我國醫療責任強制保險制度研究(碩士)

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我國醫療責任強制保險制度研究(碩士)(論文150000字)
摘要:醫療糾紛將會導致醫患關系緊張等社會秩序遭到破壞的結果。我國當前處理醫療糾紛的主要手段仍然是事后的訴訟制度,根據域外經驗,醫療責任強制保險更具有效果,實現該制度的本土化具有學術價值、應用價值和社會意義。學術價值層面,強制醫療保險制度強調本土特色、理論生命旺盛、促成學科交叉與綜合運用;應用價值層面,強制醫療保險制度符合時代背景、推動立法完善;社會意義層面,強制醫療保險制度促成社會共識、制度性監督醫療機構。基于此,為了完善侵權責任法的風險分散理論、助力醫療衛生體制改革與發展、使醫患糾紛的解決出現新思路、在實踐中給患者權益的維護和保障提供理論支撐、分散醫務人員及醫療機構的執業風險,本文基于廣義的、《侵權責任法》中的定義,以保險制度中的責任為核心,廣泛意義上理解不只作為民事責任的醫療責任,在此概念基礎上以我國醫療責任強制保險制度研究為主題展開研究。
我國醫療責任保險制度以在國家產品化及政策性文件和在各地以制度性探索的形式展開,具有多個層面的問題:醫療機構持觀望態度,仍然采取傳統的糾紛處理方式;保險公司持謹慎態度,醫療責任保險運營狀況困難;患者存在誤解。本質上講,造成上述問題的原因有:思想認識落后、規則體系混亂、強制效力缺乏、操作過程僵化、智力支撐不足。構建醫療責任強制保險制度應當首先奠定理論基礎,經濟學角度提供了福利經濟思維,認為醫療責任強制保險制度是使得整個社會的福利總量進行擴增的“放大器”、對社會福利總量進行個體化最佳分配的“協調器”、對社會福利進行政府干預、防止其出現失衡的“穩定器”;法學基礎理論認為,醫療責任強制保險是對公民健康權的保障,這在國際條約、憲法和民法中均有體現;當前社會是一個風險社會,診療活動風險是醫患糾紛解決的重要內容,風險分散理論能夠使風險承擔主體增多、壓力承擔面擴大,從而為醫療責任強制保險制度設定理論基礎。在我國,該制度建立的現實基礎應當透過醫患關系來分析,我國當前醫患關系日益惡化,從經濟學的角度看,其本質是人民群眾日益增長的醫療服務需求同仍不完善的醫療服務市場之間的矛盾;從社會學的角度看,醫生具有單向主導性,患者缺乏對信息的知情以及信息的知情;從倫理學的角度看,醫患關系具有多元的、雙向的倫理影響;同時,醫務人員的疏忽或盲目自信造成誤診、醫務工作者能力不足等也是造成現實醫患關系緊張的原因。醫療責任強制保險制度能夠保障患者權益、緩解醫療機構以及醫務工作人員的壓力、促使醫患矛盾得到緩解。作為本土化分析的對象,醫療責任保險制度具有與交強險相似的性質與制度設計,在我國更具有觀念上的可接受性。醫療責任強制保險具有社會性,能夠解決社會矛盾、照顧弱勢群體;具有功能性,能夠重建醫療信任、緩解醫患矛盾,有效彌補醫療損害,優化醫療資源配置;具有價值性,需要在效率、公平以及秩序之間進行選擇。
醫療責任強制保險制度的建立應展開立法化,因此應首先明確法律關系。投保人為醫療機構,具有解除合同的權利和按時繳納保險金、如實告知的義務;被保險人為醫療機構或醫務人員,但應當排除醫生、受委派的醫師以及實習生,具有指定受益人的權利,也承擔著告知真實情況的義務;承保主體是保險公司,具有請求被保險人繳納保險費、要求投保人和保險人如實告知、對被保險人進行一定的監督的權利,同時也具有說明保險內容、提示保險內容的義務。其次應當對保險利益進行分析。保險利益的責任基礎應當基于不同情況區分過錯責任、無過錯責任和公平責任,最終補償效果歸屬于受損害人,保費由醫療機構進行承擔,賠償額度問題實際上是侵權責任問題,應區分人身損害賠償和精神損害賠償,具體設計為直接賠償和間接賠償,積極的精神損害賠償和消極的精神損害賠償。在承包范圍的設計上應當區分以下幾個重點問題,醫療責任強制保險應當排除醫療故意引起的損害賠償,醫療過失引起的損害賠償不應當被排除,醫療意外引起的損害賠償應當納入承包范圍。醫療責任強制保險的免責事由既應當包括侵權責任法的免責事由、也應當包含保險法的免責事由,同時也應當具有本部門法律的特性,即要考量利益平衡的問題,免責事由是對各方利益的重新平衡,根據日本、臺灣地區的經驗,結合本土語境,免責事由的一般條款應當劃分為原因免責,情形免責,特定的損失、費用和責任;在具體實踐中存在就醫務人員不符合治療資質的免責,就醫務人員使用的不符合標準的醫療器材、藥品等免責,對于不在診療目的下進行的醫療活動免責,對于意料意外的免責。基于以上探討,我國醫療責任強制保險的免責事由應當區分為醫療過失責任保險免責事由和醫療意外責任保險免責事由,前者包括被保險人或其醫務人員的故意行為和非執業行為等,后者包括各類醫療意外事件引發的責任。除了以上傳統保險責任的法律制度設計之外,相關配套制度和機制也應當進行完善:其一,應當構建一元化的醫療損害鑒定制度,實現統一性;建立醫療糾紛ADR的解決方式,促成糾紛在訴訟之外的真正解決;加強醫療糾紛調解隊伍的建設,建立保險公司內部的醫療責任保險處理組織或機構,建立專家庫等;此外,醫療風險及保險大數據庫的建立和醫療責任保險基金及互助組織的建立均是時代背景下新的配套方案;整體制度設計之外,也應當強化對醫療責任強制保險的監管。

