Ken Perez 2The Institute of Medicine’s landmark report, To Err is Human: Building a Safer Health System, released in November 1999, famously declared that 44,000 to 98,000 Americans died each year due to preventable mistakes in hospitals. In addition, the report estimated the annual costs of medical errors at $17 billion to $29 billion. It’s estimated that more than 100 million Americans heard about the IOM report thanks to widespread media coverage, which conveyed the idea that medical errors were more prevalent and costly than previously thought.

In spite of all the publicity about medical errors, is the U.S. healthcare system any safer more than 16 years later?

Probably not. On May 3, BMJ (formerly the British Medical Journal) published an analysis  (login required) led by Dr. Martin Makary, a Johns Hopkins surgeon, of prior research. The analysis concluded that more than 250,000 Americans die each year from medical errors. Based on the Centers for Disease Control and Prevention’s (CDC’s) official list of the top causes of death, medical errors would rank behind only heart disease and cancer, which each took about 600,000 lives in 2014, and ahead of respiratory disease, which caused about 150,000 deaths.

The kind of medical mistakes that can be fatal range from surgical complications that go unrecognized to errors regarding the doses or types of medications administered to patients.

No one knows the precise toll of medical errors, in large part because the coding system used by CDC to record death certificate data fails to capture items such as communication breakdowns, diagnostic errors, and poor judgment, all of which can cost lives.

The economic cost of medical errors was analyzed more recently in a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. According to the findings, medical errors in 2008 cost the United States $19.5 billion—$17 billion (87 percent) of which was directly associated with added medical costs (inpatient care, ancillary services, prescription drug services, outpatient care). The remainder was due to increased mortality rates and days of lost productivity from missed work, based on short-term disability claims.

Adjusting for the increase in the U.S. population from 2008 to 2016, the current cost of medical errors can be estimated at $20.8 billion.

As other authors (e.g., Andel, et al. in “The Economics of Health Care Quality and Medical Errors,” Journal of Health Care Finance, Fall 2012) have suggested, the economic impact is actually much greater. If one applies quality-adjusted life years (QALYs) to the 250,000 people who die each year from medical errors—and assumes an average of 10 lost years of life at $75,000 to $100,000 per year—the loss in QALYs for those deaths is $187.5 billion to $250 billion. To put those figures in perspective, they represent 32 percent to 42 percent of what the federal government will spend on Medicare this year.

Hopefully, the Johns Hopkins analysis can refresh our collective awareness of the problem of medical errors and generate greater support for patient safety research, adherence to best practices, and technology innovations that help prevent harm.


Ken Perez is vice president of healthcare policy, Omnicell, Inc., Mountain View, Calif., and a member of HFMA’s Northern California Chapter.

Publication Date: Tuesday, June 21, 2016