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.     

日本医疗诉讼改革及对鉴定结论的评价

自2002年以来,日本针对医疗诉讼中鉴定人选任困难、鉴定结论提出期间长、证据价值不高、法院对鉴定结论等医学证据难以作出评价等长期存在的问题,对医疗诉讼体制作出了重大改革。鉴于我国医疗诉讼中也存在类似问题,本文对日本法的改革措施以及效果展开详细考察,以供我国参考借鉴。     

State Tort Reforms and Hospital Malpractice Costs

This study explored the relation between state medical liability reform measures, hospital malpractice costs, and hospital solvency. It suggests that state malpractice caps are desirable but not essential for improved hospital financial solvency or viability.     

日本医疗诉讼改革及对鉴定结论的评价

自2002年以来，日本针对医疗诉讼中鉴定人选任困难、鉴定结论提出期间长、证据价值不高、法院对鉴定结论等医学证据难以作出评价等长期存在的问题，对医疗诉讼体制作出了重大改革。鉴于我国医疗诉讼中也存在类似问题，本文对日本法的改革措施以及效果展开详细考察，以供我国参考借鉴。     

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.     

Medical malpractice reform and insurer claims defense: unintended effects?

In response to recent and past medical malpractice insurance crises, most states have implemented reforms meant to stabilize premiums and coverage availability. The importance of understanding whether these reforms implicitly affect the behavior and incentives of plaintiffs, attorneys, medical providers, and malpractice insurers in the intended way is crucial to policy makers, if they are to achieve their goal. This study specifically examines the effect of reforms on the claims defense efforts of insurers, given that defense expenses account for approximately 30 percent of malpractice premiums. Using state data for the period 1998-2002, we regress claims defense expenses against a variety of reform variables. These include seven tort reforms (noneconomic damage caps, punitive damage limits, attorney fee limits, modified collateral source rule, modified joint and several liability doctrine, mandatory pretrial screening, and statute of limitations) and two government-sponsored insurance mechanisms (joint underwriting associations and patient compensation funds). Claims defense expenses are found to be higher in the presence of noneconomic damage caps, punitive damage limits, and attorney fee limits--an unintended and counterproductive effect of reform--but are lower with mandatory pretrial screening and patient compensation funds.     

论在医疗纠纷诉讼中推行专家辅助人制度

医学专家意见在医疗纠纷诉讼中占有重要地位，在不同法系国家分别以鉴定和专家证言的形式出现在法庭诉讼中。目前，我国已形成了以医疗事故技术鉴定和医疗过错鉴定为主体的医疗专业技术鉴定体制，但当前面临着诸多困境。从专家证据制度改革和医学专家意见形成特点等层面分析，专家辅助人制度与普通法系国家专家证人制度类似．其和鉴定制度的有机结合可以在医疗纠纷诉讼领域构建更为理想的专家证据制度：有助于最大限度地使法律真实靠近客观真实。但过于强大的医疗专业技术鉴定制度对专家辅助人制度具有明显的压制作用．因此需适当限制鉴定制度，大力推行专家辅助人制度，同时应总结相关国家经验教训。防止专家辅助人制度产生不应有的负面效应。     

论在医疗纠纷诉讼中推行专家辅助人制度

医学专家意见在医疗纠纷诉讼中占有重要地位,在不同法系国家分别以鉴定和专家证言的形式出现在法庭诉讼中。目前,我国已形成了以医疗事故技术鉴定和医疗过错鉴定为主体的医疗专业技术鉴定体制,但当前面临着诸多困境。从专家证据制度改革和医学专家意见形成特点等层面分析,专家辅助人制度与普通法系国家专家证人制度类似,其和鉴定制度的有机结合可以在医疗纠纷诉讼领域构建更为理想的专家证据制度;有助于最大限度地使法律真实靠近客观真实。但过于强大的医疗专业技术鉴定制度对专家辅助人制度具有明显的压制作用,因此需适当限制鉴定制度,大力推行专家辅助人制度,同时应总结相关国家经验教训,防止专家辅助人制度产生不应有的负面效应。     

规范中国劳动力市场放松劳动力流动的管制

分析了中国现行户籍制度的历史沿革,并进行中外户籍制度比较,主要有加拿大、日本、韩国、印度等国,提出应吸收和借鉴外国的有益经验,改革我国现有制度中所存在的弊端,促进我国劳动力的自由流动和市场化。并提出改革的必要性、可行性和完善的具体措施。     

论医疗责任保险——从法律经济学的角度切入

医疗责任保险是从国外引入的一种制度,目的之初在于,将医师的过错责任诱发的巨大风险社会化,以期医师安心于治理病患,而病患通过保险获得相应的保险费用保障自身的权益,缓和较为尖锐的医患关系和社会矛盾。但医疗责任保险发展的现实情况却是极其不理想的,学界对于医疗责任改革已有基本共识,具体设计上却甚少有人提出更为细致的建议。可以从法律经济学这个分析的全新视角,借助成本效益、纳什均衡、博弈的思维进路,以期为医疗责任保险制度的设计另辟蹊径。     

域外视野：中国医闹之医疗纠纷解决机制探讨-兼与哥伦比亚大学李本教授商榷

医闹成了中国近二十年来重要的社会问题。李本教授在大量实证研究的基础上,从中国制度演变的角度对医闹进行了深入研究,认为患者对正式制度的信任缺失是医闹的重要根源,法律是在抗议与暴力的影响下发挥作用。法院审理医疗纠纷的过程中,判决许多没有过错的案件让医院承担责任折射出强烈的公正问题。中国政府在“医闹”中的过度回应及回应不足反映了改革后我国政府的作用及法律作用的不确定性。这些研究成果对我国当前医闹的治理及未来的制度改革都具有非常重要的参考价值。但笔者也认为,医疗纠纷审理中出现的一些不公正结果,不仅仅是中国问题,也是美国问题,过分强调中国体制或改革的原因无助于对中美两国共同问题的合理解释,究其原因,这在一定程度上与医疗证据认定的专业性及医疗专家对医疗过错认定的不确定性密切相关。     

