ABSTRACT
In the personal injury compensation system, the protection and relief of the injured people's rights to life, rights to health, and body rights are generally based on the results of disability assessment. Over the years, with the increased number of personal injury compensation cases, the practice of disability assessment have been greatly developed, and the development of disability assessment standards tends to be mature. However, the lack of basic theories for disability assessment has seriously affected the construction and unification of standards. Starting from the tort legal system of personal injury compensation, this article systematically analyzes the legal theories of disability assessment, and holds that the loss of labor ability is the legal basis for disability assessment in China, and the essence of disability assessment should be understood as the quantitative assessment of an individual's permanent loss of labor ability. This article combines the international disability assessment models and the primary concepts of American Medical Association's Guides to the Evaluation of Permanent Impairment to refine the basic concepts of disability assessment in China, such as impairment, disability, handicap, disabled people and self-care ability, etc. At the same time, it sorts out the critical issues of identification time, promotion principles and compound calculation of multiple injuries in disability assessment. It is expected to be beneficial to the theory and practice of disability assessment in personal injury compensation.
Subject(s)
Humans , Disability Evaluation , Liability, Legal , ChinaABSTRACT
OBJECTIVE：To construct China ’s Insurance Mode for ADR injury compensation model under marketing authorization holder （MAH）system，and to provide reference for reducing the medical disputes caused by ADR damage and protecting the rights and interests of patients. METHODS ：Using the methods of recommendation and “snowball”，the interviewers were invited to conduct semi-structured interviews to obtain qualitative data ，and the results were analyzed by thematic analysis. According to the results of subject analysis ，the ADR injury compensation model was designed from three aspects of insurance type setting，insurance level division and compulsory insurance protection objects ，and the Fuzzy comprehensive evaluation method based on AHP was used to evaluate the model ；questionnaire and multiple factor Logistic regression analysis was adopted to analyze the influential factors of whether drug related institutions were willing to establish ADR injury compensation system. RESULTS：A total of 40 experts were invited and 34 of them completed the interview ，with a response rate of 85.0％. At present ， the problems of ADR injury compensation in China mainly included the difficulties of third-party identification and adducing evidence of ADR injury ，the difficulty of timely and fair settlement of medical disputes caused by ADR injury ，the high cost and long time of handling ADR injury disputes ，and the uncertainty of compensation mode. More than half of the experts interviewed agreed with the compensation mode of insurance . The overall score of established model was 89.50. A total of 640 questionnaires were distributed and 559 valid questionnaires were recovered （204 drug manufacturers ，172 drug distributors and 183 medical institutions）. The effective rate of the questionnaire was 87.3％. Multiple Logistic regression analysis showed that the factors positively correlated with the approval of establishing ADR injury compensation system after the implementation of MAH system in China included the familiarity of ADR staff in drug manufacturing enterprises with ADR related policies （β＝1.697，P＜0.05），the types of drugs operated by pharmaceutical companies （β＝2.987， P＜0.05），the cognitionlevel of medical staff on ADR （β＝ 2.800，P＜0.05）. The working years of medical staff were negatively correlated with the approval of establishing ADR injury compensation system after the implementation of MAH system （ β ＝－ 2.544，P＜0.05）. CONCLUSIONS ：ADR injury compensation model designed in this study is feasible. It has reference value for reducing the economic burden of ADR patients ， treating patients ’health problems caused by ADR injury in time ，and promoting the development of China ’s drug insurance. Main influential factors for the establishment of ADR injury compensation model under MAH system contain the familiarity of ADR staff in drug manufacturing enterprises with ADR related policies ，the types of drugs operated by pharmaceutical companies ，the cognitionlevel of medical staff on ADR ，the types of drugs operated by pharmaceutical companies ，the cognitionlevel of medical staff on ADR.
ABSTRACT
OBJECTIVE：To investigate th e cognition ，attitude and behavior of part of drug practitioners in Shenzhen on compensation of adverse drug reaction （ADR）injury，and to provide relevant reference for the establishment of ADR injury compensation system. METHODS ：Taking marketing authorization holder （MAH），staff of medical institutions at the second level or above and drug regulatory authorities in the relevant meeting held in Shenzhen in 2018 as objects ，on-the-spot anonymous investigation of “questionnaire star ”was used to collect and analyze the cognition ，attitude（including attitude towards ADR compensation and ADR compensation system ）and behavior of the above-mentioned personnel to ADR compensation. The relevant suggestion was put forward. RESULTS & CONCLUSIONS ：A total of 172 questionnaires were collected （all being valid ）. In term of cognition ，the respondents generally had high awareness of ADR （response rate of ADR concept was 82.0％）. In term of attitude to ADR injury compensation ，100 respondents（58.1％）believed that ADR after medication should be compensated ，and 147 respondents（85.5％）believed that compensation should be made for serious and fatal adverse reactions. In term of attitude to ADR injury compensation system ，respondents thought that ADR damage compensation funds be undertaken by MAH for 131 case times （76.2％）. As for the difficulties in the implementation of ADR compensation ，it was considered that the evaluation of the correlation between adverse reactions and drugs led to the difficulties in the implementation of ADR compensation （143 case times ， 83.1％）；most respondents thought that the first thing to do in the implementation of ADR compensation system was to implement laws and regulations （145 case times ，84.3％）. In term of behavior ，104 respondents（60.5％）had processed costs due to ADR ， most of whom chose self-resolved （85 cases，81.7％）；112 respondents （65.1％） chose to inform medical personnels or pharmacies directly. It is suggested that the relevant departments in Shenzhen should explore and establish ADR injury compensation mechanism in Shenzhen by establishing a public oriented platform and mechanism for ADR science popularization （setting up relevant departments ，supervising the public propaganda of news media ，expanding the public propaganda to the commu nity），exploring and establishing ADR injury compensation mechanism （setting up a special legislative pilot of ADR injury regulations ，setting up ADR injury appraisal committee ），and increasing the investment in ADR testing （fully using of “Internet+”Big Data ，allocating special funds ）.
ABSTRACT
OBJECTIVE：To provide applicable suggestions for exploring the establishement of the vaccination rare adverse reactions compensation fund in China. METHODS ：Through literature research and regulation review ， the establishment background，compensation principle ，management and operation mode （including management methods ，source，uses and risk control measures）of Vaccine Injury Compensation Trust Fund in the United States were introduced in details ，while the operation effect was evaluated ，and the suggestions for the establishment of the vaccination rare adverse reactions compensation fund in China were put forward. RESULTS & CONCLUSIONS ：The U.S. National Vaccine Injury Compensation Program （VICP）imposed a certain proportion of vaccine excise tax on each dose of vaccine sold by vaccine companies ，and established the Vaccine Injury Compensation T rust F und as its fixed source of compensation funds to provide compensation for vaccine victims. The fund belonged to the special needs trust. When the vaccine victims met the compensation conditions ，they can convert their compensation rights into the beneficial rights under the trust law. The fund was managed by the Fund Management Branch under U.S. Dept. of the Treasury，and it took a variety of risk control measures such as capital guaranteed investment ，subrogation，emergency preparedness. As of 2018，a large number of fund balances had been accumulated ，which was sufficient to ensure the solvency of VICP. It is suggested that China fully learn from the successful experience of the Vaccine Injury Compensation Trust Tund of the United States ， based on the domestic reality ，start from improving the relevant legislation of the compensation fund ，building the compensation management system ，making clear the source and usage of the fund ，taking various risk control measures ，so as to explore the establishment of China ’s vaccination rare adverse reactions compensation fund ，further expand the financing channels ，stabilize the source of funds ，and improve the compensation effect.