外科新醫療科技及醫療風險的管理與倫理探討

The New Surgical Technology Combined with Risk Menagement and Ethical Dilemma

外科新醫療科技之發展，已直接的造福病患，大家都預期會延長壽命，預期太高相對風險就會增加。然而延長壽命的同時，外科新醫療科技也有和傳統手術不同的風險。在台灣，這個風險定義仍不明確，所以這方面的管理與倫理探討必需跟上潮流；從長庚醫院1998年1月實施案病例計酬的風險分擔管理制度，2009年實施『診斷關聯群，DR Gs』的風險分擔管理制度，醫院將責任交給醫師，但是政策上醫療成本的減少並沒有來回饋醫師，也沒有分擔風險，結果輕病賺錢且風險少變成醫療供給者的共識，和民眾期待重病醫療品質提昇的想法，出現醫學倫理兩難議題。為了明確定義、符合民意，對台灣社會的了解有必要落實，從醫療糾紛案例、人體試驗、刑事責任、民事責任、責任保險、健康保險，醫學倫理各個面向，進行檢討。在研究中，主要研究方向分析外科醫療風險與再界定外科醫療風險。根據風險分擔原則，提出台灣社會提昇醫療品質的建議。設法提出較符合民意需求和統計科學的解套方法，提出不同疾病嚴重程度的加權指數，針對外科醫療新科技之發展，找到民眾、醫療提供者雙贏的對策。本研究是要用法學、社會學及外科學的專業，增加台灣社會外科醫療風險管理的處理透明度與社會倫理再沉思，保護病人權益是我們最終的目的。

According to the rapidly evolving of surgical new techniques and artificial implants, it was said that the 21st Century would prolong life expectancy. However, surgical risk definition system covering surgical practice in nontraditional roles( e.g. new techniques trial, artificial implants risks) was not well developed in Taiwan. Taiwan Surgical Association carried out risk sharing management in Jan. 1998 as response to the impact of Case Payment Policy, and in 2009 to Diagnosis related groups. Physicians will be rewarded as the medical expenditure of their patients below amount paid by National Health Insurance. They focused on the money. However Taiwanese care more about quality. There is a ethic dilemma between Taiwanese and medical suppliers. In order to redefinite the surgical risk, it is necessary to understand the definition of Taiwanese society in case studies, human clinical trial, criminal responsibility, civil liability, liability insurance, and health insurance. Method : The major items of this study are two-fold: 1) to analyze surgical risks 2) to redefinite surgical risks. According to the principle of risk sharing, surgical risk will be redefined to meet the real need of Taiwanese society - surgical quality improvement. Analyzing the data of other daughter plans in this study, members will design a new definition that was developed from Taiwanese society and Statistics. The relative weights for different types of diseases will be developed. With respect to co-morbidity and complications, the new definition will cover the impacts on advance surgical technique. Results : This study found that establishing liability for surgeons would not be good public policy, and it recognized proctoring as a valuable aspect of peer review that should be protected. 1) There was not a patient-physician relationship between the patient and surgeon. 2) The surgeon had no contractual relationship with the patient or the physician he proctored. Discussion and Conclusion : In this study an unhealthy emphasis on safe, rather than efficient, conservative surgical practice for patients have served to ensure that all new technology is guilty until proved innocent and all innovation suspicious. The surgical risk management and openness to new technology is essential to determine efficacy and cost effectiveness in a prescribed format later. Successful technology is subject to greater scrutiny at a later stage than technologies that are abandoned early by their innovators, thereby introducing a selection bias. In summary, the scopy of study is based on the profession of social science, law and surgery. The study would provide the transparency about surgical risk management in the Taiwanese society. The advance for patients' protection is our goal.