医疗纠纷解决中的基本医疗保险追偿权问题研究——以337份裁判文书为分析样本  

Research on the Right of Recovery of Basic Medical Insurance in Medical Dispute Settlement——Taking 337 Judgement Documents as Analysis Samples

作　　者：刘志恒 Liu Zhiheng

机构地区：[1]云南省昆明市中级人民法院

出　　处：《医学与法学》2023年第2期63-67,共5页Medicine and Jurisprudence

摘　　要：《社会保险法》第三十条对基本医疗保险基金支付范围、先行支付和追偿做出规定,但在医疗纠纷诉讼阶段实务中,往往缺少基本医保管理者的参与,加之裁判者对于社保价值和功能的认知差异,以及诉讼程序性规定的不完善,致相同或相似的医疗纠纷案在医保支付与追偿问题上出现完全不同的裁判结果。本文梳理筛选近年已公开的裁判文书,选取明确提及或直接适用《社会保险法》第三十条的案例并梳理分析,进而研究医疗纠纷中基本医疗保险追偿权问题,再有针对性地提出了相关基本医疗保险支付和追偿问题之处理的建议,并对同类案件的说理论证予以更正和完善。Article 30 of the Social Insurance Law stipulates the payment scope,advance payment and recovery of the basic medical insurance fund,However,in practice,medical disputes often lack the participation of the basic medical insurance administrator in the litigation stage,coupled with the differences in judges'perceptions of the value and function of social insurance,and imperfect procedural provisions of litigation,as a result,the same or simi⁃lar medical dispute cases have completely different judgment results on medical insurance payment and recovery.This paper sorts out and screens the judgment documents that have been published in recent years,selects the cases that explicitly mention or directly apply Article 30 of the Social Insurance Law to sort out and analyze,and studies the issue of the right of recourse of basic medical insurance in medical disputes,then puts forward targeted sugges⁃tions on the handling of the issues related to the payment and recovery of basic medical insurance,and corrects and improves the reasoning argument of similar cases.

关 键 词：医疗纠纷 社会保险 追偿权 

分 类 号：D922.182.3[政治法律—宪法学与行政法学]