圖X幅,表X個,參考文獻X篇

關鍵詞:醫療責任保險;醫患矛盾;風險分散理論;利益平衡原則
分類號:

STUDY ON COMPULSORY INSURANCE SYSTEM OF MEDICAL LIABILITY IN CHINA
Abstract: Medical disputes will result in the disruption of social order, such as the tension between doctors and patients. The main means of dealing with medical disputes in our country is still the lawsuit system after the event, according to the extraterritorial experience, the medical liability compulsory insurance has more effect, and it has academic value, applied value and social significance to realize the localization of the system. The academic value level, the compulsory medical insurance system emphasizes the native characteristic, the theory life exuberant, promotes the interdisciplinary and the comprehensive application of the discipline, the application value level, the compulsory medical insurance system conforms to the time background, promotes the legislation consummation; Based on this, in order to perfect the tort liability law's risk dispersion theory, to help the reform and development of medical and health care, to bring about new ideas for the settlement of medical disputes, to provide theoretical support for the maintenance and guarantee of patients ' rights and interests, to disperse the practice risks of medical personnel and medical institutions, this article is based on the definition in the broad sense, the law of tort liability Taking the responsibility in the insurance system as the core and understanding the medical liability in a broad sense not only as civil liability, on the basis of this concept, the research on the compulsory insurance system of medical liability in our country is studied as the theme.
China's medical liability insurance system in the national product and policy documents and in the form of institutional exploration, there are many aspects of the problem: the medical institutions hold a wait-and-see attitude, still take the traditional way of dealing with the dispute, insurance companies cautious, medical liability insurance operating conditions difficult; In essence, the causes of the above problems are as follows: The thought is backward, the rule system is confused, the force is short, the operation process is rigid, and the intelligence support is insufficient. The construction of medical liability compulsory insurance system should first lay the theoretical foundation, the economics angle provides the welfare economic thinking, thinks that the medical liability compulsory insurance system is the "amplifier" which makes the whole social welfare total increase, the "coordinator" of the individual optimal distribution of the total social welfare, and the government intervention to the social welfare, The "stabilizer" that prevents it from appearing unbalanced; the basic theory of law holds that medical liability compulsory insurance is the guarantee of citizens ' right to health, which is embodied in international treaties, constitutions and civil law. At present, society is a risk society, the risk of diagnosis and treatment is the important content of the dispute resolution, and the risk spreading theory can make the subject of risk increased The pressure bearing face expands, thus establishes the theory Foundation for the medical liability compulsory insurance system. In our country, the realistic foundation of the system should be analyzed through the relationship between doctors and patients, at present, the relationship between doctors and patients is deteriorating, from the angle of economics, its essence is the contradiction between the people's increasing demand for medical service and the still imperfect medical service market. From a sociological point of view, the Doctor has a one-way lead, Patients lack of information and information, from the perspective of ethics, doctor-patient relationship has a pluralistic, two-way ethical impact, at the same time, the negligence or blind self-confidence of medical staff caused misdiagnosis, medical workers lack of ability, etc. is also caused by the real relationship between doctors and patients tension. The medical liability compulsory insurance system can guarantee the patients ' rights and interests, relieve the pressure of the medical institutions and medical staff, and make the doctor-patient contradiction relieved. As the object of the localization analysis, the medical liability insurance system has the similar nature and the system design with the strong risk, and has the concept acceptability in our country. Medical liability compulsory insurance has sociality, can solve social contradictions, take care of disadvantaged groups, has function, can reconstruct medical trust, relieve doctor-patient contradiction, effectively make up medical damage and optimize medical resource allocation; It is valuable to choose between efficiency, fairness and order.
