本文關鍵詞：醫(yī)患糾紛人民調解制度發(fā)展趨勢之實證研究　出處：《華東政法大學》2013年碩士論文　論文類型：學位論文

  更多相關文章： 醫(yī)患糾紛 調解 優(yōu)勢 發(fā)展趨勢 完善建議

【摘要】：近些年來，隨著經濟的快速發(fā)展和科技的進步，我國的醫(yī)療水平有了很大的進步，但是由于醫(yī)療行為的特點以及人們維權意識的提高，當人的生命健康權因不當救治而受到威脅時，就會帶來醫(yī)患沖突和醫(yī)患糾紛。特別是近兩年，人們的醫(yī)療服務訴求與能得到的醫(yī)療服務之間的矛盾越來越尖銳，醫(yī)患矛盾已經成為社會矛盾的焦點。今年三月份發(fā)生在安徽醫(yī)科大學附屬第二醫(yī)院的砍人事件更是令人觸目驚心1。醫(yī)患糾紛的傳統(tǒng)解決方式如和解、訴訟等已經逐漸顯現出其不足之處，因此如何及時有效地化解醫(yī)患糾紛已經成為影響和諧社會建設的重大問題。 面對緊張的醫(yī)患關系，自山西、上海首先試水醫(yī)患糾紛人民調解委員會制度后，初顯成效，各地開始紛紛嘗試這一制度，為醫(yī)患矛盾提供一個緩沖平臺，以期實現法律效果和社會效果的統(tǒng)一。但是由于該項制度處于運行初期因此有很多地方都不夠完備，在運行過程中出現了種種問題，如法律性質不明確，資金運轉困難等等。因此，本文想通過對山西、上海模式進行梳理，從而總結其經驗，將優(yōu)勢之處推廣全國，對劣勢之處進行完善，從而構建有中國特色的醫(yī)患糾紛人民調解制度，使雙方能夠在平等第三方的主持下互諒互讓，最終解決醫(yī)患糾紛，維護和諧的醫(yī)患關系。本文正文共五個部分。 第一部分是概述部分。該部分主要對醫(yī)患糾紛的概念進行了界定，歸納了醫(yī)患糾紛的特點，并對醫(yī)患糾紛的現狀進行了簡單的介紹。醫(yī)患糾紛的概念并不同于醫(yī)療糾紛，兩者有著很大的區(qū)別，醫(yī)患糾紛的涵蓋范圍更廣，既包括了因醫(yī)療過錯引起的醫(yī)療糾紛也包括非因醫(yī)療過錯引起的糾紛如拖欠醫(yī)療費用等糾紛。醫(yī)患糾紛作為特殊的社會矛盾具有不可避免性、主體特定性、專業(yè)性以及較大的社會影響性等特點。以長寧法院為例可以看出醫(yī)患糾紛近兩年增長趨勢明顯，糾紛的解決方式以調解為主，判決的比例較小。 第二部分是人民調解解決醫(yī)患糾紛的比較優(yōu)勢。該部分通過比較人民調解與和解、行政調解、仲裁、訴訟解決醫(yī)患糾紛的區(qū)別來指出醫(yī)患糾紛傳統(tǒng)解決方式的不足之處以及人民調解方式對這些不足的解決。和解雖然能體現當事人的合意且能節(jié)省成本，但是由于雙方力量懸殊，和解結果難以保證公正性，此外也能成為逃避衛(wèi)生行政部門監(jiān)管的手段。行政調解的范圍較小，僅僅限于“醫(yī)療事故”引起的醫(yī)患糾紛，且衛(wèi)生行政部門作為醫(yī)方的行政主管部門，中立性一直受到懷疑，因此在實踐中運用這種方式的較少。仲裁雖有便捷性、公正性的特點，但是卻要遵循嚴格的程序，且獨立性的缺乏以及專業(yè)人才的不足也使得這種醫(yī)患糾紛解決方式發(fā)展困難。而訴訟作為“最后一道防線”，有利于實現社會公平正義，然而訴訟耗時長、費用高，對于身心俱疲的醫(yī)患雙方來說并不現實，對抗式的庭審模式也使雙方嚴格對立不利于恢復和諧的醫(yī)患關系。 第三部分是醫(yī)患糾紛調解制度的域外法考察。該部分的主要內容是對國外醫(yī)患糾紛調解制度進行介紹，以期對我國有所借鑒。筆者選取了美國、德國、日本三個國家作為參考。美國的醫(yī)患糾紛調解組織即醫(yī)院下設的仲裁委員會，其多方力量的參與以及調解的中立性讓其得到了較大的發(fā)展。德國醫(yī)患糾紛調解解決的專門機構是醫(yī)療事故調解處，其不收費用以及耗時短的特性有利于醫(yī)患雙方節(jié)約成本，而完善的醫(yī)療保險制度也為醫(yī)患糾紛的調解解決提供了強有力的支撐。日本醫(yī)師會內設的醫(yī)療糾紛處理委員會承擔了對醫(yī)患糾紛的調解工作，其與保險制度的相結合也是該制度的特色之處，值得我國加以借鑒。 第四部分是對山西模式和普陀模式的實證考察。筆者通過調研的方式對兩種模式下資金的來源情況、人員組成、調解的程序及后果等方面內容進行了介紹和分析，分別總結了兩種模式的優(yōu)缺點。普陀模式中資金充沛，人員專業(yè)，調解要求在一個月內完成，關于調解協(xié)議也規(guī)定了相應的司法確認程序，然而由于仍然帶有行政色彩因此中立性難以保證，此外強制調解不免過度偏袒患方，另外，調解員過度老齡化也是其面臨的問題。在山西模式中，，社會組織的性質保證了其中立性，縣鄉(xiāng)全面覆蓋的機構設置便于將糾紛化解在萌芽狀態(tài)，特色的醫(yī)療保險責任制度也為醫(yī)患糾紛尋求了一條合理的解決之路。然而山西模式中資金的匱乏，宣傳的不足，缺乏對調解員資格的規(guī)定是山西模式不可避免的問題。 第五部分是對醫(yī)患糾紛人民調解制度未來的發(fā)展趨勢做出自己的建議。筆者在這一部分對于醫(yī)患糾紛人民調解制度的發(fā)展趨勢提出了自己的建議，主要包括以下幾方面：如何保證調解組織的中立性；如何從擴大宣傳途徑、增加宣傳內容等方面對醫(yī)調委進行宣傳，擴大其在社會上的影響；通過規(guī)定調解員的準入、回避、培訓、獎懲制度來完善調解員制度；對醫(yī)調委資金的短缺問題筆者建議目前采用公益信托的方式；建議制定醫(yī)調委工作的具體程序的統(tǒng)一標準，從受理、調解、調解協(xié)議的確認以及事后的回訪制度加以完善；此外還要完善與醫(yī)調委工作相配套的其他制度如醫(yī)療責任保險制度、專家咨詢制度等。通過這幾方面的完善筆者希望能夠為我國醫(yī)患糾紛調解制度的發(fā)展提供一些淺薄的建議，以期能為和諧社會的建設貢獻自己的力量！
