医疗损害责任纠纷案件处置医保基金方式及改进策略

The Method and Improvement Strategy of Medical Insurance Fund for Handling Medical Damage Liability Dispute Cases

《社会保险法》规定,应当由第三人负担的医疗费用不纳入基本医疗保险基金支付范围。实际操作中,大量医疗损害责任纠纷案件都是在基本医疗保险基金支付后,经法院判决,才产生了有支付义务的第三人。法院审理时一般都无视或回避医保方的利益,将患者、医保方视为平等民事权利主体的案例极为罕见。司法审判环节忽略医保基金保护的情形不容轻视,医保部门有必要推动司法部门出台司法解释,规范该类案件医保基金支付部分的处置模式,或参考工伤、商业保险领域通识,立法改变医保基金不双赔的规定以适应司法审判实务,改善司法审判与医保相关法律规定冲突的现状。

The social insurance law stipulates that the medical expenses that should be borne by the third party shall not be covered by the basic medical insurance fund.In practice,a large number of medical liability dispute cases are paid by the basic medical insurance fund,and after the court's decision,the third party has the obligation to pay.It is very rare for the court to treat the patient and the medical insurance department as the subjects of equal civil rights,on the contrary,the court always ignores or avoids the interests of medical insurance department,which can not be disregarded.It is necessary for the medical insurance department to promote the judicial department to issue a judicial interpretation and regulate the management mode of medical insurance fund payment in such cases,or refer to the general knowledge in the field of industrial injury and commercial insurance,legislate to change the stipulation that the medical insurance fund does not double compensate in order to adapt to the judicial practice,and improve the status quo of the conflict between the judicial trial and the medical insurance related law stipulation.