Prevent patients from losing money and money, and improve the medical accident insurance mechanism
Once a medical accident occurs, it will cause significant personal and property losses to the patient. According to legal provisions, if a patient is harmed due to the fault of a medical institution or medical staff, the medical institution shall bear corresponding liability for compensation in accordance with the law. The patient's harm caused by a medical accident must be borne by the patient himself. No matter how the level of medical technology develops, medical accidents always exist objectively and cannot be completely avoided. In practice, it often happens that patients and their families are "lost in life and money" and even fall into difficulties in life due to medical accidents.
The state has always attached great importance to the prevention and control of medical risks. In recent years, it has successively enacted legislation requiring the establishment and improvement of medical risk sharing mechanisms. In particular, the "Physician Law" stipulates that "the state shall establish and improve a medical risk sharing mechanism. Medical institutions shall participate in medical liability insurance or establish, Join a medical risk fund and encourage patients to take out medical accident insurance.” On April 27, 2022, the General Office of the State Council issued the "Notice on the National Health Plan for the 14th Five-Year Plan", which further clarified that the development of medical liability insurance and medical accident insurance should be "accelerated" during the 14th Five-Year Plan.
Shanghai began to explore the establishment of a medical risk sharing mechanism as early as 2002, and took the lead in launching medical liability insurance nationwide. However, in the past 20 years, Shanghai's medical risk sharing mechanism has been focusing on medical liability insurance, and "medical accident insurance" is still blank.
Establishing and improving the medical risk sharing mechanism is not only to share the fault compensation liability of medical institutions, but also to build a necessary measure to protect the people from medical accident risks. This requires the joint efforts of both the medical and insurance industries.
There are some exploratory precedents to follow. For example, in 2020, the Shanghai Municipal Health Commission in accordance with the requirements of the "Vaccine Administration Law" that "the state encourages the compensation of recipients of abnormal vaccination reactions through commercial insurance and other forms" innovatively established an insurance compensation mechanism for abnormal vaccination reactions, fully Giving full play to the dispute transfer and resolution function of insurance and setting up an insurance processing center to coordinate and handle the city's damage level assessment, dispute resolution and insurance compensation for abnormal vaccination reactions, it has become one of the important guarantee mechanisms for Shanghai's vaccination work. This is not only a successful example of Shanghai’s medical and insurance cooperation to resolve medical risks, but also a practical verification of the effectiveness and necessity of insurance as a medical sharing mechanism.
In 2017, Beijing issued a document to provide standardized guidance for hospitals to carry out medical liability insurance and medical accident insurance, which clearly encouraged insurance institutions and medical institutions to cooperate in exploring and developing medical accident insurance based on the principles of patient voluntariness, capital preservation and small profits, market regulation, and promotion of dispute resolution. Insurance products; it is stipulated that when public medical institutions introduce medical accident insurance, except for providing necessary office space and specific publicity locations to the insurance institution, they are not allowed to participate in any aspect of the insurance institution's services; each medical institution is required to make budget arrangements and cooperate with Insurance institutions should do a good job in the underwriting and renewal of medical liability insurance, and submit insurance application materials promptly and accurately to avoid being unable to settle claims normally after the insurance is withdrawn.
The author believes that the establishment and improvement of Shanghai's medical risk sharing mechanism should be accelerated with the purpose of "building medical accident risk protection for the people and ensuring high-quality medical development in Shanghai".
Drawing on relevant experience, it is recommended that the city's health authorities and insurance authorities jointly formulate working methods related to the medical risk sharing mechanism. According to the provisions of the "Physician Law" that require medical institutions to purchase medical liability insurance and encourage patients to purchase medical accident insurance, and adhere to the principle of "insurance empowers medical care, shares medical risks, and protects the rights and interests of doctors and patients", medical liability insurance and medical accident insurance are Develop relevant standard requirements and implementation specifications for insurance liability, insurance services, insurance loss determination, selection of insurance and service agencies, cost protection and procurement methods, assessment and inspection, promotion paths, supervision and management, etc. By strengthening policy guidance, we will establish and improve Shanghai's high-level medical risk sharing mechanism to maximize the risk protection role of insurance for both doctors and patients.
