台灣醫院記名通報規範與執行之實證研究──論公共衛生實踐中病患醫療資訊之保護

Abstract

國家為追求整體社會人群健康而進行許多公共衛生活動，其中許多措施都必須以蒐集病患醫療資訊的方式達成。而醫療資訊係個人私密生活之敏感性資訊，不但醫師對其有保密義務，病患對自身醫療資訊亦享有憲法上資訊隱私權之保護，從而政府在個人醫療資訊之蒐集上必須謹慎節制，且記名通報之必要與否應視公共利益強弱以及病患權益保障權衡而定。我國醫療資訊之保護係規範於個人資料保護法，個資法將醫療資訊列為第6條特種個人資料，其蒐集、處理或利用看似較一般個人資料更為嚴格，然個資法對於特種個人資料卻廣開例外，目前看來國家透過醫院蒐集大量病患醫療資訊，在正當性和資訊保護之規範上有待斟酌，整體而言，個資法對於病患之資訊隱私並未提供足夠保護。此外，目前台灣尚缺乏關於個人醫療資訊通報予主管機關之公共衛生措施與相應法規範之調查與分析研究，本研究透過質性訪談之方式了解台灣醫院應主管機關要求記名通報醫療資訊之規範與執行現況，探討不同類型醫療資訊強制記名蒐集之必要性，有無其他侵害較小之替代手段，是否應落實告知後同意，以及國家蒐集病患醫療資訊應踐行之程序，並藉由比較法分析途徑，以美國對於醫療資訊之保護規範作為我國參考借鏡，從而提出國家在公共衛生利益之追求下如何落實病患醫療資訊之保障之立法建議。

Health information is essential to many public health practices when government intends to achieve public health purposes. However, health information is considered by many to be among the most private of information. Collecting vast amount of health information promises significant public health benefits but also threatens patients’ information privacy and breaches of confidentiality between physician and patient. Therefore, when government plans public health projects, the government needs to justify if it is essential to collect identifiable health information. Health information is protected by Personal Information Protection Act in Taiwan. However, Article 6 excludes identifiable health information which may be collected by public health agencies, thus the law do not adequately protect personal health information. Current law and policy fail to reconcile individual privacy interests with collective public health interests in identifiable health information. To reconcile these two divergent approaches, this research first takes the U.S.’s legislature as an example. Secondly, we interviewed 37 hospital personals who are responsible for reporting patients’ health information to government. Based on the result of the interviews, this thesis explores which items should be reported, how hospitals collect name-based health information, what kind of procedures are taken, and what rules are followed. Furthermore, the thesis analyzes what the government’s need for access to the information, and is there a statutory mandate, health policy, or strong public interest favoring access to identifiable health information. On those bases, this thesis proposes ideas for balancing the public need for health information and individual claims to privacy while establishing process when gathering health information.