[Abstract]:In recent years, with the rapid development of economy and the progress of science and technology, China's medical level has made great progress, but because of the characteristics of medical behavior and enhance people's awareness of rights, the human rights of life and health is threatened by improper treatment, it will bring the conflict between doctors and patients and medical disputes. Especially in the past two years, the contradiction between the demand of medical services and people can get medical service more and more sharp, doctor-patient conflicts have become the focus of social contradictions. In March of this year occurred in the Second Affiliated Hospital of Medical University Of Anhui, the cut incident is a traditional way of reconciliation as a shocking 1. to solve medical disputes, litigation has gradually revealed its deficiencies, therefore how to effectively resolve disputes between doctors and patients has become the major problems affecting the construction of a harmonious society.
In the face of tension in the doctor-patient relationship, from Shanxi, Shanghai to test the water first medical dispute mediation committee system after paying off, all have started to try this system, to provide a buffer platform for doctor-patient conflicts, in order to realize the unified legal and social effect. But due to the system at the beginning of operation there are a lot of things are not complete, there are all sorts of problems in the operation process, such as unclear legal nature, capital operation difficulty and so on. Therefore, we want to pass to Shanxi, Shanghai then, and summarize the experience, will promote the national advantage, to improve the disadvantages, so as to construct the medical dispute mediation system China the characteristic, enable both sides in equal third party under the auspices of mutual understanding and mutual accommodation, the final settlement of medical disputes, to maintain a harmonious doctor-patient relationship. This paper consists of five parts.
