臺灣的醫療糾紛狀況

Status of Medicolegal Problems in Taiwan

陳等（1991）曾針對全台灣醫師進行大規模的醫療糾紛實證研究，本研究於2005 年，再度針對台灣全體醫師進行醫療糾紛實證研究，藉以比較十多年來台灣醫療糾紛變化的情況。本研究的研究母群體為2004年全台灣執業醫師進行抽樣，有效發出問卷數為6，602份，回收問卷678份，回收率為10.3％。回答問卷的醫師，與全台灣醫師的母群體之性別分布與平均年齡均相當接近。在醫療糾紛的發生部分，我們發現醫療糾紛的案件中，女性患者的比例顯著高於男性患者（54.4％ vs. 44.1％， P=0.028）。在所有的醫療糾紛個案中，病人傷害程度為死亡之個案比率最高（39.9％），而在最近一年的糾紛案件中，則以病患無身體上的傷害佔最大比率（31.2％）。若以病人的年齡區分，在所有的樣本部份，以21-30 歲及31-40 歲二個年齡層所佔的比率最高。在醫療糾紛的解決模式上，我們發現女性患者、病患重傷或者死亡的情況，其平均和解或調解金額較高（女性48.0 萬元vs.男性20.1 萬， P=0.003；輕傷17.5 萬vs.重傷40.0 萬vs.死亡67.6 萬，P<0.0001）。病患年齡層介於21-40 歲（OR=3.17， P=0.007），或者死亡（OR=1.32， P=0.024），病方提起醫療糾紛訴訟的機會較高。在病患勝訴率方面，如果患者沒有身體傷害或者僅有輕傷，並沒有勝訴機會，倘若重傷或者死亡，其勝訴率分別為11.1％ 與15.0％。我們發現病患特性與醫療糾紛的發生及解決模式有相關性存在。如何藉由病患特性以尋找醫療糾紛發生的相關危險因子，將是一個非常重要的議題。

The first nationwide survey of physicians’ experiences associated with medical malpractice in Taiwan was conducted by Dr. Rong-Chi Chen et al. in 1991. Since medical and social environments have changed dramatically in the past years, we repeated the same survey in 2005 to investigate the current status and compared the difference between 1991 and 2005. In the end of 2004, 33,036 physicians registered in Taiwan Medical Association. Totally, 6,602 questionnaires were sent effectively and 678 physicians responded. The response rate was 10.3%. The samples had similar demographic characteristics with the mother population. We found the higher prevalence of female patients (54.4%), patients who were dead (39.9%) or without body injury at all (31.2%), patients between 21-30 and 31-40 years of age among the malpractice cases. We also found female patients, patients who were dead or with severe body injury were associated with significantly higher compensation (P=0.003 and P<0.0001 respectively). Patients between 21-40 years of age (OR=3.17, P=0.007), or patients who were dead (OR=1.32, P=0.024) were associated with higher chance of litigation. Once patients did not have body injury or only mild body injury, there was no chance to win a lawsuit. The chances for patients or family to win in a trial were 11.1% and 15.0% respectively for patients with severe body injury or dead. We found patients’ characteristics were associated with the occurrence and resolution of medical malpractice.