上海某三甲公立医院执业医师责任保险现状与趋势研究

Research on the Current Situation and Trend of the Liability Insurance of Licensed Physicians in a Tertiary Public Hospital in Shanghai

目的明确执业医师责任保险(以下简称医师险)在上海某三甲公立医院的现状、推广的可行性、必要性、方案及未来趋势。方法统计2019年1月—2021年12月期间上海市第十人民医院(共计872名执业医师)全院不同风险科室、不同职称、性别、年龄段医师险购买分布以及医师险理赔情况;通过抽样问卷调查方式,掌握医师对医师险的知晓率、购买意愿及其影响因素、认可的保费、保额、分摊及推广方式;比较已购/未购医师险的医师在出现医疗纠纷后出现紧张情绪的赋分情况。结果高风险科室、高级职称、男性、>40岁年龄段医师险购买比例更高,差异有统计学意义(P<0.001)。2019—2021年医师险理赔额占总医疗纠纷赔偿比例分别为1.56%、31.27%、38.50%,期间申请理赔的医师中,61.50%获全额理赔。调查提示执业医师对医师险的知晓率为83.29%;医师险购买意愿的比例为89.50%;影响医师险购买的主要因素为医疗损害鉴定双轨制施行;能够接受的保费区间为0.5万元/年以下,期望的最高保额区间在5~30万元/年;认可的投保费用分摊及推广方式为医师和医院按比例共担及政府与职能部门主导;已购医师险医师在出现医疗纠纷后紧张情绪赋分低于未购医师,差异有统计学意义(P<0.001)。结论医师险运行现状良好,医师的执业风险、赔付压力得到分担,执业紧张情绪得到缓解,未来发展趋势及前景明朗。

Objective To clarify the status quo,feasibility,necessity,plan and future trend of practicing physician liability insurance(hereinafter referred to as physician insurance)in a tertiary public hospital in Shanghai.Methods Counted from January 2019 to December 2021 in Shanghai Tenth People's Hospital(872 practicing physicians)with different risk departments,different titles,genders,and age groups of physician insurance purchase distribution and physician insurance claims;through the questionnaire and sampling survey,to grasp the physician's awareness rate of physician insurance,purchase intention and its influencing factors,recognized premiums,insured amounts,sharing and promotion methods;compared the scores of the doctors who have purchased/have not purchased the doctor's insurance for their nervousness after a medical dispute.Results High-risk departments,senior professional titles,males,and those over 40 years old had higher proportions of physician insurance purchases,the difference was statistically significant(P<0.001).From 2019 to 2021,the proportion of physician insurance claims to total medical dispute compensation was 1.56%,31.27%,and 38.50%,respectively.Among the physicians who applied for claims during the period,61.50%were fully compensated.The sample survey showed that the awareness rate of physicians'insurance to physicians was 83.29%.The proportion of the willingness to purchase physician insurance was 89.50%.The main factors affecting the purchase of physician insurance were:the implementation of the dual-track system of medical damage identification.The acceptable premium range was below 5000 yuan/year,and the expected maximum insurance coverage range was 50000-300000 yuan/year.The approved insurance cost sharing and promotion methods were proportionally shared by physicians and hospitals and led by the government and functional departments.Physicians who had purchased physician insurance were less nervous than those who had not purchased physicians after medical disputes,the difference was statistically significant(P<0.001).Conclusion Physician insurance is operating in good condition.Physicians'practice risks and compensation pressures are shared,and practice tensions are eased.The future development trend and prospects are bright.