In April this year, a doctor-patient dispute occurred in the top three hospitals in Zou, and finally it became a medical incident, which alerted more than 20 local police cars to maintain order. On the afternoon of May 5 this year, Chen Zhongwei, the chief physician of the Department of Stomatology of Guangdong Provincial People's Hospital, was severely injured by a knife healed in his home 25 years ago. After Chen Zhong’s great husband died, the suspected man who was suspected of hurting Chen Zhongwei also fell to his death. Some insiders said that the suspect claimed that his teeth were "broken" and yellowed by Chen Dafu and asked the hospital to pay compensation.

The contradiction between doctors and patients has always been concerned by the society, and there has been an upward trend in recent years. The amount of the patient’s claim is also growing, how is this contradiction broken? Medical liability insurance (hereinafter referred to as “medical liability insurance”) with decentralized medical risks came into being. “This is a medical liability insurance mechanism that can share the risks of hospital medical treatment and protect patients' rights and interests.” Hebei Province An introductory person from an insurance company introduced.

However, according to the investigation by the reporter, although the medical insurance has been implemented for many years, the competent authorities have actively promoted it, and the medical institutions have become less and less enthusiastic, which has plunged them into a situation of “satisfaction”.

"The role of medical risk transfer is not great"

In 2007, according to the requirements of the former Ministry of Health, the State Administration of Traditional Chinese Medicine and the China Insurance Regulatory Commission on the Relevant Issues Concerning the Promotion of Medical Liability Insurance, the province has determined that each district and city chooses 1-2 medical institutions above the second level as a pilot. Medical liability insurance work.

The reporter learned from the Provincial Health Planning Commission that as of now, the province's medical liability insurance covers 67.68% of the province's secondary hospitals. Qinhuangdao City has realized the full participation of public medical institutions above the second level in the jurisdiction, and Shijiazhuang, Tangshan, Langfang, Xingtai and other places have achieved the unified protection of public medical institutions above the second level in the urban area.

It is understood that the medical institution is the insured party and the insured party of the medical liability insurance. Insurance premiums include medical institution insurance premiums and medical staff premiums, which are paid annually by medical institutions. Medical institution insurance premiums are drawn from the medical institution's business income and are included in the cost of medical institutions; medical staff insurance premiums are in principle borne by medical personnel. The hospital's premiums are divided into high, medium and low grades according to the hospital's grade and bed number. Within the same compensation limit, the large hospitals with high risks, many operations and many difficult patients have high insurance premiums. The insurance premium rate of medical staff varies according to the level of the medical institution where the medical staff is located, the risk of the department, occupation, and professional title, high risk and high premium, low risk and low premium.

For hospitals, the establishment of medical insurance is to transfer medical risks and help to deal with medical disputes.

Then, after the dispute occurred, was the medical risk transferred?

A person in charge of a orthopedic hospital in Shijiazhuang told reporters that their hospitals are buying medical insurance every year for two years, but they feel that they are not very useful. If there is an accident, some family members of the patient should go to the hospital or look for the hospital. The trouble is still noisy. The family members of the patient do not think that getting insurance claims from the insurance company can make up for the shortcomings caused by the medical accident. In fact, the insurance compensation The money can't match the expectations of the patient's family.

It is reported that some medical insurance premiums are 10,000 yuan, that is, if the medical institution's single compensation amount is less than 10,000 yuan, the insurance company will not pay, and some small and medium medical institutions have encountered medical dispute cases. Smaller, a hospital has paid 49 disputes in the past few years, and 30 of the less than 10,000 yuan. These 30 compensations are all issued by the hospital, so the hospital thinks that the medical insurance has little effect. In addition, medical liability insurance has a compensation limit. In the event of large compensation, the hospital still has to bear the above quota. When I bought the insurance, I had to make a big profit. The medical insurance made many hospitals feel that they had "protected the white guarantee."

"The design of medical insurance clauses needs to be improved"

Dr. Zhang is a doctor at a well-known provincial hospital in our province. He said that once a dispute arises, some insurance companies are not active. Instead, the hospital's people must repeatedly go to the insurance company to take the manpower to focus on whether they can pay. The insurance company has the final say about how much it costs.

In this regard, the person in charge of an insurance company said that they only recognized the mediation agreement and the court judgment of the medical commission. The amount of compensation reached by the hospital and the patient mediation will not be paid by the insurance company.

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