诊疗的合理性和关联性鉴定方法之研究——以医保门诊“慢特病”费用审核方法为借鉴

Study on the Rationality and Relevance Appraisal of Medical Diagnosis and Treatment——Taking the Auditing Method of Medical Insurance Outpatient"Chronic Disease"as Reference

诊疗的合理性和相关性鉴定在司法实务中的需求不断增加,但法医学临床鉴定领域对此尚无统一、明确的鉴定规范及标准。医保门诊“慢特病”费用审核同诊疗的合理性和关联性鉴定,两者的价值目标一致,后者可充分借鉴前者技术规范。为确保鉴定意见的客观性、科学性,司法鉴定人应遵循以原发性疾病为限原则、符合法律规范原则、符合技术规范原则,对送检材料的客观性、相关性、合理性进行审核。

The rationality and relevance of diagnosis and treatment appraisal is increasing in judicial practice,but there is no uniform and clear specification and standard in the field of forensic clinical appraisal.As for Medical insurance outpatient"chronic disease"cost audit and rationality and relevance of diagnosis and treatment appraisal,they have same value goal,and the latter can fully learn from the former’s technical specifications.In order to ensure the objectivity and scientificity of the appraisal opinions,the judicial appraiser should follow the principle of primary disease as the limit,the principle of legal norms,the principle of technical norms,and review the objectivity,relevance and rationality of the materials submitted.