医疗损害赔偿中医疗保险费用垫付与追偿存在的问题及对策

The problems and countermeasures on medical Insurance disbursementsand and recoupment in medical damage compensation

治疗结束后,患者的医疗费用通常是由基本医疗保险实时结算。如果随后发生医疗损害赔偿,医疗机构又会作为侵权人按照责任比例承担一定的医疗费,这就与医疗保险机构先行支付的医疗费发生重合。是否对两者进行抵扣?不同地区、不同审级的法院做法截然不同。本文通过分析不同做法的利弊,认为不予抵扣与追偿合并的解决途径更符合基本医疗保险和人身损害赔偿金的性质与立法本意,但在追偿数额上应充分考虑医疗损害责任的比例划分,公平合理地平衡患者、医疗机构和医疗保险基金三者的利益。

After treatment,the patient＇s medical expense are usually paid by real-time settlement of the Basic Medical Insurance.If compensation for medical malpractice occurs subsequently,medical institutions as the infringer will undertake certain medical expenses in accordance with the proportion of liability,and thus it will overlap with advance payment by medical insurance institutions.Whether deducted the payment from the compensation,the courts in different level of trial and different regions made different decisions.This paper analyzed the advantages and disadvantages of different judgments and considered that deduction combined with recoupment by medical insurance institutions was more reasonable as it is in full accord with the legal character and legislative intent of Basic Medical Insurance and Compensation for Personal Injury.However,medical liability proportion in the amount of recoupment should be taken into consideration,in order to fairly and reasonably balance the interests between patients,medical institutions and medical insurance fund.