顯影劑過敏之風險管理與保險模式之先驅性研究

Abstract

醫療作業中，醫師常須在極短的時間內，就病人的問題，作成判斷，進行處置。但無論醫師有無過失，一旦醫療結果不如預期，便可能引起醫療糾紛。醫療糾紛發生後無論是處理時間、賠償費用等所產生的問題已經成為台灣醫師執業上的困擾，間接造成民眾健康照護上的問題。本研究之目的，即是希望進以研究者本身之放射科專科，探究在無過失醫療行為下，對於因顯影劑過敏而造成死亡之病人損害填補之合理機制。 顯影劑注射過敏之風險屬頻率低(1/10萬~2/10萬)，但損失幅度高(死亡)之事故，可以保險方式移轉風險。本研究參考國內現行之理賠水準，將每一死亡個案補償金上限訂為600萬元，依據發生率每10萬之2推估，每年純保費約3,000萬，附加費用則介於914萬~1054萬之間。 本研究討論之保險承保作業可以採基金會的方式進行。若為委辦其他現有之機構，每人次保費為170元，若為獨立型機構辦理每人次保費為176元。該保險費用的分攤，建議可由政府負擔50%(88元)，醫療院所25%(44元)，顯影劑藥物製造業者及輸入業者負擔25%(44元)。 保險費用可於醫院於病人接受注射顯影劑時徵收，由醫院批價時加批顯影劑過敏風險的保險費用。醫院每月應就實際收費人數與金額，轉帳至指定之基金帳戶，作為保險運作之經費。 一旦發生承保範圍的事件，由基金會進行理賠審查，經審查確認後，支付理賠金予受益人。受益人資格可依民法相關法規辦理。

Physicians often require prompt and instant judgments and actions to treat their patients. Nevertheless, if the results or demands are not met by the patients or family, it ended up as a medical dispute. Medical dispute are cost and time consuming and it become the main leading cause for medical students to choose their specialty. The purpose of this study hopes to develop a well and reasonable compensatory mechanism for helping the patients and radiologists who involved in the contrast medium allergy mortality. The incident of contrast medium allergy mortality is rare, (1/100,000 ~2/10 million). However, the cost of life is tremendous for both the patients and radiologists involved. We recommended an insurance model for risk transferring. A beneficiary can claim a total sum of 6 million Yuan in each incidence and a net premium of about 30 million a year are estimated. A foundation for running the insurance issues is suggested. The estimated premiums are 170 Yuan per person if the foundation is run by commission unit or 176 Yuan per person if which is run by independent agency. Our study proposed the premium allocation as Government 50%, medical institutes 25%, drug agency 25% . The settlement of claim will be reviewed by committee members from foundation. Beneficiary eligibility must comply with the civil law regulations.