The first part is an overview. This part of the main concept of medical disputes were defined, summarizes the characteristics of medical disputes, and analyzes the status quo of medical disputes were introduced. The concept of medical disputes and medical disputes are different from both, there are great differences, disputes in a broader scope, including the medical disputes caused by medical mistakes including non fault caused by medical disputes such as arrears of medical expenses, medical disputes disputes. As a special social contradiction is inevitable, the subject of specific, professional and greater social impact etc. in Changning court as an example can be seen in medical disputes in recent years obvious growth trend and the way to resolve disputes mediation based on the judgment, the proportion is smaller.
The second part is the comparative advantage of people's mediation to resolve medical disputes. Through the comparison of people's mediation and reconciliation, administrative mediation, arbitration, litigation between the settlement of medical disputes to solve the shortcomings of traditional medical disputes that way and people's mediation on these problems resolved. Although the settlement can reflect the parties and can save cost however, due to the power disparity, the reconciliation to ensure impartiality, also can become evade the administrative department of health supervision method. Small scope of administrative mediation, simply "medical accident" caused by medical disputes, and health administrative departments as the administrative department in charge of the hospital, neutrality has been suspected, so use this way is less in practice. Although the convenience of arbitration, characteristics of fairness, but they must follow strict procedures, and the lack of independence Lack of professional talents and makes the settlement of medical disputes and litigation. The difficulty of development as a last line of defense, is conducive to the realization of social fairness and justice, but litigation is time-consuming and high cost for the patient exhausted both sides is not realistic, adversarial trial mode makes both strict opposition is not conducive to recovery the harmonious doctor-patient relationship.
The third part is the study of foreign law dispute mediation system. The main content of this part is on the foreign medical dispute mediation system are introduced, with reference to our country. The author selected the United States, Germany, Japan, the three countries as reference. The medical dispute mediation group of the United States is woven hospital under the arbitration committee, participate in the multi power and neutral mediation let it get great development. The German medical dispute mediation specialized agencies to solve the medical malpractice mediation, the fees and short time-consuming characteristics conducive to saving the cost of both doctors and patients, and improve the medical insurance system for medical dispute mediation provides a strong the support of the Japan Medical Association. The medical disputes committee within the commitment of medical dispute mediation work, and the insurance system combining the characteristics of the system is It is worthy of our country to learn from it.
The fourth part is the empirical study of Shanxi model and Putuo model. Through the research methods of sources, the two modes of Fund staff, mediation procedures and consequences and other aspects are introduced and analyzed, summarizes the advantages and disadvantages of the two modes. Mode in Putuo professional, with plenty of money the mediation request completed within a month, the mediation agreement also stipulates the corresponding judicial confirmation procedure, however, is still the administrative neutrality so it is difficult to guarantee, in addition in addition to compulsory mediation not excessively favors the patient, and the problem of aging is the mediator over face. In Shanxi mode, the nature of social organization guarantee the neutrality, comprehensive coverage of county institutions to resolve disputes in the bud, the characteristics of medical insurance system for medical disputes to seek a reasonable However, the lack of funds in the Shanxi model, the lack of publicity, and the lack of regulations on the qualifications of the mediators are unavoidable problems in the Shanxi model.
The fifth part is to make suggestions on the future development trend of the people's mediation system of medical disputes. The author puts forward his suggestions in this part of the people's mediation system of doctor-patient disputes, development trend, mainly includes the following aspects: how to ensure the neutrality of the mediation organization; how to expand propaganda way, increase publicity content etc. the propaganda of the medical committee tune, to expand its influence in the society; through the provision of mediators of access, avoidance, training, rewards and punishment system to improve the shortage of the system; the medical committee tune money proposals currently used the way of public trust; unified standards, recommended the development of specific procedures for the work of the medical committee tune from acceptance mediation, return system, confirmed that the mediation agreement and the subsequent improvement; in addition to the other system and perfect the medical committee tune job matching such as medical liability The insurance system, expert consultation system and so on. Through these improvements, the author hopes to provide some superficial suggestions for the development of doctor-patient dispute mediation system in China, in order to contribute to the construction of a harmonious society.

【學位授予單位】：華東政法大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：D926;D922.16

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