從醫療改革談日本醫療服務契約面臨的問題

Discussing the Present Problems of Japan’s Medical Service Contract from the Perspective of Medical Reform

日本醫療制度改革自1997年開始，診療費個人負擔比例從10%提高至20%，到2002年則提高至30%。而在政府給付診療報酬費部分，2002年刪減2.7%，至2006年則刪減3.16%。這樣的小泉流式「醫療改革」，雖其政策目標針對「預防生活習慣病」及「縮短住院日數」二點，卻導致醫療臨床產生降低高價位醫療機器使用率、降低高價位藥品使用率、降低外來就診率、縮短住院期間、改變用藥方式、生化檢查選項傾向低價初階化不精密選項而放棄高精密高價位選項檢查、興起視訊診斷、居家醫療崛起等的諸多現象及爭議。這些爭議或現象，對傳統醫療服務契約法律關係所造成的衝擊，如傳統醫療機構與其從業人員間關係、醫療契約締結模式（醫病關係）、醫師說明義務範圍、醫療水準判定標準、病患自主決定權的行使等，其適用與解釋上將面臨不少問題。本文從日本醫療契約服務的觀點，論述日本傳統醫療制度下所提供醫療服務法律關係，進而，觀察從2006年以後至2016年日本新制醫療改革下，將使醫療服務契約面臨哪些值得關注的爭議。

Japan’s medical system reform had begun since 1997, with patient medical expense ratio increasing from 10% to 20%, and rising to 30% in 2002. On the other hand, government medical expense decreased 2.7% in 2002 and 3.16% in 2006. Although the goal of the government policy is to prevent illnesses arising from daily habits and decrease inpatient days, such Koizumi style “medical reform” had caused the following: reduction of highcost medical equipment utilization rate in medical clinical use; decrease in high-cost medicine utilization rate; decline in outside patients; decrease of inpatient days; change in ways medicines are used; inclination of biochemical test items to become low-cost, basic, and non-precise, rather than high-cost and highly precise; emergence of video examinations; home medical treatment and other phenomena and issues. These have all impacted aspects of traditional medical service contract law, such as the relationship among traditional medical institutes and their employees, medical contract concluding mode (doctor-patient relationship), the extent of doctors’ obligation to explain, the benchmark for the quality of medical service, patients’ exercise of their autonomy, among others. The suitability and interpretation of these aspects have given rise to many problems. The present thesis discusses issues related to medical service law under 2016 Japan’s traditional medical service system. Furthermore, noteworthy issues of medical service contract under Japan’s new medical reform will be discussed.