Economic viability and sustainability of the Catalan medical professional liability insurance model
In Catalonia, Spain, a singular and unique model of medical professional liability insurance has been developed. This model is regarded as highly beneficial, providing substantial benefits to professionals, the government, citizens, society, and patients. Its main feature is the delegation of the management of claims to the medical association by the insurer. In view of the difficulties in obtaining insurance coverage worldwide, the Council of Medical Colleges of Catalonia (CMCC) model has been examined. This analysis evaluates and contrasts the viability and economic sustainability of the model. A retrospective analysis was conducted on 4,832 medical malpractice claims and their compensation costs between 2002 and 2017, evaluating these against the premiums paid to the insurer. The technical return reached 6.39% (€7.78 million), with an estimated additional financial yield ranging between 3.61% and 33.39% depending on the investment scenario, confirming the overall economic viability and sustainability of the model. It is concluded that the delegation of claims management by the CMCC insurer to the CMCC enables the analysis of claims information, thereby facilitating the implementation of clinical safety initiatives that have a double positive impact. Firstly, these initiatives contribute to the viability and economic sustainability of the model by reducing the number and cost of claims. Secondly, they promote clinical safety through the knowledge and use of data, the modification of medical actions, the minimization of the risk of adverse events, the anticipation of claims, the improvement of clinical safety, and contribution to medical training.
Aljaffary, A. (2026). A review of the global feasibility of medical malpractice insurance: Legal frameworks, economic viability, implementation challenges, and impact on patient safety. Journal of Family and Community Medicine, 33(2), 71–83. https://doi.org/10.4103/jfcm.jfcm_376_25
Arimany-Manso, J., Gómez-Durán, E., Bruguera, M., & Aubia, J. (2013). Un modelo integral y de gestión directa del aseguramiento de la responsabilidad profesional médica en Cataluña [A comprehensive and direct management model for ensuring medical professional liability in Catalonia]. Medicina Clinica. 141(7). 300–4. [In Spanish] http://doi.org/10.1016/j.medcli.2013.02.025
Arimany-Manso J., Benet-Travé J., Martin-Fumadó, C. (2026). Beyond adversarial and no-fault systems: the mixed Spanish framework of healthcare professional liability. Journal of Forensic and Legal Medicine. 122:103228. https://doi.org/10.1016/j.jflm.2026.103228
Autoridad Macroprudencial Consejo de Estabilidad Financiera. (2020). Informe anual 2019 AMCESFI [AMCESFI Annual Report 2019]. Madrid: Ministerio de Asuntos Económicos y Transformación Digital - Banco de España - Comisión Nacional del Mercado de Valores. [In Spanish] https://www.amcesfi.es/f/webwam/rcl/publicaciones/archivos/AMCESFI-Informe_Anual_2019.pdf
Baker, T. (2004). Medical malpractice and the insurance underwriting cycle. DePaul L. Rev., 54, 393. https://via.library.depaul.edu/law-review/vol54/iss2/10
Catsalut. (2026). SISCAT: comprehensive public health system in Catalonia. https://catsalut.gencat.cat/ca/coneix-catsalut/presentacio/model-sanitari-catala/siscat/
Cohen, B.J. (2026) Betting on the Body: Private Equity Portfolio Funding of Medical Malpractice Litigation and the Financialization of Patient Justice. Journal of Law and Health 39 (3), 167. https://engagedscholarship.csuohio.edu/jlh/vol39/iss3/5
Council of Medical Colleges of Catalonia. (2026). Qui som [who we are]. https://www.ccmc.cat/ca/ccmc/home
Cummins, D., Weiss, M., & Zi, H. (1998). Organizational form and efficiency: an analysis of Stock and Mutual Property-Liability Insurers. Working paper, Wharton Financial Institutions Center, University of Pennsylvania, PA. http://doi.org/10.2139/ssrn.2098
Danzon, P. (1984). The frequency and severity of medical malpractice claims. The Journal of Law and Economics, 27(1), 115-148. https://repository.upenn.edu/server/api/core/bitstreams/5bafa4dd-3155-4cf2-a267-c3b978a82790/content
