中醫師醫療業務責任保險之相關法律問題

Legal Issues of Medical Professional Liability Insurance on Chinese Medicine

陳俞沛(Yu-Pei Chen) ； 林建智(Jan-Juy Lin)

《中正大學法學集刊》 37期 (2012/11) Pp. 189-239

https://doi.org/10.30094/NCCULJ.201211.0004

摘要

近年來，中醫界醫療糾紛發生頻率有逐漸提高的趨勢，成為影響醫病關係和諧與維持良好醫療品質的重大隱憂，中醫師可藉責任保險制度，管理執行業務風險並獲取專業及法律的協助。對於醫療責任保險，雖然中醫師界多持肯定態度，但卻多未投保。究其原因，在於中醫師對該險種不瞭解而望之卻步外，其他因中醫較難客觀量化、醫療鑑定難度高。主管機關對中醫藥管理法規多變與模糊使輔助人員定位不明，影響中醫醫責（綜）險承保範圍之認定，使保費釐定與賠款估算較為困難，且易造成保險糾紛。此外，中醫師非常重視保險人防禦義務之履行與完整的服務，故保險人應加強責任保險填補經濟損失外之權利保護功能，協助被保險人抗辯及和解，以保障被保險人之心境安寧。再者，現行保單條款以西醫為主要考量對象，尚無專為中醫師設計之保單，建議可先審究中醫藥特性與現況，為中醫師量身訂作專用保單，甚至與中醫師公會合作推出團保性質之保單，以滿足中醫師之需求，增加中醫師對責任保險制度之信賴，提高其投保意願，使中醫責任保險成為管理醫療糾紛風險之有效工具。

關鍵字

中醫師 ； 醫療糾紛 ； 醫療業務責任保險 ； 防禦義務

並列摘要

In recent years, the increasing medical disputes in Chinese medicine deteriorated the harmonization in physician-patient relationship and the quality of medical services. Professional liability insurance can transfer the malpractice risk to and get legal assistance from an insurer. Although Chinese medical physicians identify with the functions of the insurance but very few of them acquired such coverage. Without the insurance protection, physicians are keen to adopt defensive measures to reduce the occurrences of disputes. Their unwillingness of acquiring the insurance arised from the high extent of unpredictability in Chinese medical malpractice litigation due to poor knowledge about such insurance services, lack of objective standards in Chinese medical, no Chinese In recent years, the increasing medical disputes in Chinese medicine deteriorated the harmonization in physician-patient relationship and the quality of medical services. Professional liability insurance can transfer the malpractice risk to and get legal assistance from an insurer. Although Chinese medical physicians identify with the functions of the insurance but very few of them acquired such coverage. Without the insurance protection, physicians are keen to adopt defensive measures to reduce the occurrences of disputes. Their unwillingness of acquiring the insurance arised from the high extent of unpredictability in Chinese medical malpractice litigation due to poor knowledge about such insurance services, lack of objective standards in Chinese medical, no Chinese medical experts in review committee, no uniform opinion in judicial sector, and no objective standards in claim settlements. Regardless of whether negligent or not, most practitioners became afraid of lawsuit and selected to pay huge compensation to settle the disputes in private. It encouraged patients to take different irrational measures or abuse criminal prosecution as a threat to get civic compensation. Under such a circumstance, it is more difficult to precisely calculate the premium and adjust the claim.In addition, the regulations relevant to the Chinese medicine are unpredictable and ambiguous. It makes the coverage of the professional liability insurance uncertain. It is suggested that the regulatory authority should examine the practice and characteristics to reach for a legitimate opinion or to revise the controversial regulations. It is also recommended that the insurer shall fulfill its defense obligations to create the peace of mind for the policyholders. With an increasing trust and confidence, medical professional liability can therefore be more acceptable for Chinese medical physicians as an efficient risk management tool.

並列關鍵字

Chinese Medicine Physicians ； Medical Disputes ； Medical Professional Liability Insurance ； Duty to Defend

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