Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/97911
標題: 醫療責任社會化之研究-以英格蘭為例
A Study on the liability of Medical obligation
作者: 王培任
Peir-Renn Wang
關鍵字: 全民健保;公醫制度;醫療責任;履行輔助人;National Health Insurance;National Health Service;Medical Liabilities;Employee and independent contractor
引用: 中文部分(姓氏筆畫序) 江金太, 歷史與政治,桂冠,1987 何兆武譯,Jean-Jacques Rousseau著,社會契約論,唐山,1987 李佳玟,「風險社會下的反恐戰爭」,月旦法學雜誌,2005,第 118 期 汪浩譯,Ulrich Beck 著,風險社會:通往另一個現代的路上,巨流,2004 沈冠伶,武器平等原則於醫療訴訟之適用,收錄於民事證據法與武器平等原則,初版第1刷,2007年 林萍章,醫療調解前置主義之爭議,月旦法學雜誌,216期,2013 邱聯恭(講述),許士宦(整理),《口述 民事訴訟法講義(一)2015年筆記版》,自版,2015 施世駿譯,Franz-Xaver Kaufmann著,比較福利國家:國際比較中的德國社會國,巨流,2006 張耘慈,台灣地方法院民事醫療糾紛判決之實證研究,國立陽明大學公共衛生研究所碩士論文,民國98年 陳自強,民法上和解之效力,政大法學評論,61期,1999 陳學德,醫療糾紛處理與醫學倫理―臺中地院 醫療試辦經驗分享,澄清醫護管理雜誌,2014 陳學德著,醫療風險與糾紛解決之道――從臺灣臺中地方法院試辦醫療制度談起,2013,收於:陳聰富編,醫療糾紛處理之新思維(一)――以臺中地院醫療試辦制度為中心,2014 陳學德編、林義龍著,醫療糾紛處理與鑑 定 醫療糾紛處理新思維(二),2014 陳學德編著,臺中地院醫療調解、諮詢、鑑定制度經驗分享,2014 陳聰富,醫療訴訟舉證責任——最高法院98年度台上字第276號民事判決評釋,法令月刊第61卷 葛謹,英格蘭公醫制度訴訟管理局(NHSLA)簡介,臺灣醫界第 60卷第1期, 2017 葛謹,英格蘭醫療處理制度:對改進我國制度之啟示,臺灣醫界第51卷第2期, 2008, 詹森林,德國醫療過失舉證責任之研究,收錄於醫療過失舉證責任之比較,初版第1刷,2008年 趙旭東、方文譯, Anthony Giddens著,現代性與自我認同,左岸,2002 劉邦揚,我國地方法院刑事醫療糾紛判決之實證研究,國立陽明大學公共衛生研究所碩士論文,民國97年 蔡維音,全民健保體制下醫療疏失責任之歸屬,中原財經法學,第十二期,2004 蔡維音,從全民健保觀察醫病關係之變遷,應用倫理研究通訊,第二十一期,2002 英文部分 Bonnie F. Fremgen Medical law and ethics. Pearson/Prentice Hall. 2006 Jo Samanta, Ash Samanta, Medical Law, Macmillan, 2015 John. Duncan Marshall, The Old Poor Law, Macmillan, London, 1985 Kant Patel, Mark E. Rushefsky, Healthcare Politics and Policy in America, 2014 Paul Pierson, Dismantling the Welfare State? Reagan, Thatcher, and the Politics of Retrenchment, Cambridge University Press, 1997 Sir William Beveridge, Full Employment in a Free Society, W. W. Norton & company, inc. 1945, P25 Tan SY, Medical Malpractice,World Scientific,2006 Thomas Donaldson and Thomas W. Dunfee, Ties that Bind: A Social Contracts Approach to Business Ethics, Harvard Business School Press, 1999, Ulrich Beck, Ecological Politics in an Age of Risk, Wiley, 1995
摘要: 
社會契約論認為,當個人將權利讓渡給社會或國家後會喪失部分權利,但也因此讓保障更為加強。這種透過社會契約保障弱勢和維護公共利益的概念,可以說是近代福利國家的起源之一,台灣的全民健保制度也是植基於這個概念。
既然實施全民健保制度是符合社會大眾所期待,那麼這個制度所導致的影響和後果是否也應由社會全體一起承擔?全民健保制度改變了醫療給付的方式並進而影響醫療行為、醫院管理、病患行為,甚至醫學教育,也因此造成醫療人力分配不均並且間接導致醫療爭議頻仍,這些全民健保制度所帶來的後遺症也應該是社會集體的責任。
風險社會中的新風險常常是各種風險交錯綜合後所形成的集合,所以往往無法單純透過制度調整就消除,所以,將系統性的風險歸因於個人反而會讓風險更為複雜且難以控制。若要降低全民健保相關的風險並讓制度可長可久,就不能將病患個人風險轉嫁與醫療體系之上,也不應將醫療系統的風險全歸責於醫療人員。
雖然目前我國因醫療爭議而在刑事部分定罪之醫師比例與一般刑事案件相比仍算不高,但以刑逼民的方式卻仍讓多數醫療人員疲於奔波法院,更為了避免爭議而可能採取防衛性醫療,讓全民健保財務狀況惡化,這些潛在醫療浪費的影響可能比健保署直接承受醫療爭議所產生的損害賠償還大。英格蘭的公醫制度發現到制度面的問題可能會導致醫療爭議,也因此設計了許多不同的補償方案,除非是重大過失或故意,針對醫院受雇的醫療人員概括承受其民事損害賠償責任,也就是將英美法中的從屬性履行輔助人的概念應用在公醫制度本身之上,讓公醫制度中的受僱者能夠不需要擔心系統因素所導致的風險,也同時讓受損害的病人及家屬能盡速獲得應有的補償與了解事件真相。

Natioanl Health Insurance in Taiwan was developed on the theory of social contract and its necessity and beneficial for all residents in Taiwan. However, impacts and influences of this program are underestimates. The implementation of universal health care changed the behavior of both healthcare provider and patients which might results in medical negligence. Healthcare provider would do more check-up and waste money just for prevent of medical negligence. The cost of practicing defensive medicine is still unknown, but it can waste more money than reimbursement of medical negligence. Although few physicians in Taiwan were sentenced to prison based on Criminal law, most medical negligence cases were reimbursed according to Civil law.
Medical liabilities of doctors who works in hospital of England would be covered by National Health Service, which means the concept of tort law was also applied in medical negligence cases. These doctors were regard as employee of National Health Services.
In some way, healthcare providers who practice in Taiwan are also kinds of employee of National Health Insurance. Therefore, the medical liabilities of these people should also be covered by National Health Insurance and reimbursement should also paid by global budget of National Health Insurance.
URI: http://hdl.handle.net/11455/97911
Rights: 不同意授權瀏覽/列印電子全文服務
Appears in Collections:法律學系

Files in This Item:
File SizeFormat Existing users please Login
nchu-107-5099024004-1.pdf990.58 kBAdobe PDFThis file is only available in the university internal network    Request a copy
Show full item record
 

Google ScholarTM

Check


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.