摘要
目的通过问卷调查,了解医护人员对医疗纠纷第三方调解的认知和调解模式的倾向,分析影响医护群体对第三方调解的信任因素,提出关于构建医疗纠纷的第三方调解机制的建议。方法 2012年8月-12月,参照既往有关医疗纠纷第三方调解的文献资料,从对医患关系的认识以及对第三方调解机构的组织架构(包括地点设置与主管部门),人员配备、调解依据、效力来源以及经费保障等方面设计问题,制作《医疗纠纷第三方调解认知调查问卷》,对5所不同级别医院的全体医护人员进行整群随机抽样调查。将所得原始数据逐条录入计算机建立数据库,以SPSS 18.0软件对数据进行统计分析。结果 1医护人员对第三方调解的知晓程度较高。2医护人员对于调解地点倾向集中于法院或司法行政部门,主管部门则认为应是卫生行政部门;在调解失败后,多数医护人员选择通过司法途径继续解决纠纷;对于调解结论的效力,多数医护人员倾向于以仲裁形式确认。3医护人员认为调解人员应具备医学以及法学的专业背景,多数受访医护人员倾向于采用司法鉴定的结论作为调解依据,此外,确定赔偿的法律依据方面,医生偏向于适用《医疗事故处理条例》。4四成以上的医护人员认为第三方调解应由财政拨款解决经费问题,过半数的医护人员认为应由保险公司支付。结论 1建议将第三方调解机构设置于法院或司法行政部门,并由法院或司法行政部门主管第三方调解机构。2建议调解员由法学专业及医学专业人员共同组成;而在调解过程中,建议通过司法鉴定对医疗纠纷的争议焦点进行鉴定,明确责任划分及归属,提升调解效率。3建议政府在各级财政拨款的基础上引入医疗责任险制度,通过法律法规形式强制医疗机构购买医疗责任险,为第三方调解机构的运作提供经费支持;同时加强对承保医疗责任险的保险公司的监管,避免保险公司对调解工作的干扰。
Objective To understand the cognition and mediation tendencies of health care workers in terms of third-party mediation for medical disputes, analyze the factors influencing the trust of both doctors and patients on third- party mediation, and propose suggestions on building third-party mediation mechanisms for medical disputes. Methods Between August and December 2012, we made the cognition questionnaire on third-party mediation for medical disputes based on the past medical literature, and the knowledge of doctor-patient relationship as well as third-party mediation agency＇s organizational structure （including locations and management authorities）, staffing, mediation basis, validity sources and fund ensuring. We performed the random cluster sampling survey on all health care workers in five hospitals of different levels. The original data were put into the computer for statistical analysis by SPSS 18.0. Results The knowledge of health care workers on third-party mediation was high. They believed that the best place for solving medical disputes should be the court or judicial administrative department, and the management authorities should be health administrative departments. In case of mediation failure, the majority of health care staff chose to continue to solve the dispute through legal channels. For the effectiveness of mediation conclusion, most health care workers tended to believe in the form of arbitration. They thought that mediators should have professional background of medicine and law; the majority of those surveyed doctors tended to accept forensic conclusions as a basis for mediation. For determining the compensation, doctors were in favor of Applicable Regulations for Medical Malpractice. Over 40% of medical staff believed that third-party mediation should be financed by government financial allocation, and more than half of the medical staff believed that it should be paid by the insurance company. Conclusions Third-party mediation should be set in and managed by the court or judicial and administrative departments. Mediator group should be formed by professionals of law and medical sciences. In the mediation process, it is recommended that the focus of controversy should be identified by forensic identification in order to form a clear division of responsibilities and high mediation efficiency. We recommend that the government introduce in financial allocations at all levels on the basis of medical liability insurance system, and force medical institutions to purchase medical liability insurance through the regulations of law, in order to provide funding support for the operation of third-party mediation organizations. Meanwhile, medical liability insurance companies should be operated under strict supervision to avoid their interference on the mediation work.
出处
《华西医学》
CAS
2015年第8期1552-1558,共7页
West China Medical Journal
关键词
医疗纠纷
第三方调解
问卷调查
模式
医疗责任险
非诉讼解决
Medical disputes
Third-party meditation
Questionnaire
Model
Medical liability insurance
Non-litigation
