社会医疗保险与侵权损害赔偿竞合问题研究  

Research on the Competition and Cooperation between Social Medical Insurance and Tort Damage Compensation

作　　者：蒋逸天 JIANG Yitian(Southeast University,Nanjing,Jiangsu 210000,China)

机构地区：[1]东南大学,江苏南京210000

出　　处：《医学与法学》2025年第2期88-92,共5页Medicine and Jurisprudence

基　　金：国家社科基金重大项目“突发重大公共卫生事件防控的法治体系研究”(项目编号:20&ZD189)的阶段性成果。

摘　　要：社会医疗保险与侵权损害赔偿竞合在司法实务中存在“扣除说”和“不予扣除说”两种相互冲突的裁判观点;研究2018—2023年相关裁判文书的实证可看出,“不予扣除说”所提出的法律关系不同、赔偿金额增加等论证理由难以成立,而“扣除说”与《社会保险法》第30条规定相契合,符合“不得重复受偿”的社会医疗保险基本法理,亦不会损害被侵权人的合法权益;基于此我国应完善基本医疗保险基金追偿制度,通过司法解释等方式将社会保险行政部门列为诉讼第三人,以诉源治理为导向来实质性化解相关纠纷。In the judicial practice,there are two conflicting judgment viewpoints,"deduction theory"and"no deduction theory",in the Competition and cooperation between social medical insurance and tort damage compensation.From the empirical study of relevant judgment documents from 2018 to 2023,it is found that it is difficult to establish the arguments of different legal relationship and com-pensation amount increase raised by the"no deduction theory",and the"deduction theory"is consistent with the provisions of Article 30 of the Social Insurance Law,is in line with the basic legal principle of"no repeated compensation",and will not damage the legitimate rights and interests of the infringed.Based on this,China should improve the basic medical insurance fund recovery system,list the social insurance administrative department as the third party of litigation through judicial interpretation,and effectively resolve re-lated disputes with the source of litigation management as the guidance.

关 键 词：社会医疗保险 侵权损害 保险基金追偿 《社会保险法》 

分 类 号：D923[政治法律—民商法学] R-05[政治法律—法学]