Seguro de responsabilidade civil médica não garante segurança do paciente / Medical liability insurance does not guarantee patient safety

O presente ar tigo, pautado no método hipotético-dedutivo, tratou do seguro de responsabilidade civil médica no Brasil diante do aumento das ações judiciais relacionadas à saúde. A partir de uma pesquisa com abordagem qualitativa e utilização de procedimentos bibliográficos e documentais, objetivou-se descobrir se a contratação de seguros profissionais teria um possível efeito preventivo de proteção ao médico e ao paciente contra danos durante a assistência. Para tanto, apresentaram-se noções introdutórias sobre esse tipo de seguro e os principais desafios contemporâneos relacionados a sua utilização para, finalmente, se avaliarem as prováveis consequências dele frente às ações indenizatórias. Verificou-se que a contratação do seguro de responsabilidade civil médica ainda não alcançou números expressivos no país, e que a inexistência de imposição legislativa e a ausência de incentivo pelo conselho profissional competente podem ser fatores que contribuem para esse cenário. Com desafios pré-existentes semelhantes, a experiência nos Estados Unidos demonstrou efeito contrário à prevenção, com o crescimento de ações indenizatórias e o surgimento de uma nova crise. Por fim, os resultados apontaram para a solidificação da segurança do paciente em detrimento das adversidades decorrentes da adesão ao seguro.

The present article, based on the hypotheticaldeductive method, dealt with medical liability insurance in Brazil in view of the increase in health-related lawsuits. From a research with a qualitative approach and the use of bibliographic and documental procedures, the objective was to discover whether the contracting of professional insurance would have a possible preventive effect of protecting the doctor and the patient against damages during care. To do so, introductory notions about this type of insurance and the main contemporary challenges related to its use were presented, and finally, the probable consequences of this type of insurance Against indemnity claims were evaluated. It was verified that the contracting of medical liability insurance has not yet reached expressive numbers in the country, and that the inexistence of legislative imposition and the absence of incentive by the competent professional council may be factors that contribute to this scenario. With similar pre-existing challenges, the experience in the United States has demonstrated the opposite effect to prevention, with the growth of indemnity suits and the emergence of a new crisis. Finally, the results pointed to the solidification of patient safety at the expense of the adversities arising from insurance adherence.

Seguro de responsabilidade civil profissional em Odontologia: simulação de apólices considerando o perfil padronizado do cirurgião-dentista brasileiro / Professional liability insurance in Dentistry: policy simulation considering the standardized profile of the Brazilian dentist

Introdução: em Odontologia o seguro de responsabilidade civil tem a proposta de garantir um aporte financeiro em caso de condenação judicial por processos indenizatórios propostos por pacientes. Este mecanismo permite que o profissional desempenhe sua atividade com mais tranquilidade. Objetivo: o presente trabalho teve por objetivo relatar um caso simulado onde foram analisados comparativamente três tipos diferentes de seguro de responsabilidade civil para o cirurgião-dentista, disponíveis no mercado brasileiro. Material e Métodos: através de revisão de literatura, buscou-se traçar um perfil do cirurgião dentista brasileiro padronizado. Na sequência através de busca na Plataforma Google através dos termos "seguro", "responsabilidade civil" e "odontologia", foi possível encontrar diversas seguradoras. Aleatoriamente foram selecionadas as três primeiras que permitiam preencher propostas on-line de seguro. A partir disso, obtiveram-se três cotações, as quais foram motivos de análise. Resultados: o cirurgião-dentista brasileiro padronizado é caracterizado pelo sexo feminino e especialidade em ortodontia. O valor para a contratação variou entre R$ 1.014,74 e R$ 2.296,67, sendo o prazo de vigência do seguro de doze meses para todas as seguradoras, com cobertura nas esferas cível, criminal e administrativa. Conclusão: O presente estudo mostrou a importância de os profissionais da Odontologia conhecerem bem cada cláusula do produto ou seguro que está sendo oferecido e como elas podem impactar na atividade clínica para realmente poderem fazer o uso pleno do seguro de responsabilidade civil

Introduction: in Dentistry, civil liability insurance has the purpose to ensure financial support in case of judicial conviction in indemnity processes for patients. This mechanism allows the professionals to develop their activity with more confidence. Objective: This paper aims to report a simulated case where three different types of liability insurance for dentists available in the Brazilian market were comparatively analyzed. Methods: through a literature review, we sought to draw a profile of a standardized Brazilian dental surgeon. Through a search on the Google Platform using the key-words "insurance", "civil liability" and "dentistry", it was possible find several insurance companies. The first three were randomly selected that allowed the filling of insurance proposals online. So, three quotations were obtained, which were reasons for analysis. Results: The Brazilian's dental surgeon profile was characterized by female with an orthodontics specialty. The contracting amount ranged between R$1,014.74 and R$2,296.67, with the insurance term being twelve months for all insurance companies, with coverage in the civil, criminal and administrative spheres. Conclusion: This study showed the importance of dentistry professionals knowing well each clause of the product or insurance that is being offered and how they can impact in the clinical activity being able to make full use of the liability insurance

Practical experience of medical liability insurance and third-party mediation mechanism at Heilongjiang Provincial Hospital / 中华医院管理杂志

Heilongjiang Provincial Hospital has scored an initial success in dealing with medical disputes since the medical liability insurance and third-party mediation mechanism were introduced into the hospital in 2013.The paper identified problems found in the practice,and recommended the following:rationalizing the cost of insurance coverage,expanding scope of third-party mediation properly,enhancing professional authority in assessment of medical dispute cases,simplifying insurance compensation procedure,and consolidating the legal status of the medical dispute mediation institutions,for better resolution of such disputes.

