論德國指定醫師費制度

Selected Physician Fee System in Germany

德國透過指定醫師費讓特殊專科醫師願意受僱於醫院，維持醫院之醫療品質，也讓醫療經驗得以傳承。為了避免醫療資源被少數人壟斷，並肯定職務代理之可能性。同時透過嚴格的醫院職務代理可能性之特殊說明義務要求，以保障病患之自主權。只要法條能適度規範，指定醫師機制，並不會造成「名醫被少數人所擁有」之不公平現象，其所實現的是一個立足點平等，而非齊頭式的平等。可知重點不在禁止，而是適度之規範。未來若臺灣能施行指定醫師制，重點在於細緻規範這錯綜複雜之法律關係。本文肯定德國學說與過去實務之見解，指定醫師制度建構，在臨床實務會成立三種契約：醫院醫療契約、選擇性給付醫療合約與醫師附加醫療契約。以醫院醫療契約為主契約，而後二者為從契約，僅具債之拘束力，指定醫師僅在親自執行時，或者經病患同意之職務代理人執行醫療手術時，有指定醫師費之給付請求權。

Charging a fee for a particular Doctor is illegally in Taiwan, but not in German. In order to avoid the monopoly of medical resources by a few people, Germany allows medical treatment agents. Through the strict obligation to inform patient of possible medical treatment agent to protect the patient’s autonomy. Through good regulations of law would not result in an unfair phenomenon in which “well-known doctors are owned by a few people”. There are three contracts established during patient, hospital and Physician. Master medical treatment contract is established between patient and hospital in Germany. The second contract is agreement of charging an extra fee of requesting a doctor. Prerequisite of full agreement of patient is carrying out to inform patient of charging of requesting a doctor and inform patient of possible medical treatment agents. The particular doctor will establish an extra medical treatment contract with patient. The three Contracts protect patient Autonomy. The German experience is a good sample for Taiwan.