我国应当建立医疗事故强制责任险制度

医疗事故责任保险是现代医疗服务的重要组成部分,是社会承担医疗风险,保障医患双方合法权益,维护医疗秩序的重要机制。世界上许多国家已普遍实行医疗责任保险制度,并把它作为法定保险,强制执业医师购买,如果没有参加医疗责任保险,医院或医生就不能执业。但我国的国情不同于国外,不能盲目效仿国外的做法。我国应增加和开拓化解医疗纠纷的社会渠道,建立和完善医疗风险的社会承担机制,实施由就诊人或社会的公益基金投保的医疗责任保险制度,将会是解决我国医疗损害赔偿纠纷的有效机制。     

医疗责任保险的法律构筑

医疗责任保险,台湾称为医师责任保险,西方称为医疗过失责任保险(Medical malpractice Insurance)或专家责任保险(Professional Liabiliaty Insurance)是责任保险史上最为现代的一个险种。依照我国《保险法》第十条第二款"除法律行政法规规定必须参加的保险之外,保险公司和其他单位不得强制他人订立保险合同,"及国务院正在修订的《医疗事故处理办法》(第十稿)(下称新办法)第六条"国家扶持和推动建立医疗风险制度,医疗机构应当参加医疗职     

略论我国医疗责任保险和医疗保险之间的关系

目前,医疗损害事故层出不穷,医患关系较为紧张,为缓解这种紧张关系,医疗责任保险和医疗保险发挥着重要的作用。本文指出在发生医疗损害事故以后,医疗责任保险和医疗保险作为对受损患者的救济方式,应当厘清二者之间的关系,以期协调医患之间的关系。除此以外,本文也将探讨我国侵权法归则原则对医疗责任保险和医疗保险之间关系的影响,并且提出了制度架设。     

医疗责任保险制度初探

笔者从医疗风险、医疗责任保险的可保性及医疗责任保险的性质与意义等方面多角度的进行详细的论述,对医疗责任保险制度在国内外的发展及现状进行了较为客观的分析,最后结合我国实际,在借鉴国内外成功经验的基础上提出了我国建立医疗责任保险制度的初步构想。     

我国医疗责任保险制度价值探究

医疗责任保险的法律制度价值在于其对社会主体的"有用性"。本文通过对医疗侵权责任的局限性的探讨,提出要解决我国医疗损害赔偿责任承担的困境有待于医疗责任保险制度的引入。对医疗责任保险的引入价值进行进一步阐释,认为医疗责任保险的引入符合我国的现实需求,该制度的引入具有法律价值。     

解决医疗纠纷新途径探析:医师责任保险

我国当前的医患关系空前紧张,医师和患者的权益保护需要引进或开发新的解决机制——医师责任保险。作者在文中对医师责任、医师责任保险的概念作了阐述,进而对建立医师责任保险制度的必要性、途径和几个主要问题作了初步的考虑和分析,并提出尝试性的建议。     

强制医疗责任保险的正当性及制度保障

强制责任保险的正当性在于其追求"社会公益"的目的。医患关系具有强烈的社会公共性,医疗责任保险有助于维护社会公益,强制推行具有正当性。要通过构建强制医疗责任保险合同条款听证制度来确保医疗责任保险的"公益性"和正当性;该制度的要点包括确立听证程序为审批强制医疗责任保险条款的前置程序、建立有效的听证代表遴选机制和规范的听证程序、确立听证会笔录的法律效力、推动医疗质量安全信息与保险部门共享等。     

美国医疗责任保险制度困境的破解之道及其启示

美国现行医疗责任保险制度存在保费畸高、保险范围日益缩小、高危疾病经常被拒诊、防御性医疗普遍、历史经验费率评定数据的共享机制阙如、系统化预防机制存在"真空"地带等问题。为妥当解决医疗纠纷危机,美国理论界一直试图从制度和系统两个层面探讨医疗责任保险危机的解决之道,而各州政府也在总结经验教训的基础上,加大医疗和保险方面法律制度的改革力度,试图探索一套广泛、系统、相辅相成且协调一致的改革方案。当下,我国的医疗体制改革势必涉及医疗责任保险制度的构建,对此,可以借鉴美国医疗责任保险法律制度的运作经验并克服其不足,加强医疗机构内部管理、提升医疗技术水平,构建以历史经验费率评定制度和医疗系统内部医疗事故汇报制度为外化形式的医疗责任事故系统化预防机制、无过错补偿制度,推动建立适合我国国情的医疗责任保险法律制度,分散医疗风险和医疗责任风险,从而缓解甚至极大地消除医患纠纷,推动和谐社会的建设。     

