醫療爭議調解模式的初探

南華大學機構典藏系統 > 管理學院 > 企業管理學系(管理科學碩/博士班,非營利事業管理碩士班) > 博碩士論文-非營利事業管理碩士班 > Item 987654321/21977

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題名:	醫療爭議調解模式的初探
其他題名:	A Study for Intermediation of Medical Malpractice
作者:	李宜親 Lee, I-ching
貢獻者:	非營利事業管理研究所呂朝賢 Chao-hsien Leu
關鍵詞:	醫療糾紛;爭議調解;醫療爭議 intermediation;medical dispute;medical malpractice
日期:	2005
上傳時間:	2015-07-06 16:18:08 (UTC+8)
摘要:	長期以來，由於醫療資訊的不對稱及疾病的不確定性，使得民眾成為處於醫療環境下的弱勢族群；因此，一但發生醫療爭議時，民眾便會不知所措，不知如何處理相關的事項，至此若無相關單位的協助，民眾則必需單獨面對具有優勢的醫療專業團隊，也只能被迫式的接受和解。故本研究嘗試以文獻整理及訪談方式，藉由：民眾，醫療院所，民間團體及政府等四個構面來瞭解：1、民眾的申訴管道及民間可運用之社會資源2、醫療院所如何處理醫療爭議案件及其賠償3、醫療爭議案件的鑑定及其調解模式　　　以做為建立醫病雙方均可接受的醫療爭議調處之參考，希望能藉由協助民眾處理醫療爭議並保障民眾權益，達到做為醫病溝通之橋樑及並促進醫病雙方的關係；並依研究結果提出相關的研究建議。　　　本研究發現：1、民眾的資訊缺乏：長期以來民眾便一直處於資訊不對稱的狀態。然而研究發現民眾不但對醫療專業的資訊缺乏，連對自己本身的權益及尋求協助的資訊也處於缺乏的狀態下。2、醫療院所掌握優勢：本研究發現，醫療院所是一個高度專業分工的合作團隊，在這個團隊中的組成份子，不僅是醫事人員，尚包括各層級的專業人員，例如：社會工作人員，公關人員，醫療行政人員，律師，……等專業人員。每一個人都具有其相關之專業知識，相形之下，在面對醫療爭議案件時，則自然的處於絕對的優勢之中。3、民間組織的資源不足：由於組織的宗旨及缺乏競爭的優勢，使得原本就已經缺乏競爭力的民間組織更加難以生存。4、政府缺乏調解效率及無法有效監督醫療院所：缺乏專業的醫事鑑定人員做醫事鑑定，缺乏醫療爭議調解的時效性，缺乏醫療專業知識或相關經驗的調解人士，面對如此調處方式，當然無法令人有所信服其調處結果。而且在醫療爭議確認醫療疏失後，甚至未對產生疏失人員提出懲戒。5、醫療爭議調處所面臨的困境：研究發現電子病歷的推行，使得病歷所具有証據的地位受到動搖；全民健保的給付引導醫療服務的提供；消保法適用醫療行為的爭議無法定論，使得醫療消費者，被排除於保護法之外；未規範賠償制度，導致金額賠償無定論。　　　研究建議：1、應建立單一專責調處機構，協助民眾處理醫療爭議之案件。不僅可以整合所有醫審會之資源，加強時間的管理，加速案件的審查與調處；建立專業醫事鑑定作業制度，培訓專業鑑定人員，以協助釐清案件中的爭議與疑義。2、建立通暢的申訴管道，提供民眾使用；加強資訊的傳播，使民眾瞭解自己的權利並能悍衛自己的權益。3、應建立相對優勢的監督機制加以制衡。4、政府主管機關應建立一個民間組織共同之平台，協助資源的整合，加強監督與管理，強化民間組織的體質，使其去蕪存菁，代替政府監都醫療院所，協助改善醫療環境5、政府主管機關應加強修法，並加以規範，使其降低對醫療爭議調處之影響。　　Patients have long been on the weaker side of medical malpractice due to lack of medical information and poorly educated knowledge about medicine and disease. Therefore, when medical malpractice happens, patients do not know how to handle the issues. If they don't go to the right channel to access the assistance, they will need to face the professional medical lawyers or firms by themselves, and be forced to accept the unfair settlement.　　　This research is to combine reviewing research papers and interviewing four different groups. The four groups include patients, hospitals, local organizations and government. We hope that from those four points of view, we could learn more about these medical malpractice problems in the following areas: 1. Ways or channels to sue for the medical malpractice, and to access the helpful social resources. 2. How the hospital deals with the medical malpractice cases and makes the settlement with the clients. 3. The authentication of the medical treatment dispute cases, and the settlement procedure.　　　The main purpose of this research is to suggest acceptable solutions to medical disputes for both doctors and patients. By means of providing help to patients to deal with the medical disputes and protecting their rights, the research attempt to be the bridge connecting doctors and patients, and also improve their relation. Our research results are as follows: 1. Patients lack medical information: They always lack correct medical information. In this research, we discover that patients not only lack proper medical information, but they also lack the proper way to access the assistance, and that they don't even understand their rights. 