医患纠纷人民调解制度发展趋势之实证研究

发布时间：2018-01-14 08:15

本文关键词：医患纠纷人民调解制度发展趋势之实证研究　出处：《华东政法大学》2013年硕士论文　论文类型：学位论文

【摘要】：近些年来，随着经济的快速发展和科技的进步，我国的医疗水平有了很大的进步，但是由于医疗行为的特点以及人们维权意识的提高，当人的生命健康权因不当救治而受到威胁时，就会带来医患冲突和医患纠纷。特别是近两年，人们的医疗服务诉求与能得到的医疗服务之间的矛盾越来越尖锐，医患矛盾已经成为社会矛盾的焦点。今年三月份发生在安徽医科大学附属第二医院的砍人事件更是令人触目惊心1。医患纠纷的传统解决方式如和解、诉讼等已经逐渐显现出其不足之处，因此如何及时有效地化解医患纠纷已经成为影响和谐社会建设的重大问题。面对紧张的医患关系，自山西、上海首先试水医患纠纷人民调解委员会制度后，初显成效，各地开始纷纷尝试这一制度，为医患矛盾提供一个缓冲平台，以期实现法律效果和社会效果的统一。但是由于该项制度处于运行初期因此有很多地方都不够完备，在运行过程中出现了种种问题，如法律性质不明确，资金运转困难等等。因此，本文想通过对山西、上海模式进行梳理，从而总结其经验，将优势之处推广全国，对劣势之处进行完善，从而构建有中国特色的医患纠纷人民调解制度，使双方能够在平等第三方的主持下互谅互让，最终解决医患纠纷，维护和谐的医患关系。本文正文共五个部分。第一部分是概述部分。该部分主要对医患纠纷的概念进行了界定，归纳了医患纠纷的特点，并对医患纠纷的现状进行了简单的介绍。医患纠纷的概念并不同于医疗纠纷，两者有着很大的区别，医患纠纷的涵盖范围更广，既包括了因医疗过错引起的医疗纠纷也包括非因医疗过错引起的纠纷如拖欠医疗费用等纠纷。医患纠纷作为特殊的社会矛盾具有不可避免性、主体特定性、专业性以及较大的社会影响性等特点。以长宁法院为例可以看出医患纠纷近两年增长趋势明显，纠纷的解决方式以调解为主，判决的比例较小。第二部分是人民调解解决医患纠纷的比较优势。该部分通过比较人民调解与和解、行政调解、仲裁、诉讼解决医患纠纷的区别来指出医患纠纷传统解决方式的不足之处以及人民调解方式对这些不足的解决。和解虽然能体现当事人的合意且能节省成本，但是由于双方力量悬殊，和解结果难以保证公正性，此外也能成为逃避卫生行政部门监管的手段。行政调解的范围较小，仅仅限于“医疗事故”引起的医患纠纷，且卫生行政部门作为医方的行政主管部门，中立性一直受到怀疑，因此在实践中运用这种方式的较少。仲裁虽有便捷性、公正性的特点，但是却要遵循严格的程序，且独立性的缺乏以及专业人才的不足也使得这种医患纠纷解决方式发展困难。而诉讼作为“最后一道防线”，有利于实现社会公平正义，然而诉讼耗时长、费用高，对于身心俱疲的医患双方来说并不现实，对抗式的庭审模式也使双方严格对立不利于恢复和谐的医患关系。第三部分是医患纠纷调解制度的域外法考察。该部分的主要内容是对国外医患纠纷调解制度进行介绍，以期对我国有所借鉴。笔者选取了美国、德国、日本三个国家作为参考。美国的医患纠纷调解组织即医院下设的仲裁委员会，其多方力量的参与以及调解的中立性让其得到了较大的发展。德国医患纠纷调解解决的专门机构是医疗事故调解处，其不收费用以及耗时短的特性有利于医患双方节约成本，而完善的医疗保险制度也为医患纠纷的调解解决提供了强有力的支撑。日本医师会内设的医疗纠纷处理委员会承担了对医患纠纷的调解工作，其与保险制度的相结合也是该制度的特色之处，值得我国加以借鉴。第四部分是对山西模式和普陀模式的实证考察。笔者通过调研的方式对两种模式下资金的来源情况、人员组成、调解的程序及后果等方面内容进行了介绍和分析，分别总结了两种模式的优缺点。普陀模式中资金充沛，人员专业，调解要求在一个月内完成，关于调解协议也规定了相应的司法确认程序，然而由于仍然带有行政色彩因此中立性难以保证，此外强制调解不免过度偏袒患方，另外，调解员过度老龄化也是其面临的问题。在山西模式中，，社会组织的性质保证了其中立性，县乡全面覆盖的机构设置便于将纠纷化解在萌芽状态，特色的医疗保险责任制度也为医患纠纷寻求了一条合理的解决之路。然而山西模式中资金的匮乏，宣传的不足，缺乏对调解员资格的规定是山西模式不可避免的问题。第五部分是对医患纠纷人民调解制度未来的发展趋势做出自己的建议。笔者在这一部分对于医患纠纷人民调解制度的发展趋势提出了自己的建议，主要包括以下几方面：如何保证调解组织的中立性；如何从扩大宣传途径、增加宣传内容等方面对医调委进行宣传，扩大其在社会上的影响；通过规定调解员的准入、回避、培训、奖惩制度来完善调解员制度；对医调委资金的短缺问题笔者建议目前采用公益信托的方式；建议制定医调委工作的具体程序的统一标准，从受理、调解、调解协议的确认以及事后的回访制度加以完善；此外还要完善与医调委工作相配套的其他制度如医疗责任保险制度、专家咨询制度等。通过这几方面的完善笔者希望能够为我国医患纠纷调解制度的发展提供一些浅薄的建议，以期能为和谐社会的建设贡献自己的力量！
[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.

【学位授予单位】：华东政法大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：D926;D922.16

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