論醫療傷害之不責難補償制度

不責難醫師的補償制度看似一個陌生、成本極高且無預防除錯功能之制度，然此種制度模式卻在瑞典已運行數十年，不但有效處理醫療糾紛之問題，醫病關係間亦相處融洽，繼而獲得病人與醫師的高度讚賞。瑞典病人保險補償制度的施行成效吸引大量國際文獻對其制度內容進行探討，也使得各國立法者嘗試將不責難的補償制度模式融入自身體制。故，本論文擬就不責難補償制度之起源——瑞典病人保險補償制度，探討該制度之形成背景、法規內容、醫療傷害類型、補償認定標準等。此外，所謂不責難補償制度，即是在補償體系中不論醫師之醫療處置有無過失，僅就醫療傷害是否符合認定標準而予以病人補償。其中所有相關審查文件、有關醫療傷害發生之事故原因、醫師之醫療處置等皆處於保密狀態，並不會通報至醫療監督體系。惟，在此前提下，瑞典又發展出另一種確保醫療品質與維護病人安全的監督機制。本文希望透過對瑞典《病人傷害法》之探討研究，仔細剖析瑞典病人保險補償制度相關法制內容與程序流程。爾後，再與我國目前施行成效斐然之《生產事故救濟條例》做比較研究。雖因我國與瑞典的立法目的與社會背景差異之原因，在制度內容設計上有所不同，然而，兩者間卻具有類似的精神，因而瑞典法制實可以作為我未來醫療糾紛救濟專法的參考對象，進而期望未來能以《生產事故救濟條例》為中心，擴大運用至其他科別，探索出屬於我國獨有之全面性醫療事故救濟制度。

關鍵字

醫療傷害；醫療糾紛；醫病關係；不責難補償制度；瑞典病人保險補償制度；《生產事故補償條例》

並列摘要

The “No Blame Compensation” seems to be an unfamiliar, expensive, and non-preventing or debugging system, but this system has been serviced in Sweden for decades. It is not only effectively handling medical disputes, but also has been a harmonious relationship between doctors and patients, which is highly appreciated by patients and doctors. The effectiveness of the implementation that Swedish patient insurance compensation system has attracted many of international documents to discuss the content of it. It also makes the legislators of other countries try to integrate this compensation system into their own systems. Therefore, this paper intends to use the origin of the “No-blame Compensation system” which is the Swedish Patient Insurance Compensation System, to discuss the background of the formation of the system, the content of the regulations, the types of medical injuries, and the standards for compensation. Also, the spirit of “no blame”, means regardless of whether the doctor's medical treatment is at fault or not, the patient will be compensated only for whether the medical injury meets the recognized standards in the compensation system. All relevance review documents, causes of accidents about medical injuries, and doctor’s medical treatment are kept confidential and will not be reported to the medical supervision system. However, under this prerequisite, Sweden has developed another regulatory mechanism to ensure the quality of medical care and patient safety. This paper would like to analyze the relevant legal content and procedures of the Swedish Patient Insurance Compensation System through by the Swedish "Patient Injury Act". Further, I will compare it with the "Childbirth Accident Emergency Relief Act " currently implemented in our country. Although there are differences in the design of system content due to differences in legislative purpose and social background between our country and Sweden, however, both of them have a similar spirit. Therefore, the Swedish legal system could actually be used as a reference for our medical dispute relief law in the future. Furthermore, with the "Childbirth Accident Emergency Relief Act" as the center, and the application can be expanded to other disciplines to explore a comprehensive medical accident relief system unique to our country.