【作者】 程杰；

【导师】 姜战军；

【作者基本信息】 华中科技大学 ， 社会学， 2013， 博士

【摘要】 人的一生离不开医疗行为。医疗行为具有侵权性、有限性、不确定性等特点。医疗损害由医疗行为引发，既有因错误的医疗行为所致的医疗过错损害，又有由现有医疗知识、技术、条件下无法避免和克服的副作用、并发症和医疗意外造成的医疗无过错损害。我国现有对于医疗损害的救济制度以医疗侵权损害赔偿为主。面对大量的医疗损害事件，以医疗侵权损害赔偿为主的、单一的医疗损害救济制度面临着诸多困境；处于起步阶段的非强制医疗责任保险在填补患者损害和分担医疗风险方面也捉襟见肘。发达国家对医疗损害进行救济时，根据本国经济、社会、文化等因素的特点，采用了医疗责任保险、医疗损害无过错补偿、社会保障等制度，建立了不同的、适合各自国情的医疗损害社会化救济模式。美国以医疗责任保险为主，有些州建立了特定医疗损害的无过错补偿制度；瑞典通过患者赔偿法案建立了具有浓厚社会保险色彩的患者赔偿保险制度；新西兰在人身损害范围内排除了侵权责任赔偿的救济，对包括医疗损害在内的人身意外伤害实行全面无过错补偿的制度。发达国家建立和实施医疗损害社会化救济制度的经验告诉我们，医疗损害社会化救济制度是解决医疗损害救济问题的有效模式；侵权损害赔偿并非对医疗损害救济最好的方式；国家财政支持重视对医疗损害受害患者的补偿成为目前趋势。近代以来的侵权责任社会化是医疗损害社会化救济的基础。突破侵权法的藩篱，矫正正义和分配正义可以在损害社会化救济中达致协调；经济分析法学也认为作为损害分散的形式，责任保险这种损害社会化救济的方式是有效率的。在我国，医疗损害受害患者需要得到比通过侵权赔偿更加及时、合理的救济；而侵权责任制度下医方赔偿能力也需要损害社会化救济制度的支持；同时医疗损害社会化救济制度弥补了现行基本医疗保险体系的不足，对解决医疗纠纷具有重要作用。逐渐完善的医疗侵权责任法律制度、开展机动车交通事故责任强制保险的经验、部分地区和保险公司商业保险运作的经验、现行的社会医疗保险制度可以借鉴都是我国建立医疗损害社会化救济制度的有利条件。我国应建立政府、医疗机构、医师、患者一起参与，共同分担医疗损害，以强制医疗责任保险和医疗无过错损害补偿基金为主体的，即独立于医疗侵权损害赔偿制度又与其紧密联系的医疗损害社会化救济制度。更多还原

【Abstract】 The life of illness and death can not be separated from the health care behavior.Medical acts of infringement limited, uncertainties, and other characteristics. Medicalinjury caused by medical behavior, both the fault damage due to the error caused bymedical practices, and the no-fault damage there can not be avoided and overcome theside effects, medical complications and medical accidents by the existing medicalknowledge, technology, conditions.Our existing relief system for medical damages inmedical tort damages. Face a lot of medical damage events,medical tort damages basedsingle health damage relief system faces many difficulties.The role of non-compulsorymedical liability insurance in its infancy in the medical damage relief is also limited.Developed medical damage relief, according to the characteristics of the country’seconomic, social, and cultural factors, medical liability insurance, no-fault system ofcompensation, and social security is adopted, different medical harm social relief modesuitable for respective countries. United States is given priority to Medical LiabilityInsurance, Some states have established specific medical harm no-fault compensationsystem; Swedish established patients compensation insurance system with strong socialinsurance color through the patient ’s Compensation Act; New Zealand excluded inpersonal injury within the relief of tort liability and Implement a comprehensiveno-fault compensation system of medical damage, including personalaccident.Developed countries to establish and implement medical harm the social reliefsystem experience tells us that the tort action for damages is not the best way to themedical damage relief. National forces to intervene, the emphasis on medical damagecompensation of victims become the current trend;The importance of medical harm inempirical research and statistics;medical harm social relief does not inevitably lead to adecline in the quality of medical services.Since modern times, the socialization of tort liability is the foundation of medicaldamage social relief.Break through the barriers of tort law, corrective justice anddistributive justice can be reached at the expense of social relief coordination; economic analysis of law also think as scattered damage form,liability insurance for such damagethe social relief is efficient.In our country, the implementation of medical harm social relief system formedical injury tort liability system provide an institutional guarantee to make up for thedeficiencies of the current basic medical insurance system, has an important role inresolving medical disputes.Gradual improvement experience in medical tort liabilitylegal system, the implementation of mandatory liability insurance, In some areas, andthe experience of the operation of insurance companies commercial insurance, thecurrent social medical insurance system can learn from, and improve the healthadministrative management system are our country to establish socialized medicaldamage the favorable conditions of the relief system. Medical harm social relief systemshould be mandatory medical liability insurance and social insurance nature of medicalthe fault damage compensation insurance as the main,government, medical institutions,physicians, patients join shared medical damage.更多还原