论医疗损害技术鉴定危机与改革

法律规定的不完善以及法官对鉴定结论的依赖性造成了目前医疗鉴定中,医疗事故技术鉴定与法医学医疗鉴定共存的二元化局面。侵权责任法在民事赔偿上否定了医疗事故的概念,提出以医疗损害责任为核心的民事责任制度,使医疗鉴定面临了新的问题。医疗事故技术鉴定机制和法医学医疗鉴定机制都存在种种缺陷,不能完全满足侵权责任法对医疗鉴定的新的需求。无论是鉴定结论的固有属性还是侵权责任法的新的技术内容都要求对现有的医疗事故技术鉴定模式进行改革,建立起符合《侵权责任法》要求的医疗损害技术鉴定制度。     

医疗损害鉴定主体改革刍议

医疗损害鉴定主体,包括鉴定机构及鉴定人,是医疗损害鉴定制度改革的起点。医疗事故鉴定模式中的专家组并不是鉴定主体,但其合议制的实质对鉴定结论的科学性具有重要作用,应予保留。应改革鉴定结论形成机制,允许出具多样化的鉴定结论。医疗损害鉴定制度的改革应采取司法行政部门主管、司法鉴定机构组织鉴定工作、医学会推荐鉴定人的模式。由于医学的专业性极强,鉴定人应当来自于现任专职医务人员。在保证鉴定人中立性、公正性的同时,要重视保证医务人员参与鉴定工作的积极性。     

Medical malpractice litigation: do the British have a better remedy?

Medical malpractice claims are filed nearly ten times more frequently in America than they are in Great Britain. British patients generally adopt a less adversarial stance toward medical malpractice than do American patients. This Article examines the British malpractice system, as compared with the American system, and explores the differences between the two, in terms of costs and fees, liability rules, statutory provisions, and judicial attitudes toward malpractice litigation. The Article also discusses British social and institutional factors, such as the "taint" of litigation and the National Health Service, and evaluates how these factors affect British malpractice litigation. The Article presents the alternative forums available to British patients in seeking satisfaction for their medical service complaints. The Article concludes with an evaluation of how these factors achieve the three societal objectives of malpractice litigation: reparation, emotional vindication and deterrence.     

法院司法体制现状及改革前瞻

为确保人民法院依法独立审判,法院司法体制应当改“块块领导”为“条条领导”;解决司法活动行政化的问题,必须改革“集体负责制”、“首长负责制”为“法官负责制”;实现司法公正必须革除“暗箱操作”,强化公开审判,改“纠问式”审判方式为“控（辩）式”审判方式;法官队伍必须走“精英之路”,以高标准、高素质、高品位的法官选任制度为保证,建设一支专家型、复合型的法官队伍。     

医疗损害鉴定主体改革刍议

医疗损害鉴定主体,包括鉴定机构及鉴定人,是医疗损害鉴定制度改革的起点。医疗事故鉴定模式中的专家组并不是鉴定主体．但其合议制的实质对鉴定结论的科学性具有重要作用,应予保留。应改革鉴定结论形成机制,允许出具多样化的鉴定结论。医疗损害鉴定制度的改革应采取司法行政部门主管、司法鉴定机构组织鉴定工作、医学会推荐鉴定人的模式。由于医学的专业性极强,鉴定人应当来自于现任专职医务人员。在保证鉴定人中立性、公正性的同时,要重视保证医务人员参与鉴定工作的积极性。     

柔性执法:和谐行政的有效保障

随着我国社会主义市场经济体制的日益完善,传统的刚性行政执法忽视行政相对人权益的弊端已日渐显露,而柔性行政执法以其灵活性强、注重行政相对人意愿的优势已经发挥了巨大的作用,并且在构筑和谐行政关系中必将会占据愈来愈重要的地位。     

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."     

Administrative compensation of medical injuries: a hardy perennial blooms again

Periods in which the costs of personal injury litigation and liability insurance have risen dramatically have often provoked calls for reform of the tort system, and medical malpractice is no exception. One proposal for fundamental reform made during several of these volatile periods has been to relocate personal injury disputes from the tort system to an alternative, administrative forum. In the medical injury realm, a leading incarnation of such proposals in recent years has been the idea of establishing specialized administrative "health courts." Despite considerable stakeholder and policy-maker interest, administrative compensation proposals have tended to struggle for broad political acceptance. In this article, we consider the historical experience of administrative medical injury compensation proposals, particularly in light of comparative examples in the context of workplace injuries, automobile injuries, and vaccine injuries. We conclude by examining conditions that may facilitate or impede progress toward establishing demonstration projects of health courts.     

Educational malpractice and setting damages for ineffective teaching: a comparison of legal principles in the USA,England and Australia

The extent to which educational institutions and their teachers in the USA, England, and Australia should bear legal responsibility in damages for ineffective classroom teaching is the subject of this article. At the heart of the controversy regarding educational malpractice is the issue of remedies. Federal and state courts in the USA have resisted awarding damages where such an award would appear to sound in educational malpractice. However, although courts in Australia have yet to declare with any degree of certainty, they appear positioned to follow the English approach that ostensibly acknowledges a school's duty of care to provide effective education for all children.