我院实施医疗安全风险金制度的实践与思考

Practice and Reflection of medical safety risk fund system in hospital

我国现行的医疗安全风险化解机制主要包括医疗责任保险和医疗风险基金。但是,医疗责任保险制度无法直接规范医务人员的行为,而医疗风险基金缺乏行政法上的法律依据,且存在适用范围上的局限性。江苏省人民医院施行的医疗安全风险金制度具有"社会化"风险分担功能、奖惩结合功能、管理传导功能,但是同时也存在风险金单元单一、筹集标准调整规则简单等制度缺陷。我院于2011年起施行的《医疗安全风险金管理办法》修正案在制度评价的基础上,按照持续改进的原则,合理区分了医疗过失行为的性质和责任程度,并设立了共保金制度,对于规模较大的医院具有借鉴意义。

The existing risk elimination systems for medical safety in China mainly include medical liability insurance and medical risk fund. However, the system of medical liability insurance cannot directly standardize the behaviors of medical personnel, while medical risk fund has no legal basis of administrative law and is limited with respect to the scope of application. The risk fund system for medical safety implemented by Jiangsu Province Hospital possesses the functions of ＂social＂ risk sharing, combination of reward with punishment, and management transmission, but it also has such defects as single risk fund unit and simple raising standards and adjustment rules. On the basis of system evaluation, the amended Management Measures for Risk Fund of Medical Safety executed by the Hospital since 2011 reasonably differentiate the natures and accountability system of medical negligence behaviors in the principle of continuous improvement and establish the co-insurance fund system, which can be used as the reference for hospitals in a relatively large scale.