Dirección General de Seguros y Fondos de Pensiones. (2007). Informe 2007 Seguros y Fondos de Pensiones [2007 Report on Insurance and Pension Funds]. Madrid. [In Spanish]
Dirección General de Seguros y Fondos de Pensiones. (2009). Informe 2009 Seguros y Fondos de Pensiones [2009 Report on Insurance and Pension Funds]. Madrid. [In Spanish]
Dirección General de Seguros y Fondos de Pensiones. (2011). Informe 2011 Seguros y Fondos de Pensiones [2011 Report on Insurance and Pension Funds]. Madrid. [In Spanish]
Dirección General de Seguros y Fondos de Pensiones. (2014). Informe 2014 Seguros y Fondos de Pensiones [2014 Report on Insurance and Pension Funds]. Madrid. [In Spanish]
Dirección General de Seguros y Fondos de Pensiones. (2018). Informe 2018 Seguros y Fondos de Pensiones [2018 Report on Insurance and Pension Funds]. Madrid. [In Spanish] https://dgsfp.mineco.gob.es/es/Publicaciones/DocumentosPublicaciones/Informe%20Sector%202018.pdf
EIOPA. (2018a). EIOPA defines its supervisory convergence priorities. Vol. 4. Frankfurt. https://www.eiopa.europa.eu/system/files/2019-04/eiopa_defines_its_supervisory_convergence_priorities_0.pdf EIOPA. (2018b). Financial Stability Report. December 2018. Luxembourg: Publications Office of the European Union. https://www.eiopa.europa.eu/publications/financial-stability-report-december-2018_en
EIOPA. (2020). Impact of ultra low yields on the insurance sector, including first effects of COVID-19 crisis. Luxembourg: Publications Office of the European Union. https://www.eiopa.europa.eu/publications/impact-ultra-low-yields-insurance-sector-including-first-effects-covid-19-crisis_en
EU Tenders. (2026). TED website. https://ted.europa.eu/en/notice/-/detail/102421-2022
Gómez-Durán E., L., V.-R. M., Martin-Fumadó, C., Klamburg, J., Padrós-Selma, J., & Arimany-Manso, J. (2018). Physicians as second victims after a malpractice claim: An important issue in need of attention. Journal of Healthcare Quality Research, 33 (5), 284-9.https://doi.org/10.1016/j.jhqr.2018.06.002
González M. C., I., & Marqués, J., M. (2013). Las entidades de seguros ante el nuevo entorno financiero [Insurance companies in the new financial environment]. Estabilidad Financiera Banco de España, 25, 127–39. [In Spanish] https://repositorio.bde.es/handle/123456789/11456
INESE. (2018). La competencia y los bajos tipos impiden a las aseguradoras la consecución de rendimientos “adecuados” [Competition and low interest rates prevent insurers from achieving “adequate” returns.]. [In Spanish] https://www.inese.es/la-competencia-y-los-bajos-tipos-impiden-a-las-aseguradoras-la-consecucion-de-rendimientos-adecuados/
Kozarevic, S., Sain, Z., & Hodzic, A. (2014). Obstacles to implementation of solvency li regime in nonlife insurance companies in Bosnia and Herzegovina. UTMS Journal of Economics, 5(2), 199-211. https://www.econstor.eu/handle/10419/105290
MacMinn, R., & Ren, Y. (2011). Mutual versus stock insurers: a synthesis of the theoretical and empirical research. Journal of Insurance Issues, 101-111. https://www.jstor.org/stable/41946318
Martín-Arroyo, J. (2019). Las comunidades sufren para encontrar aseguradora para sus errores médicos [Communities struggle to find insurers to cover their medical errors.]. El País. [In Spanish] https://elpais.com/sociedad/2019/03/22/actualidad/1553269470_082255.html
Martínez López, F. (2005). La transferencia de riesgos en el Sistema Nacional de Salud: el aseguramiento de la responsabilidad patrimonial [Risk transfer in the National Health System: ensuring liability coverage]. Problemas y opciones. Revista de administración sanitaria siglo XXI, 3(1), 193–204. [In Spanish] https://enfispo.es/servlet/articulo?codigo=1138786
Martín-Román, Á., Moral, A., & Rosales, V. (2025). Judges and court productivity: evidence from Spanish labour courts. European Journal of Law and Economics, 60(2), 249-283.https://doi.org/10.1007/s10657-025-09846-y
Markowitz, H. (1952). Modern portfolio theory. The Journal of Finance, 7 (11), 77-91. https://doi.org/10.1111/j.1540-6261.1952.tb01525.x
Mello, M. M., Studdert, D. M., & Brennan, T. A. (2003). The new medical malpractice crisis. New England Journal of Medicine, 348(23), 2281-2284.https://doi.org/10.1056/NEJMp030064
