涉医疗纠纷非诉讼处理程序的医疗责任保险合同纠纷案件实证分析  

Empirical Analysis of Medical Liability Insurance Contract Disputes Involving Non-litigation Procedures in Medical Disputes

作　　者：衡敬之 徐正东 Heng Jingzhi(The Law School of Southwest Medical University,Luzhou,646000)

机构地区：[1]西南医科大学法学院,泸州646000 [2]成都中医药大学马克思主义学院,成都610075

出　　处：《医学与社会》2020年第3期116-120,共5页Medicine and Society

基　　金：国家哲学与社会科学基金资助项目,编号为16BFX162;四川医事卫生法治研究中心资助项目,编号为YF16-Z07。

摘　　要：随机选取涉及医疗纠纷非诉讼处理程序的医疗责任保险合同纠纷案件230件,从时空分布、原告特征、被告特征等5个方面分析其特征,并对非诉讼处理结果与医疗责任保险合同纠纷法院判决进行了交叉分析,发现当前我国医疗纠纷非诉讼处理程序与医疗责任保险制度存在衔接不畅、医责险格式合同与诊疗实践相脱节等问题。对此,有必要在完善《医疗纠纷预防和处理条例》医疗风险分担制度的基础上,强调医疗机构、非诉讼处理机构与医疗责任保险公司间的协调、联动,增强二者的参与积极性;同时,结合诊疗实践完善医疗责任保险合同条款,特别是风险损失率、保险责任、赔偿限额、免赔额条款,满足医疗机构实际需求,为保证二者的衔接奠定基础。A total of 230 cases of medical liability insurance contract disputes involving non-litigation procedures in medical disputes were randomly selected.After the analysis of its general features from five aspects of the distribution of time and space,the characteristics of the plaintiff and the defendant and so on,and cross analysis between the result of non-litigation and the court judgment of medical liability insurance contract dispute,a series of problems were found,such as the non-litigation procedures of medical disputes in China are not connected with the medical liability insurance system,and the format contract of medical liability insurance is divorced from the medical practice.Therefore,it is necessary to strengthen the coordination and linkage between medical institutions,non-litigation institutions and medical liability insurance companies and enhance their participation enthusiasm on the basis of improving the medical risk sharing system in the regulations on the prevention and treatment of medical disputes.At the same time,the medical liability insurance contract clauses,especially the clauses of risk loss rate,insurance liability,limit of compensation and deductible,should be improved in combination with medical practice,so as to meet the actual needs of medical institutions and lay a foundation for maintaining the connection between them.

关 键 词：医疗纠纷 非诉讼处理程序 医疗责任保险 合同条款 

分 类 号：R197.1[医药卫生—卫生事业管理]