美國醫療過失糾紛處理之發展與變革

Historical Development and Reform of Medical Malpractice Dispute Resolution in the United States

近年來，醫療糾紛議題深受我國醫界與法界及醫療社會學領域所熱議。主因在於民眾法律意識抬頭，凡事訴諸司法訴訟途徑，造成醫療糾紛及醫療之民刑事訴訟已成為常態，使得醫護人員於執業時無法受到保護，爆發醫療危機。我國行政院雖於2012年12月公布醫療糾紛處理及醫療事故補償法草案，惟迄今仍未獲立法院三讀通過。當前的醫療訴訟尚以民法侵權行為訴訟解決，本文為探討如何解決當前制度可能帶來醫病雙輸的醫療危機，以美國制度為研究對象，瞭解其醫療侵權行為制度之發展與變革，包含制定對醫病有善且較有利之制度，並祈做為我國借鏡與參酌。 In recent years, the topic of medical disputes has attracted significant attention from Taiwan’s medical, legal, and medical sociology. The primary reason for this is that the public has an increased awareness of legal matters, as well as knowledge that incidents are settled according to law; this has created a situation in which medical disputes and civil proceedings and criminal proceedings have become normalized. This has made it impossible for medical professionals to receive protection during their work and has created a medical crisis. Although Taiwan’s Executive Yuan published a draft of the Medical Dispute and Medical Compensation Act in December 2012, it has yet to become law. Currently, medical litigation must be settled according to tort law. In order to explore how to resolve the potential for legal quagmires related to medical disputes that the current system may bring about, this paper reports research on United States institutions as a means for understanding the historical development and reform of American medical tort law. This includes the determination of an improved and more favourable system. It is our hope that this research can serve as a useful reference for Taiwan.

衛生署以健康城市的概念為依據，推行社區健康營造相關計畫，希望能在每一鄉、鎮、市（區）都能有一個社區健康營造單位，結合當地資源，鼓勵社區民眾能主動關心並解決社區健康議題。本研究採郵寄問卷方式，以台南市2005-2009年來接受機關補助的社區健康營造的機構為調查對象，普查29間社區健康營造中心，回收問卷共計16間機構，回收率達55.1%。從社區健康營造中心的組織特性、經費來源、志工團隊運作、組織合作成效、社區民眾參與程度等面向，瞭解其運作與成效。研究結果發現，不同類型的組織，在社區健康營造活動當中所能發揮的功能與特色亦不相同。醫院、衛生所等具有醫療背景的團體承辦社區健康營造在專業資源及人力方面皆較其他組織充裕，有較高的比例持續營運，且在經費來源部份多能獲得院所本身的預算編列支援。此外，營造中心與社區組織合作情形越好，營造中心持續營運的可能性越高。然而，缺乏贊助資金被認為阻礙營造中心永續發展的主要困難點；在規劃活動議題上，應重視社區民眾健康需求調查分析，使健康營造中心能夠推行對於民眾有著吸引力且確實符合需求與期待的活動。