論醫療損害風險社會化分擔──以全民健康保險之國家責任為核心

Social Sharing of Medical Damage Risks-Focusing on the State Responsibility of National Health Insurance

醫療損害賠償責任，通說認為不應適用無過失責任，而過失責任理論因過失認定及因果關係舉證困難等，已倍受質疑。且臺灣實施全民健保制度，醫病法律關係因政府介入主導醫療市場，質變為具公法性質，並對醫療損害產生國家責任。醫療責任保險則因保單條款設計及保險實務運作無法滿足市場需求，分散醫療責任風險的功能不彰，而強制投保醫責險之妥適性及合憲性仍有疑慮，亦無法彰顯國家責任，應非理想之醫療損害風險分散機制。本文參考預防接種、藥害及生產事故受害救濟制度，配合「醫療糾紛處理及醫療事故補償法」草案部分精神，提出醫療損害風險社會化分擔的觀點。認為臺灣以全民健保制度，將健康風險分散至全體社會成員的同時，其所產生之醫療損害風險，亦應由醫療提供者、醫療使用者及政府共同分擔，不但可彰顯國家責任，亦可使受害的病人能及早獲得補償，達到心理與經濟安全之保障；並藉由控制醫療執業風險，降低防禦性醫療，節省醫療及訴訟成本，達成醫、病及政府三贏之最終目的。

The liability of medical liability is generally non-applicable for no fault liability principle, however the application of the theory of negligence liability has been questioned since the issues of the faulty determination and the difficulty of proof of causality. Moreover, there is a National Health Insurance in Taiwan, which results to the nature of legal relationship between doctors and patients has transformed towards public law because the medical market is dominated by the government and it has a state responsibility for medical damage. Medical liability insurance is unable to meet the market demand due to the design of policy terms and insurance practice, and it's function of dispersing the risk of medical liability is ineffective. Furthermore, there are still doubts about the appropriateness and constitutionality of compulsory medical insurance and it is impossible to clearly present the state responsibility, therefore compulsory medical insurance is not the ideal mechanism for medical risk d ispersion. This article proposes the frameworks of social sharing of medical liability risks by reference to the current system of drug injury, vaccine injury, and childbirth accident emergency and the spirit of the draft of ''medical disputes and medical accident compensation law''. The author believes that Taiwan's National Health Insurance system will spread the health risks to all members of society. At the same time, the risk of medical liability can be shared by medical providers, medical users and the government, which not only manifests state responsibility, but also enables to compensate the victimized patient as soon as possible, which can achieve psychological and economic security. As a result, it can achieve the goal of win-win in the tripartite parties, physician, patient and government by controlling the risk of medical practice, reducing defensive medical care and saving medical and litigation costs.