摘要
本文对海南省推行全省统一的医疗责任保险方案实施两年来,在运行过程中存在的问题与对策从医院层面进行分析,认为医疗纠纷通过医责险赔偿仍面临诸多矛盾和问题。主要表现在:一是保险公司的逐利性和医院对投保的初衷存在巨大差异,购买医责险并非医院自愿;二是医责险在理赔中困难重重,该赔不赔、随意压价、限制受理范围等等导致调解失败,医院没有真正从医疗纠纷中解脱出来,"医闹"问题仍困扰医院;三是保险方案设计和保费调整系数不合理,医院承担的保费过高,而赔偿过低,未能达到风险转嫁的目的。作者提出不断完善医疗纠纷赔偿机制,尝试建立医疗风险互助金制度。
Medical liability insurance programme has been implemented in Hainan province for over two years, and obviously there exist many contradictions and problems in the process of implementation from the hospital perspective. This paper analyses those problems and proposes some solutions. Firstly, hospitals are involuntary to buy compulsive medical insurance because of the substantial divergence between the running after money of the insurance company and the purpose to buy insurance of the hospitals. Secondly, due to the failure of mediation such as no compensation for the needed, deliberately pushing down the compensation, and limiting accepted range, hospitals, that are still suffered by ＇medical disturbance＇, have not really extricated themselves from the medical disputes. Thirdly, due to the unreasonable insurance scheme design and premium adjustment coefficient, the premiums hospi- tal undertake are too high while the compensation are too low. As a result, it failed to achieve the purpose of risk shifting. The author suggests constantly improving compensation mechanism of medical disputes through developing the mechanism of ＇Medical risk mutual aid money＇.
出处
《中国卫生法制》
2013年第3期55-57,共3页
China Health Law
关键词
医疗纠纷
赔偿机制
医疗责任保险
理赔
医疗风险互助金
Medical disputes
Compensation mechanism
Medical liability insurance
Settlement of claims
Medical risk mutual aid money
