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隨著醫療科技之發展，人類平均壽命逐年延長，然而醫療科技的進步，並沒有帶予我們百分百的醫療安全，反而造成更多不可預知的醫療風險。此外，隨著民國84年開始施行的全民健康保險制度，導致病患就醫成本大為降低，加上部分新聞媒體產業誇大渲染相關醫療糾紛之報導，使得醫病關係逐漸朝向緊張化發展，進而導致醫療糾紛的發生率逐年提升，造成醫療產業五大皆空之窘境。探究臨床醫師不願繼續堅守崗位之原因，除了長期健保給付的不合理外，其主因仍是擔心可能發生於己身之醫療糾紛，因為一旦行醫過程中發生醫療糾紛，除了醫療訴訟審理過程漫長，所造成之心理壓力難以言諭外，加上屢見高額之賠償金額的判決，更讓許多臨床醫師棄械投降。為此，行政院衛生福利部開始推動修訂醫療法，希望藉由合理之醫療刑責使醫師刑責明確化，故行政院於民國101年12月13日提出增訂醫療法第82條之1:「醫事人員執行醫療業務，以故意或違反必要之注意義務且偏離醫療常規致病人死傷者為限，負刑事責任。但屬於醫療上可容許之風險，不罰。前項注意義務之違反，應以該醫療領域當時、當地之醫療水準、醫療設施及客觀情況為斷」。惟於立法院社會福利及衛生環境委員會審查時，基於保護病患權益，亦希望改善醫療現狀並消除法界疑慮，委員會要求行政院提出「醫療糾紛處理及醫療事故補償法」作為增訂醫療法第82條之1的配套措施。其重點包含，「調解前置制度」及「不責難補償制度」，希望藉由此雙管齊下，可以逐漸改善我國醫療產業之現況。此乃因我國醫療刑事判決平均約需3.12年，但衛福部統計近十年醫事鑑定結果發現，其中僅約17%醫事人員被認定醫療上有疏失，平均賠償金額為200萬元，扣除律師費、交通費等支出，病患僅獲得約120萬元賠償金，如此耗損時間與人力的訴訟過程卻是低定罪率的結果，相當不合乎成本概念，故希望藉由設立強制調解及補償基金等制度，滿足病方之需求進而避免訟累，藉以保障醫病雙方且改善現今的醫療環境。故，本文由醫療行為、醫療事故及醫療糾紛基本概念為初步之探討，進而分析我國醫療糾紛之現況及其困境，並從國家責任之觀點探討醫療糾紛處理及醫療事故補償法之相關問題，最後針對「醫療糾紛處理及醫療事故補償法草案」進行全面性探討，並與國內、外目前已施行之相關醫療事故補償法為其比較，藉以提出檢討及建議。 With the development of medical technology, average human life extends every year. However, advances in medical technology did not bring us a hundred percent of medical safety,but caused more unpredictable medical risks. In addition, the government began to carry out a national health insurance system in 1995. It resulted in greatly lower medical costs for patients. Moreover, part of the news media exaggerated to report related medical disputes that made doctor-patient relationship more intense. So it led to the increase of medical disputes year by year. So that it results in "medical five for not". Looking into the reason that clinic doctors won´t continue to do the work, in addition to unreasonable NHI payment, they themselves are worried mainly that medical disputes will likely occur. As medical disputes once occur in the course of practices, in addition to the long legal process that will bring about the mentally unspeakable pressure, together with lots of frequent compensations, as a result more and more doctors give up and surrender. Thus the Ministry of Health and Welfare began to promote an amendment to the Medical Care Act that the doctor´s criminal liabilities could be clarified by reasonable means. Then the Executive Yuan on Dec. 13th ,2012 proposed to amend section 1 of article 82 for the act: "Medical personnel of performing medical practices shall be charged with criminal liabilities as they not only intend to violate the necessary notice of duty but practice beyond usual rules resulting meanwhile in the death or injury of patients. But there´s no penalty if the risks are medically permissible. The said violation of "notice of duty" shall be judged by the medical field at that time, local medical standards, medical instruments and the objective situation". But when the Social Welfare and Environmental Hygiene Committee of the Legislative Yuan examined, based on protecting interests of patients, hoping also to improve present medical status and eliminate judicial doubts, the committee requested the Executive Yuan to present supporting measures of "pre-mediation system "and"irresponsible remedy system" for "medical dispute treatment and medical matter remedy act".By these two approaches, the present situation of our medical industry might gradually be improved. On an average our final judgments of medical criminal cases cost about 3.12 years.But according to nearly 10 yearsmedical judgments by the Health Department, only about 17% of medical personnel were identified as medical negligence. The average compensation was NTD 2million. Except for lawyer´s fees, transportation fees, etc, patients could only get NTD 1.2 million. Such waste of time and labor for law process was often the cause of lower conviction rate. That´s quite unreasonable for concept of cost. It´s therefore hoped that by establishing the system of compulsory mediation and remedy funds, the patient´s requirement could be reached. In the meantime, boring law proceedings became less. Through the protection of doctor-patient relations, the medical environment would change for the better.Therefore, the basic idea of this subject on medical conduct, medical matter and medical disputes is now being primarily discussed. Further analysis of our current disputes and difficulties are required. Besides, from the standpoint of national responsibilities, we shall look into the relevant issues about the compensation acts for medical disputes and happenings. Finally, we shall carry on the comprehensive discussions basically on "the remedy draft for medical disputes and happenings". Meanwhile, we shall propose a review and suggestions as compared with domestic and foreign related remedy acts for the medical matter. |