Mello, M. M., Studdert, D. M., & Kachalia, A. (2014). The medical liability climate and prospects for reform. Jama, 312(20), 2146-2155. https://doi.org/10.1001/jama.2014.10705
Morales-Ferrero, J. I., Martin-Fumadó, C., & Arimany-Manso, J. (2026). Analysis of medical professional liability claims in Catalonia, Spain (2002–2017). Global Health Econ Sustain. https://doi.org/10.36922/ghes.8481
Nelson III, L., Morrisey, M., & Kilgore, M. (2007). Damages caps in medical malpractice cases. The Milbank Quarterly, 85(2), 259-286. https://pmc.ncbi.nlm.nih.gov/articles/PMC2690332/pdf/milq0085-0259.pdf
OECD. (2006). Policy Issues in Insurance. Medical Malpractice. Prevention, Insurance and Coverage options. nº11. Paris: OECD Publications. https://www.oecd.org/content/dam/oecd/en/publications/reports/2006/12/medical-malpractice_g1gh76dd/9789264029057-en.pdf
Pandey, S. K., & Sharma, V. (2023). Alarming rise in consumer cases/medical malpractice claims with huge compensation: How to safeguard medical professionals? Indian Journal of Ophthalmology, 71(3), 1041-1043. https://doi.org/10.4103/IJO.IJO_2530_22
Senado. (2017). Moción por la que se insta al Gobierno a regular el baremo indemnizatorio de los daños y perjuicios sobrevenidos con ocasión de la actividad sanitaria, tal como se recoge en la disposición adicional tercera de la Ley 35/2015, de 22 de septiembre [Motion urging the Government to regulate the scale of compensation for damages and losses arising from healthcare activity, as set out in the third additional provision of Law 35/2015, of September 22]. Macrid: Diario de Sesiones del Senado núm. 73 de 14/03/2017. [In Spanish] https://www.senado.es/legis12/publicaciones/pdf/senado/ds/DS_C_12_73.PDF
Servicio de Estudios Fundación Mapfre (2018). El mercado Español de seguros en 2017 [The Spanish insurance market in 2017]. Madrid: Fundación Mapfre. [In Spanish] https://documentacion.fundacionmapfre.org/documentacion/publico/i18n/media/group/1097438.do
Servicio de estudios Fundación Mapfre (2019). El mercado Español de seguros en 2018 [The Spanish insurance market in 2018]. Madrid: Fundación Mapfre. [In Spanish] https://documentacion.fundacionmapfre.org/documentacion/publico/i18n/media/group/1099983.do
Standing Committee of the Hospitals of the European Union. (2004). Insurance and Malpractice. Final report of HOPE¡¯s Sub-Committee on Co-ordination Brussels. Brussels. http://www.hope.be/wp-content/uploads/2015/11/71_2004_OTHER_I
Statistical Institute of Catalonia. (2026a). Certified doctors. Provinces. https://www.idescat.cat/indicadors/?id=aec&n=15810&lang=en
Statistical Institute of Catalonia. (2026b). Hospital health professionals. By categories and doctors by services. Provinces. https://www.idescat.cat/indicadors/?id=aec&n=15813&lang=en
Tesoro Público. (2020a). Average interest rate 2001-2019. https://www.tesoro.es/en/deuda-publica/historico-de-estadisticas/tipo-inter%C3%A9s-medio
Tesoro Público. (2020b). Effective interest rates of new bonds. https://www.tesoro.es/en/deuda-publica/hist%C3%B3rico-de-estadisticas/tipos-efectivos-nuevas-emisiones
The European Insurance and Reinsurance Federation. Contribution by the European Insurance and Reinsurance Federation (CEA). (2009). The ever-growing challenge of medical liability: national and European responses, 204-206. Brussels: Council of Europe. https://www.coe.int/en/web/cdcj/completed-work/standard-setting/medical-liability
Torre-Enciso, I. M. (2014). Modelos Internos en Solvencia II [Internal Models in Solvency II]. Anuario jurídico y económico escurialense, (47), 389-406. [In Spanish] https://dialnet.unirioja.es/servlet/articulo?codigo=4639705
Valle, S. (2019). Valle S. Asegurar el riesgo en la sanidad pública cuesta 75 millones y “ es poco” [Insuring against risk in public healthcare costs 75 million and “that’s not enough”]. Diario Médico. [In Spanish] https://www.diariomedico.com/medicina/politica/asegurar-el-riesgo-en-la-sanidad-publica-cuesta-75-millones-y-es-poco.html
Vilardebó Miró, M. (2013). La política de inversión de las compañías aseguradoras ¿Influirá Solvencia II en la toma de decisiones? [Will Solvency II influence the investment policies of insurance companies?]. Barcelona: Universitat de Barcelona. [In Spanish] https://diposit.ub.edu/items/2b26920a-7b7a-48e9-8492-07a22c514ddf