More

It may seem counterintuitive that a smaller territory could lead to more business, but in healthcare, sales is much more than just a numbers game. It's essential to connect with each stakeholder and understand their buying motives during the sales process.

Sales grew consistently once I dug deep into each account rather than spreading my efforts wide across the entire territory. Greater riches don't automatically result from an expanded prospect pool; in fact, it can have the opposite effect. It's better to meticulously work the accounts you've already engaged than drive all over creation in search of your next sale—even if it means forgoing the best key lime pie you've ever tasted.

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Written by Mace Horoff of Medical Sales Performance.

Mace Horoff is a representative of Sales Pilot.  He helps sales teams and individual representatives who sell medical devices, pharmaceuticals, biotechnology, healthcare services, and other healthcare-related products to sell more and earn more by employing a specialized healthcare system.

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