2. The hospital is always the advantaged one: In the research, we realized that the hospital has a highly organized professional team to deal with medical disputes. The team is composed of the medical personnel, and other professionals, such as social workers, public relationship officers, medical assistants, lawyers etc. Each person has his respective duty for solutions of the medical disputes. Hence, when a medical malpractice happens, the hospital always stands on the advantaged side. 3. The NPOs who help the patients deal with the medical disputes don't have enough resource: Owing to their unique missions, and lack of competitive ability, it's hard for them to survive from the competition. 4. Government hasn't yet establish an effective mechanism to intermediate the medical disputes and to monitor the hospitals: It lacks professionals to authenticate and intermediate the medical disputes, and fails to set up instant responsive system to intervene the disputes; therefore, it is sure that patients cannot accept the intermediation government has made. Furthermore, when it was evident that there was malpractice involved in the medical dispute, the hospital and the doctor hadn't been blamed on their faults. 5. The problems encountered during the intermediation of the medical disputes: Now all the medical records are asked to be in electronic format, so their status of legal evidence have been shaken. Bureau of National Health Insurance (BNHI) can only cover certain operation and medicine payment, thus forcing doctors and hospitals to make certain rule to insure hospitals or doctors receive money from BNHI. It's still uncertain whether the Consumer Protection Act (CPA) applies to the disputes of medical service consumption. Hence, the medical service consumers are exempted from the protection of the CPA. Finally, The failure of the establishment of the amends system also traps the intermediation into an uncertain situation that there are no standards to justify the amounts of amends.　　　Based upon the research results, our suggestions are as follows. 1. Government should set up an agency responsible for the intermediation of the medical disputes, and the provision of the assistance to the patients. It will contribute to the integration of the resources held by existing medical dispute councils, the improvement of the time management, and the speed up of the examination and the intermediation of cases. Besides, to enhance the professionalism of the authentication of the medical disputes, and to develop the training and education of the authenticators, it's helpful for the solutions of the medical disputes. 2. There should be an institution accessed by patients to claim a plea for the medical malpractices. Government should disperse the information about the medical disputes to make the patients understand and defend the rights they have. 3. Government should establish a monitor system to maintain the equilibrium between doctors and patients. 4. Government should setup a mechanism to coordinate all the relevant NPOs, to integrate their respective resources, to improve their supervision and management. It should support the quality NPOs, and let the unsuitable ones eliminated. The quality NPOs will be delegated to monitor the operation of hospitals and supervise them to improve their services. 5. Government should try its best to amend the unsuitable legislations and to execute the existing laws and rules. Government should avoid the legal regulations to impede itself to intermediate the medical disputes.
顯示於類別:	[企業管理學系(管理科學碩/博士班,非營利事業管理碩士班)] 博碩士論文-非營利事業管理碩士班

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