我國醫療糾紛處理政策之研究-以「醫療法82條」與「醫療事故預防及爭議處理法」草案為探討中心

Abstract

1985年健保實施後，醫病關係因量變而產生質變，1990年代多件受矚目之醫療糾紛案件，致使醫病關係急劇惡化，醫療糾紛訴訟案件也在2000年達到高峰，醫師不願從事高風險科別，出現「四大皆空」醫師人力不足的現象，加上醫界採取防衛性醫療，台灣社會因此付出極大代價。 2017年12月29日「醫療法第82條」修法，被視為回應醫界「醫療刑責合理化」訴求，雖然修法意欲將醫療刑事責任限縮於「故意責任」之範疇，但因事實上沒有改變刑法實體法運作，其認定仍為法院之心證。同年底之「醫療事故預防及爭議處理法草案」是我國討論多年之「醫療糾紛處理政策」再次叩關立院，但因屆期不連續之故，2018年5月後迄今未有進度。 探討國內外醫療糾紛刑事政策後發現，希冀以醫療法第82條修法讓醫師除罪化，並不足以解決問題，應以「國家補償」及「社會風險分擔理論」制定補償政策，方能根本解決醫療糾紛，蓋因「醫療事故」係醫療風險實現，導致病人遭受損害，其損害填補不該由醫、病任一方承擔，應由全民社會一同承擔風險。 本文建議以「混合制之醫療補償制度」作為相關政策立法前之損害填補機制，其目的在於解決紛爭、填補損害，且藉由重大風險之疾病由國家補償政策之施行，建立「社會風險共同分擔」之概念，作為未來施行醫療強制險之共識。

Since the Healthcare in Taiwan (National Health Insurance) has been implemented in 1985, medical relationship has gone through qualitative changes due to the increase in the quantity. In the 1990s, a great number of remarkable medical disputes occurred. In 2010, medical relationship worsened drastically, and the number of medical dispute legal cases reached its peak, leading to doctors’ unwillingness to practice medicine in high-risk departments. Physician shortage occurred in four major medical departments: Department of Internal Medicine, Department of Surgery, Department of Obstetrics and Gynecology, and Department of Pediatrics. In addition, medical profession’s adoption of defensive medicine has made Taiwan society pay a high price because of medical dispute. On December 29th, 2017, the “amendment to Article 82 of the Medical Act” passed by Legislative Yuan was considered as the response to the appeal of “rationalizing criminal liabilities in medical procedures” raised by the medical profession. At the end of the same year, 10 years after Taiwan has first started to discuss “Medical Dispute Resolution Policy”, “the Draft of the Medical Accident Prevention and Dispute Resolution Act” reached the Legislative Yuan again. However, due to the “non-carryover principle” on unpassed bills, there has not been any further progresses since May 2018. This article will discuss the medical dispute criminal policies in Taiwan and other countries, and the concepts of “national compensation” and “social risk sharing policy”: Medical accident is the realization of medical risks that cause physical damage to patients. Compensation on damage should not be borne by either side of the medical practitioner or the patient. It should be supported by the whole society. This article suggests adopting “hybrid system of medical compensation” as the damage compensation system during the transitional phase, before medical dispute legislation being fully established in Taiwan. The purpose is to resolve dispute and compensate damage, and through the implementation of national compensation on significant-risk diseases, establishes the concept of “social risk sharing” and the consensus of establishing compulsory medical insurance in the future.