论我国强制医疗责任保险制度的构建——以无过错补偿责任为分析进路

医疗损害责任的分配是医患之间矛盾的根本所在。强制医疗责任保险制度尽管与交强险同属于强制保险,但二者有很大不同,其产生缘于患者和医务人员所面对的医疗风险,实际是国家和政府为衡平医患之间利益、调节医患矛盾,对医疗损害责任和风险再分配的一项责任保险制度。医疗损害责任属于侵权责任法的调整范畴,但我国侵权法对医疗损害责任的调整囿于过错责任的藩篱而无法实现对患者医疗损害的填补,由此带来的后果是医患关系紧张,医疗风险无法分散,医疗资源代际分享不公平。因此我国应当构建以无过错补偿责任为基础、政府和患者参与投保的强制医疗责任保险制度,实现医疗责任保险制度与侵权法的衔接。     

购买医师责任保险是推行多点执业的必备条件

医师从事诊疗活动无论是单点执业还是多点执业都难免产生医患纠纷,甚至会出现需要赔偿的医疗损害。既往医师单点执业过程中若患者在诊疗活动中受到损害,医疗机构及其医务人员有过错的一般由医疗机构承担赔偿责任,医师多点执业后若仍采用这一赔偿模式则明显不利于这项惠民政策的实施。建议将医师个人购买医师责任保险作为"强制性"条款纳入到多点执业医师与另一医疗机构所签署的合同或协议中,通过医师责任保险化解异地执业时的医疗损害赔偿责任。     

Medical malpractice as reflected by the forensic evaluation of 4450 autopsies

A multicentre retrospective analysis of 4450 autopsies carried out due to suspicion of medical malpractice in 17 German institutes of forensic medicine from 1990 to 2000 was performed for the German Federal Ministry of Health. During the time period analysed an increase of cases could be mentioned. The main results of the study are: in the cooperating institutes the total number of autopsies due to suspected medical malpractice ranged from 1.4 to 20%. In more than 40% of the cases preliminary proceedings were started because the manner of death was certified as non-natural or not clarified. Hospital doctors were more affected by medical malpractice claims than doctors in private practice. However, the number of confirmed cases of medical malpractice was higher for doctors in private practice than for hospital doctors. Although surgery is still at the top of the disciplines involved in medical malpractice claims the number of confirmed surgical cases was below the average. Mistakes in care were confirmed to be above the average. Medico-legal autopsies are still a very sufficient method to evaluate cases of medical malpractice: 2863 cases could already be clarified by autopsy. Up to now there is no systematic registration of medical malpractice charges in Germany. A systematic registration should be initiated to build up and/or improve error reporting systems and, thus, to improve patient safety. Compared to other sources of medical malpractice claims (arbitration committees of the medical chambers, reference material of health and insurance companies, files of civil courts) the data of the present multicentre study are in so far unique as only lethal cases were evaluated and a complete autopsy report was available as basis of an expert opinion in alleged medical malpractice cases.     

医疗责任保险的思考

大力发展医疗责任保险,对医疗执业过失给患者造成的损害进行充分赔偿,在保障患者和医疗机构及其医务人员的合法权益,优化医疗环境和医疗公共秩序方面有重要的促进作用。由于我国医院主体是公立医院,侵权法人身损害赔偿相对于综合医院尚未到重大程度,并且综合性医院每年发生的医疗过失案件基本确定,选择满足面临危险的医院财务安全需要的医疗责任保险模式,如医疗责任保险信托等,才能促进医疗责任保险的发展。实践表明,商业性医疗责任保险不宜成为我国医疗责任保险的主体。建立独立的医疗过失纠纷调解鉴定机构,才能保证医疗责任保险顺利开展。     

论强制性医疗损害赔偿保险制度的建立

通过对我国医疗损害赔偿给付现状的分析,对国外医疗责任保险及给付的比较,认为:只有通过立法来建立一种强制医疗损害赔偿保险制度才能较合理地解决医疗损害受害人损害赔偿的兑现问题,同时,又不使医疗法人的正常医疗行为因此受到影响;并进一步指出了建立该种保险制度所存在的问题和对策。     

Patient Compensation Funds: legislative responses to the medical malpractice crisis