The establishment of medical liability compulsory insurance system should be legislated, so the legal relationship should be defined first. The insured is a medical institution, having the right to terminate the contract and the obligation to pay the insurance money on time and to truthfully inform; The insured shall be a medical institution or medical officer, but the physician, the appointed physician and the trainee, with the right to designate the beneficiary, and the obligation to inform the truth, should be excluded; It has the right to ask the insured to pay the insurance premiums, to require the insured and the insurer to give truthful notice to the insured, and also to have the obligation to explain the content of the insurance and the content of the insurance. Secondly, the insurance interests should be analyzed. The liability basis of insurable interest should be based on different circumstances to distinguish fault liability, without fault liability and fair liability, the ultimate compensation effect belongs to the injured person, the premium is borne by the medical institution, the compensation limit is actually the tort liability problem, which should distinguish the personal injury compensation and the mental damage compensation, specifically designed for direct compensation and indirect compensation, Positive mental damage compensation and negative mental damages. The design of contract scope should be divided into the following key issues, medical liability compulsory insurance should exclude medical intentional damage compensation, medical negligence caused damage compensation should not be excluded, medical accident caused damages should be included in the scope of the contract. The exemption of medical liability compulsory insurance should include the exemption cause of tort liability law, should also contain the exemption cause of insurance law, but also should have the characteristics of the department's laws, that is, to consider the issue of balance of interests, the exemption is to balance the interests of all parties, according to the experience of Japan, Taiwan, combined with the local context, The general clause of the exemption cause shall be divided into the reason exemption, circumstances, specific losses, costs and liabilities; in the practice of the medical personnel in the absence of compliance with the treatment of the exemption, in respect of medical personnel used substandard medical equipment, drugs and other exemptions, for not the medical activities carried out under the exemption, An exemption from unexpected surprises. Based on the above discussion, the exemption of medical liability compulsory insurance should be divided into the exemption cause of medical negligence liability insurance and medical accident liability insurance, the former includes intentional behavior and non practice of the insured or its medical personnel, the latter includes the responsibility of all kinds of medical accidents. In addition to the legal system design of traditional insurance liability, relevant supporting system and mechanism should also be perfected: firstly, we should construct the unified medical damage appraisal system, realize the unification, establish the solution way of ADR of medical dispute, promote the real solution of the dispute outside the lawsuit, and strengthen the construction of the mediation team of medical dispute, To establish a medical liability insurance treatment Organization or institution within an insurance company, establishment of expert database and so on; In addition, the establishment of medical risk and insurance databases and the establishment of medical liability insurance funds and mutual aid organizations are the new supporting schemes under the background of the Times, and the supervision of compulsory medical liability insurance should be strengthened in addition to the overall system design.

Keywords: medical liability compulsory insurance, doctor-patient contradiction, risk dispersion theory, interest balance principle
Classification:
 
