醫師民事責任風險分散制度之研究－以醫院醫療糾紛基金為中心

Abstract

近年來醫療糾紛頻傳，逐漸破壞我國醫療服務之秩序。病人透過民事訴訟追究醫師個人的醫療過失責任，讓醫師獨自面臨莫大的責任風險，訟累及法院天價的判賠金額使醫師背負執業壓力，又以醫院醫師背負者最為沉重。醫療責任風險造成醫師艱困的執業環境，已大大影響我國的醫療品質，實非你我福祉，因此醫師面臨的民事責任風險實有分散之必要。

醫療責任保險雖試圖成為分散醫師風險的良藥，醫界卻決定自食其力，由醫院成立「醫療糾紛基金」來分散醫師的風險。由於醫療糾紛為醫界的敏感議題，故鮮有研究探討此基金之運作實況，因此，本文遂以我國大型醫院為研究對象，透過實證研究建構醫院醫療糾紛基金之樣貌，接著釐清醫師選擇風險分散制度的考量，並比較醫院醫療糾紛基金與其他風險分散制度之不同，以提供我國建立醫療責任風險分散制度之建議。

本文自研究結果得出以下結論：第一，醫院醫療糾紛基金可分為「醫事人員互助金」與「醫院基金」兩種類型，醫事人員互助金實為保險，互助金管理委員會則應轉型成為醫療責任保險合作社，受到保險法監管。第二，應以「醫院醫療糾紛基金」與「醫糾法草案醫療事故補償基金」為主，並輔以「醫療責任保險」，共同為醫師分散醫療責任風險，並即時填補病家損害，以盡快、妥適地解決醫療糾紛，降低醫療糾紛對我國醫療服務體系的衝擊。

The amount of medical dispute has arisen in recent years. Physicians face much more civil litigations than before, especially those who work in the hospitals. The risk of being involved in malpractice civil litigations brings the physicians a stressful working environment and has greatly affected the quality of the medical treatment. Distributing the medical malpractice risk will reduce physicians’ stress and improve the quality of health care.

Although some insurance companies provide medical malpractice insurance policies on the market, physicians and hospital administrators are inclined to use the retention fund from their hospitals to distribute the risk. The retention fund is called “Medical Dispute Resolution Fund.” Since the medical dispute is the sensitive issue in the hospitals, there have been few studies on the fund. Hence, this study attempts to clarify the rules of the fund, recognize physicians’ demands on risk distribution, and compare different risk distribution systems in countries. Ultimately, this study purposes to improve the risk distribution system in Taiwan.

The findings provide the following conclusion: First, the fund can be classified into “the mutual fund from the medical personnel” and “the fund from the hospital”. The mutual fund should be applicable to insurance acts and regulations. Also, the mutual fund management boards should transform into insurance cooperatives. Second, the risk should be distributed by the hospitals’ medical dispute resolution fund and a governmental medical incident compensation fund, and supplemented by commercial medical malpractice insurance policies. The risk distribution system can also solve medical dispute by compensating the patients and their families in a more timely manner. A well-designed risk distribution system will prevent our public medical system from serious damages by medical dispute.