再探非訟醫糾調處之成效：臺灣《醫預法（草案）》改革前哨

Revisiting the Effects of Alternative Dispute Resolution: Reform of Medical Malpractice Dispute Law in Taiwan

目標：鑒於以訴訟解決醫糾之局限，醫界與法界致力開闢訴訟外爭議解決 (Alternative Dispute Resolution, ADR)，本文簡析臺灣多元ADR並聚焦兩項計畫，2013年「醫法雙調委模式」、2017年「多元雙向醫療爭議 處理機制試辦計畫」，評估醫糾調處的成效。 方法：資料來源為衛福部醫事司網路公開資料，2008年-2018年各縣市地方衛生局醫糾調處案件、成立案 件、耗時天數，比較時間點分T1（2008-2012年)（參照組）、T2（2013-2016年）、T3（2017-2018年）， 採用一般線性模式，將新政策（雙調處）成果以時間趨勢及縣市層次區分。依變項為醫糾調處成立率、 調處耗時天數，自變項為醫法雙調委（有早期經驗(n=7)、無早期經驗(n=13)），參加動機強（有參加試辦 (n=13)、參加動機弱（未參加試辦(n=7))），第三方專業評析（有(n=16)、無(n=4)），都市化程度（直轄市 6、非直轄市11)）。 結果：全臺整體調處成立率T2期-T3期2014年-2018年分別為49.95%、41.29%、42.80%、37.43%、34.29%， 平均歷程44.38天。有無早期醫法雙調委經驗、有無參加試辦、都市化程度（六都、非六都），對調處成立 率之影響，皆未達顯著差異，有專業評析其調處成立率(47.0%)高於無專業評析(22.0%) (p=0.014)、調處耗時 天數（47.66天）高於無專業評析（31.25天） (p=0.05)。 結論：ADR推動後短期內調處成立率未見提升，調處有加入專家評析後，成立率明顯提升，耗時天數較 久，但是與訴訟相比，仍較具時間效率。

 

Objective: The time required for malpractice lawsuits is generally considered to be excessive. Alternative dispute resolution (ADR) is another resolution path for malpractice disputes. ADR refers to out-of-court approaches to resolve conflicts. As health care and malpractice costs continue to rise, interest in methods such as mediation and arbitration is increasing. This study explored the effects of medical malpractice mediation in Taiwan. Methods: Data covering 2008 to 2018 from the Department of Medical Affairs of the Ministry of Health and Welfare were obtained and classified into three time-based groups: T1(2008–2012; reference group), T2 (2013– 2016), and T3 (2017–2018). A general linear model was adopted, and the outcome measures of the new policy were evaluated in terms of time trends and city-level differences. The dependent variables were the success rate of mediation and the time required for mediation. The independent variables were experience level of the medical–legal dual committee (early experience: n=7; no early experience: n=13), motivation to participate (strong motivation: n=13; weak motivation: n=7), third-party professional evaluation (yes: n = 16; no: n = 4), and urbanization level (urban: n=6; rural: n=11). By using a quasi-experimental design, we compared the outcomes between urban and rural areas. Results: The overall success rates of mediation were 49.95%, 41.29%, 42.80%, 37.43%, and 34.29% during 2014–2018, and the average time required for mediation was 44.38 days. The success rate for ADR participation (45.70%) was significantly higher than that for ADR nonparticipation (26.85%; p=0.038), and the time required for mediation with expert consultations (47.66 days) was significantly longer than that without expert consultations (31.25 days; p=0.05). No significant difference was observed in the mediation success rate or mediation time between urban and rural areas. Conclusions: After the promotion of ADR, the mediation success rate did not increase rapidly. When mediation was applied to third-party dispute analysis and opinions, its success rate and duration increased. However, compared with litigation, mediation was still more efficient.