目  錄
第1章緒論    1
1.1問題的提出    1
1.2研究意義與目的    1
1.2.1  研究意義    1
1.2.2  研究目的    4
1.3  研究現狀    8
1.3.1  域外對醫療責任保險實行強制之后的效用的研究    9
1.3.2  關于我國醫療責任保險制度建構與發展現狀的研究    12
1.3.3  醫療責任保險制度的建立和意義研究    14
1.3.4  是否應當構建強制性醫療責任保險制度的研究    15
1.3.5  醫療責任保險制度中的法律關系研究    15
1.3.6我國部分省市醫療責任強制保險試點的實效研究    16
1.4研究思路、方法和研究內容    17
1.4.1研究思路    17
1.4.2研究方法    19
1.4.3研究內容    20
1.5相關概念界定    21
1.5.1醫療的定義    21
1.5.2責任的定義    22
1.5.3醫療責任的定義    23
1.5.4保險的定義    24
1.5.5醫療保險與醫療責任保險的區分    25
第2章我國醫療責任保險的制度困境與成因    27
2.1我國醫療責任保險制度現狀描述    27
2.1.1  國家層面的推進    27
2.1.2地方層面的探索    28
2.2我國醫療責任保險制度的發展困境    28
2.2.1  醫療機構的觀望    28
2.2.2保險公司的謹慎    29
2.2.3  患者的誤解    30
2.3我國醫療責任保險制度陷入困境的成因    30
2.3.1思想認識滯后    30
2.3.2規則體系混亂    31
2.3.3強制效力缺乏    31
2.3.4操作過程僵化    32
2.3.5智力支撐不足    33
2.4小結    33
第3章醫療責任強制保險制度建構的理論邏輯與現實背景    35
3.1醫療責任強制保險制度的理論基礎    35
3.1.1實行醫療責任強制保險的經濟學動因    35
3.1.2醫療責任強制保險對健康權的保障    40
3.1.3醫療行為的風險性與風險分散理論    44
3.2我國建立醫療責任強制保險的現實背景:以醫患關系為中心    48
3.2.1我國當前日益惡化的醫患關系及其實質    49
3.2.2醫療責任強制保險對醫患關系的緩解作用    54
3.3觀念上的可接受性:與交強險的比較    56
3.4小結    61
第4章醫療責任強制保險制度的定性、功能和價值選擇    64
4.1醫療責任強制保險的社會性    64
4.1.1社會性的概念辨析    64
4.1.2醫療責任強制保險社會性的體現    65
4.2醫療責任強制保險制度的功能    66
4.2.1重建醫療信任,緩解醫患矛盾    66
4.2.2有效彌補醫療損害    67
4.2.3優化醫療資源配置    68
4.3價值選擇    69
4.3.1效率價值    69
4.3.2第三方介入帶來的公平性    69
4.3.3個人自由與公共秩序的共同實現    70
4.4小結    71
第5章醫療責任強制保險制度中的法律關系    72
5.1投保人、被保險人與承保主體    73
5.1.1醫療責任強制保險制度中的投保人    74
5.1.2醫療責任強制保險制度中的被保險人    77
5.1.3醫療責任強制保險制度中的承保主體    80
5.2醫療責任強制保險的保險利益    84
5.2.1保險利益的責任基礎    84
5.2.2保險利益的歸屬主體    86
5.3醫療責任強制保險的保費承擔    87
5.3.1保費的承擔主體    87
5.3.2保費的確定依據    88
5.4醫療責任強制保險的賠償額度    90
5.4.1賠償額度的決定因素    90
5.4.2賠償額度的具體設計    92
5.5小結    93
第6章醫療責任強制保險的承保范圍    95
6.1我國醫療責任保險承保范圍的現狀    95
6.2我國醫療責任強制保險承保范圍的確定    95
6.2.1醫療故意引起的損害賠償不應承保    96
6.2.2醫療過失引起的損害賠償應當承保    99
6.2.3醫療意外引起的損害賠償應納入承保范圍    102
6.3小結    106
第7章醫療責任強制保險的免責事由    108
7.1免責事由概述    108
7.1.1免責事由    108
7.1.2免責事由的類型    109
7.1.3保險合同免責事由    109
7.1.4我國醫療責任免責事由的立法模式    110
7.2免責事由:醫療責任強制保險的利益平衡    111
7.2.1醫療責任強制保險可能帶來的利益失衡問題    111
7.2.2免責事由是對各方利益的重新平衡    112
7.2.3醫療責任保險免責事由的明確說明    113
7.3域外醫療責任保險免責事由的相關規定    114
7.3.1日本醫療責任保險免責事由    114
7.3.2我國臺灣地區醫療責任保險免責事由    115
7.4我國醫療責任強制保險免責事由的具體設計    116
7.4.1免責事由的一般條款    117
7.4.2實踐中我國的醫療責任保險免責事由    120
7.4.3免責事由的具體設計    123
7.5小結    124
第8章相關配套制度和機制的完善    126
8.1醫療損害鑒定制度的一元化構建    126
8.1.1當前二元對立的醫療損害鑒定制度    126
8.1.2一元化醫療損害鑒定制度的優勢    128
8.1.3一元化醫療損害鑒定制度的構建路徑    131
8.2建立醫療糾紛ADR解決    136
8.2.1ADR的主要類型    137
8.2.2醫療責任保險中ADR的建構    139
8.3配套機構的建設和完善    141
8.4醫療風險及保險大數據庫的建立    142
8.5醫療責任保險基金及互助組織建立    144
8.6強化對醫療責任強制保險的監管    145
8.6.1美國醫療危機帶來的保險監管啟示    146
8.6.2構建有力的醫療責任強制保險監管機制    146
8.7小結    148
第9章結語    149
參考文獻    154
附錄:醫療責任強制保險條例(主要條款建議稿)    155

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