Fifteen states have created Patient Compensation Funds in response to the increased cost and reduced availability of medical malpractice insurance associated with the so-called "medical malpractice crisis." Patient Compensation Fund statutes limit health care providers' liability to a specified amount, and establish state-administered funds to compensate victorious malpractice plaintiffs for damage awards in excess of that amount. This Note examines the Patient Compensation Fund mechanism, evaluates its effectiveness as a compensation system for malpractice victims, and recommends particular provisions that might enhance its effectiveness. The Note concludes that the Patient Compensation Fund mechanism is an effective means of increasing the availability and of reducing the cost of medical malpractice insurance, and should be adopted by other states experiencing a "medical malpractice crisis."     

Is there an acceptable answer to rising medical malpractice premiums?

This article explores the key issues involved in the attempts at reform of the present medical malpractice system. Investigating the effects that federal tort reform legislation would have on physicians, patients, lawyers, and the medical malpractice insurers, Dr. Gunnar succinctly outlines the issues surrounding the present "crisis in healthcare" and explores the separate interests involved. The article examines the economic forces influencing the medical malpractice insurance industry, reviews previous tort reform, and predicts the future of federal tort reform legislation. Dr. Gunnar concludes by proposing alternatives for malpractice reform.     

Reconsidering medical malpractice reform: the case for arbitration and transparency in non-emergent contexts

This Article proposes a two-pronged legislative response to the current debate over medical malpractice insurance. The author does not advocate mandatory caps on malpractice damages, nor the imposition of a uniform regime on the field of medicine. Rather, he articulates some of the important legal, medical, and societal benefits that would come from embracing arbitration in the non-emergent medical malpractice context. The author also calls for the reformulation of the National Practitioner Data Bank to achieve greater transparentcy and to leverage advances in information technology and data-mining software to measure the risk levels of individual practitioners. This reform, in turn, would open up the possibility of greater subcategorization of premiums and more effective deterrence in medical malpractice insurance.     

《侵权责任法》确立医疗损害责任制度的意义

我国《侵权责任法》第七章确立的医疗损害责任制度全面体现了平等保护医患双方合法权益的立法精神;该法使用“医疗损害责任”的概念充分体现了民事权利保护法和救济法的性质;医疗损害责任制度的确立构建了一元化的医疗损害责任体系,彻底改变了对医疗纠纷案件法律适用“二元化”的现象;医疗损害责任归责原则体系的确立,有利于公正、合理的裁判各种医疗损害纠纷案件;医疗损害责任制度的确立推动我国最高司法机关修订了《民事案件案由规定》,从而明确了医疗纠纷案件的案由;对有效解决医疗损害责任的赔偿范围和标准的法律适用等问题产生了积极的意义。     

日本医师会医师赔偿责任保险制度介评

始建于1973年的日本医师会医师赔偿责任保险制度,经过近40年的发展,已成为日本医疗事故纠纷解决体系中的不可或缺的机制。该制度的实施不仅为医师供给了价格低廉的保险产品,还为医疗事故纠纷的解决提供便捷渠道。尽管这一制度还不尽完善,但这并不妨碍我们从中汲取经验和启示。     

医疗损害证明责任分配规则研究

证明责任在医疗损害赔偿纠纷中发挥着风险分配的重要作用,我国近十年的立法充分利用证明责任分配规则来体现立法政策的转变。早期立法体现的证明责任倒置规则导致了大量的非合理性医疗行为,这在更大范围内损害患者的利益。《侵权责任法》矫正了这种倾向,《侵权责任法》根据各种具体情形,规定了更为详细的归责要件,相应地,证明责任分配规则也更加详细具体,较好地分配了医疗风险,平衡了医患双方的诉讼负担。     

No-fault cerebral palsy insurance: an alternative to the obstetrical malpractice lottery

Sixty percent of malpractice premiums paid by obstetricians go to cover suits for alleged birth-related cerebral palsy (CP). Yet substantially less than half of that money goes to CP victims, and less than 10 percent of children with CP receive any compensation at all from tort suits. This paper proposes a system that would compensate all children born with CP for most handicap-related expenses, in exchange for which the children would be foreclosed from bringing suits alleging birth-related malpractice. Malpractice would be policed by a state board, which would investigate all CP cases. This proposal would be more equitable than current systems. It would also be less expensive, since it would avoid costly litigation and decrease the cost of obstetrical malpractice insurance.