The Impact of Governmental Medical Reimbursement on the Duty of Care: Comparative Legal Studies between Taiwan and the United States

在許多情況下，政府會藉由主管機關的保險制度，給付對於該保險制度之下因此所產生的醫療費用。此種醫療行為在獲得政府醫療費用的給付前，必須符合其對於該醫療行為規範的要求，因此當政府的行為規範要求與民事侵權行為的注意義務要求相衝突時，法律的爭議因此而產生。此種可能的法律爭議議題，最近真實發生有關牙科根管治療的事件中，造成是否政府對於醫療行為所設的標準應優先於法院對於民事侵權行為注意義務的判斷問題上的討論。在本文中，經由美國對於此一議題的討論以及試圖解讀其背後的思維，來加以說明實證醫學的重要性。同時本文對於實行實證醫學的其它相關的配套措施亦提出說明。這其中包含了加強健保制度下醫事爭議審議委員會的機制，加強醫療過失的責任保險制度以及加強進修教育以減低可能醫療訴訟的不確定性，因此唯有建立實行前述的整體架構，方為對於因為政府給付人民醫療費而可能對於執行醫療行為的醫療照護責任產生衝擊的議題最好回應。這也是本文想要在政府、病患與醫療機構三者之間取得最佳平衡點的主要目的。

關鍵字

全民健保；醫療過失；實證醫學；注意義務

並列摘要

For a government to reimburse medical expenses through an insurance policy issued by the authorities is quite common in the modern world. In such circumstances, any medical treatment procedure must accord with the government’s requirements in order that the medical facility is paid for the expenses incurred via such an insurance policy. A legal issue arises whenever the government’s requirements conflicts with the duty of care associated with a tort based cause of action. This predicted legal concern really did occur recently and involved an incident related to root canal therapy. The central problem revolves around whether the court will accept that the standard of medical treatment set by the government preempts the duty of care in tort action. In this article, we discuss a similar case in the United States and how our government and legal system have handled a similar situation. In attempting to explain the thinking and attitudes in this case, this article will borrow from the experience in the United States and promote the importance of evidence-based medicine. This article will also indicate related supplementary measures that are important to the execution of evidence-based medicine. These measurements includes enhancing the mechanism of the Disputes Settlement Board that was established under the National Health Insurance Act, promoting the system of malpractice insurance and enforcing continuing education in order to alleviate the uncertainties associated with possible malpractice litigation. Only by making the above changes can the best solution be found in order to deal with the impact of government medical reimbursement on duty of care during medical treatment. The purpose of this article is to try and strike a balance between government, patient and physician.

並列關鍵字

National Health Insurance ； malpractice ； evidence-based medicine ； duty of care

國際替代計量

The Impact of Governmental Medical Reimbursement on the Duty of Care: Comparative Legal Studies between Taiwan and the United States

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