自「生育事故爭議事件試辦計畫」探討「醫療糾紛處理及醫療事故補償法」之立法走向──醫界觀點

From the 'Birth-Related Dispute Incident Pilot Plan' to Explore the 'Medical Disputes and Medical Incinent Compensation Law' Legislative Trends to View the Medical Community

行政院衛生福利部，自2012年1月1日開始實施「鼓勵醫療機構辦理生育事故爭議事件試辦計畫」，優先推動生育事故風險事件救濟，大幅減少生產相關訴訟案件，由2011年的30件，降到試辦後平均1年8.5件（下降約72％），成效斐然。然因請求權人並非受害人或其家屬而是接生醫療院所，造成實務上的困擾及弊端，宜修法改進。衛生福利部已提出「醫療糾紛處理與醫療事故補償法」草案到立法院。在醫療糾紛處理法方面，開放民間鑑定及調解管道，並落實醫療糾紛去刑事訴訟化。在醫療事故補償法方面，以行政補償取代司法賠償，本文認為事故補償大而不當，醫療事故補償基金緣木求魚；風險救濟垂手可得，整合醫療風險受害救濟基金水到渠成；過失賠償理所當然，強制醫師投保責任保險立竿見影，所以「醫療糾紛處理及醫療事故補償法」草案宜修改為「醫療糾紛處理及醫療風險救濟法」。

The Ministry of Health and Welfare started implementing the Encouraging Medical Institutions to Manage Birth-Related Dispute Incident Pilot Plan in the beginning of 2012, which gave priority to promoting relief for birth-related incidents. Since then, there has been a significant reduction in birth-related litigation, from 30 cases in 2011 down to an average of 8.5 (decrease of approximately 72%) cases per year. However, the standing to file a claim does not rest in the patients or their families but with the medical institutions that perform the delivery, a drawback that causes distress and should be amended. The Ministry of Health and Welfare has sent a draft legislation of the Medical Malpractice Dispute Resolution and Medical Incident Compensation Act to the Legislative Yuan to be debated. The Act allows for private expert determination and mediation during the medical dispute and reduces its criminal nature. In terms of medical incident compensation, it replaces judicial compensation with administrative compensation. This article argues that incident compensation and the use of a medical incident compensation fund to cover all incidents are too costly and inappropriate; using a relief fund, however, is doable given the current infrastructure and can address the problem of medical risk. As for medical malpractice, the enforcement of physician liability insurance would allow the victims to be justly compensated.