医疗责任保险模式比较分析  

Comparative Analysis of Medical Malpractice Liability Insurance Models

作　　者：张涵 赵桐 李春宓 云利兵[1,4] ZHANG Han(West China School of Preclinical and Forensic Medicine,Sichuan University,Chengdu,Sichuan,610041,China)

机构地区：[1]四川大学华西基础医学与法医学院,四川成都610041 [2]四川大学法学院,四川成都610207 [3]四川省成都市武侯区人民法院,四川成都610046 [4]四川智慧社会智能治理重点实验室,四川成都610027

出　　处：《医学与社会》2024年第4期81-89,共9页Medicine and Society

基　　金：国家社会科学基金资助项目,编号为22WFXB006;四川智慧社会智能治理重点实验室研究项目,编号为AegisSRF2023001;国家级大学生创新创业训练计划交叉学科子计划项目,编号为C2023123302。

摘　　要：医疗责任保险被视为缓解医患矛盾、分担医疗风险、促进卫生健康事业稳健发展的重要工具,但其在我国仍面临保险模式不明确、应用于医疗纠纷预防处理的体系不健全、产品供给少且投保意愿匮乏等瓶颈问题。藉此研究国内医疗责任保险已运行的传统投保理赔模式、与个人利益挂钩、共保体、自保型等主流模式,重点总结了政府支持、设置附加险和特色保险模式等实践经验;同时也梳理了美国、日本、瑞典等国分别代表的互助模式、医师协会联合承保模式、综合性赔偿模式的主要现状与特点。通过比较分析各种医疗责任保险模式在组织、实施以及投保等方面的特征,基于不同地域的模式优点、多元主体调解路径、纠纷处理体系的多角度保障、优质保险产品的实施效果等有效经验,明确提出应融合多模式优势、拓展医疗纠纷诉讼外的调解处置、建立医疗预警系统、构建科学的产品内容等建议,为防控医疗风险提供优化路径。Medical liability insurance is regarded as an important tool to alleviate the contradiction between doctors and patients,share medical risks and promote the steady development of health service.But it still faces the bottleneck problems in our country,such as the unclear insurance model,imperfect system to apply to the prevention of medical disputes,low supply of products and lack of insurance willingness.Based on this,we studied the main modes of medical liability insurance in China,such as the traditional insurance claim settlement mode,linked to individual interests,coinsurance and self-insurance,and summarized with emphasis on the government support,setting additional insurance and characteristic insurance modes.At the same time,we also summary the main status and characteristics of mutual assistance model represented by the United States,joint underwriting model of doctors'associations represented by Japan,comprehensive compensation model represented by Sweden.By comparing and analyzing the characteristics of various medical liability insurance models in terms of organization,implementation and insurance,based on the advantages of different regional models,multi-subject mediation paths,multi-angle guarantee of dispute settlement system,implementation effects of excellent insurance products and other effective experiences,it has clarified the countermeasures and suggestions,including integrating the advantages of multi-mode,expanding mediation and disposal outside medical dispute litigation,establishing medical early warning system,and constructing scientific product contents,so as to provide an optimal path for preventing and controlling medical risks.

关 键 词：医疗责任保险 医疗纠纷 医疗损害 模式 

分 类 号：R-05[医药卫生]