論強制醫療責任保險—從立法的觀點評析強制醫療責任保險法草案

Abstract

醫療科技之進步、醫療行為之複雜多樣化，甚至國民法律知識之提升，均導致了醫療糾紛數量之增加。至無法預醫療糾紛之產生，往往是因為發生了醫病雙方於醫療行為初始時，所不欲發生，甚至無法預料之結果。關於醫師或醫院方面有無過失，不僅是醫病雙方緊張關係之根源，也是醫療糾紛之重點。若無法適切針對醫療糾紛之特徵進行處理，有可能會導致醫病雙方不信任、醫師採取防衛性醫療等不利於國民健康安全之問題。據此，如何有效且和諧的處理醫療糾紛一直是全體國民所關心之議題，尋求一個有效解決醫療糾紛的制度，也是醫界與法界共同努力之目標。 我國目前仍以訴訟制度作為解決醫療糾紛之主要手段，然而這樣的紛爭解決方式存在著許多缺點，例如因醫療糾紛涉及高度專業性以及證據偏在等因素導致病患舉證困難、鑑定制度因法院欠缺醫療專業知識而無法有效使用、訴訟時間冗長無法迅速填補病患損失、醫師面臨訴訟壓力影響其日常執業等。至於保險市場上所販售之任意性醫療責任保險，也因為投保率過低而無法填補訴訟制度之缺失。鑑於目前實務運作之缺點，因此應有建立強制醫療責任保險法之必要，如此一來不僅可以擴大保險保障範圍，提昇國民對醫療責任保險之接受度，更能有效透過價格機制達成分散風險之目的。 在論述強制醫療責任保險法之建構方向時，本文參考了世界上其他有推行類似醫療保險或補償制度之國家的經驗，包括了美國維吉尼亞州新生兒腦部傷害無過失補償制度、瑞典病人賠償保險制度、紐西蘭意外補償制度、英國NHS國家代償制度、日本醫師會醫師賠償責任保險等五國制度，作為建構強制醫療責任保險法上位概念時之參考，同時檢討我國強制醫療責任保險法草案之缺失。比較五國外國立法例後之心得包括：訴訟並非解決醫療糾紛之最好方式、國家力量介入且以填補受害人為主之補償制度為目前趨勢、責任保險不必然造成醫療品質之低落等。 以第三章比較法研究心得為基礎，本文於第四章對這部強制醫療責任保險法提出具體修正建議，包括了：立法者應獨立於傳統侵權訴訟外設計保險制度、給予病患合理的損害賠償、建立迅速簡易之賠償申請程序、建構符合病患程序利益之鑑定制度、決策過程公開透明化、制定維護醫療品質之配套措施等。希望透過這些修正，強化對病患之損失填補，緩和醫病間之間對立關係，有效減少醫療糾紛之數量與改善目前醫療訴訟的缺失。

The advance of medical technologies, the diversity of medical behaviors and the enhancement of citizens’ legal knowledge all lead to the increase of malpractice lawsuits. Malpractice lawsuits usually derive from the unexpected or unwanted outcomes. Whether the doctor or hospital is negligent is usually the key question in a malpractice case. If we cannot handle the question based of the features of medical behaviors, it is highly possible that there will be untrustful relationships between doctors and patients, or the defensive medicine. As a result, how to resolve the malpractice cases effeciently and peacefully shall be the problem worth a lot of concerns. In Taiwan, patients usually solve malpractice problems through litigations. However, litigations have a lot of problems, such as the difficulty for the patient to prove the negligence of the doctor, or the tremendous pressure for the doctor to face the risks of being sued. Although there are voluntary medical liability insurance sold in Taiwan, the comparatively low percentage of buying this insurance makes it unable to improve the drawbacks of mediacal lawsuits mentioned above. Therefore, it is necessary to enace the Act of Compulsory Medical Liability Insurance for the benefits of broadening the insurance coverage, enhancing the acceptance of the medical liability insurance and strengthing the function of spreading risks. In elaborating how to enact the Compulsory Medical Liability Insurance Act, thos this thesis refers to other relevant medical compensation or insurance schemes in the world, such as the Virgina Birth-Related Neurological Injury Compensation Program, the Patient Injury Act in Sweden, the Injury Prevention, Rehabilitation and Compensation Amendment Act (2007) in New Zealand, the National Health Service Indemnity in UK, and the Doctor Compensation Liability Insurance in Japan. After analyzing the five schems aforementioned, we have learned several important messages. For instance, seeking litigations is not the best way to solve malpractice conflicts. Based on the lessons learned for the comparative methodology made in the previous chapter, the thesis tries to illustrate how to construct a compulsory medical liability system which can appropriately and effectively improve the current problems in Taiwan, by providing concrete suggestions of modifying the Draft of Compulsory Medical Liability Insurance Act. For example, it is necessary to have a simple and rapid procedure for applying for the compensation, and other measures for strengthening the injury prevention function.