Ways to Achieve Social Co-governance of Food Safety---Research Report of Social Co-governance in Yunnan Province / 中国药师

The 13th five-year plan pointed out clearly that it is necessary to implement food safety strategy , and form a manage-ment system for strict and efficient social co-governance of food safety .The paper introduced the practice and the results of food safety co-governance in Yunnan province , and provided some proposals with the purpose to help the development of food safety co -governance work in the other areas .

The comparative study of the Mongolian Health professional’s liability insurance system with some foreign countries / Шинэ санаа Шинэ нээлт

Risk management practice and decision making are paramount for doctors to improving patient outcomes and managing the total cost of risk in our evolving healthcare landscape. In Mongolia there are no legal regulations about health professional’s liability insurance. The aim of the study is to provide relative information about the legal environment, systems and financing of liability insurancefor health professionals in selected foreign countries and Mongolia and to look at what policies and regulations could be applied to Mongolia.We carried out a policy study focused on health professionals’ liability insurance in four selectedcountries. We investigated health professionals’ liability insurance situation in Mongolia in the year of 2012-2014 byReviewing and analyzing the data related to health professionals liability insurance voluntary from the top six insurance companies’ by size and interviewing managerial level staff at these companies Studying court decisions related to health professionals’ errors to see how many health professionals could be prevented from court hearing Studying patients’ complaints against health professionals as filed with the Ministry of Health andSports to see how much risks are facing by health professionals.There are two main legal systems we discovered regarding resolution of health professionals’accountability for patient complaints: Court sentencing. Examples include Mongolia and the United States. Reimbursing the loss. Examples include Switzerland, Finland, New Zealand, Canada, Australia, England, and the Russian Federation. There are two insurance types for health professional’s liability: А. Compulsory B. Voluntary1 In USA, Canada and England, the liability insurance system for health care providers developed late in 19th and earlier in 20th century. Today, both private and nonprofit insurance entities in these countries insure health professionals and members of the health professionals’ association. England has rich experience of health professional’s liability insurance and the system is too large. Data fromthe England legal system shows that one case may take up to 4 years to receive a final decision. In order to determine health professionals’ fault with regard to claims, a health professionals’ liability damage assessor is needed who is well experienced and trained in healthcare law. Mostly not more than 30 percent of the claims are reimbursed. In Canada, statistical trends show claims against health professionals continue to increase. As a result, doctors prescribe additional laboratory tests and other additional investigations which increase health sector costs. In Russia in 2010 the health professional’s liability insurance law is approved and the implementationwill start January 2017. In Mongolia in 2012-2014, there were registered 373 complaints and errors against health professionals and 162 clients applied court complaints. During this period, 27 health professionals received court sentences. Health professionals liability insurance premium is calculated 0.8-3.5 percent of the insurance valuation. In 2012-2014 total 4377 health professionals insured voluntarily against professional liability.In most developed countries health professionals are protected from sentence to court. Averagecomplaints against health professionals have continued to increase steadily similarly in other countries.Therefore health professional’s professional risk is increasing. It shows that it is very important to improve the legal environment of the liability insurance system for Mongolian health professionals. of coronary atherosclerosis.

Investigation on the awareness and demand for medical liability insurance of doctors：Case study of a top 3 general hospital in Guangzhou / 中国卫生政策研究

Objective:This paper aims to investigate the awareness and demand for medical liability insurance of doctors, and to provide policy recommendations for the further development of medical liability insurance in China. Method:A stratified random sampling survey is conducted on doctors from a Top3 general hospital in Guangzhou, and the relevant departments and individual doctors were interviewed. Results:The higher the risk in a department, the higher their awareness of medical liability insurance becomes;the longer the length of service for a doctor, the more understanding of medical liability insurance the doctor has. Medical liability insurance is generally supported by doc-tors with a strong willingness of demand, but they opinions on bearing and sharing the insurance premium are quite different. Discussion:Doctors still lack sufficient knowledge of medical liability insurance due to the lack of effective publicity. The structural mode of medical liability insurance is still relatively vague, and the government leadership and market operation ability have a serious shortage. Suggestion:This paper suggest to improve the relevant laws and regulations of medical liability insurance, to strengthen government supervision and publicity, to build a reasonable development model of medical liability insurance in line with the national circumstances, and to strengthen an effec-tive combination of government leadership and market operation.

Thoughts on practice of medical liability insurance at the hospital / 中华医院管理杂志

An analysis of medical liability insurance practice at the hospital in the past 6 years found that medical liability insurance failed to work as expected in medical dispute prevention and risk sharing.The analysis also found that such an insurance will take a greater role in risk sharing,exposure to conflicts,cause discovery,and responsibility,with enhanced government role in guidance and intervention.Thus medical liability insurance is highly advocated by such means as compulsory execution,coordinating mechanism of insurance funding,prevention“medical dispute profiteers”,and adaptation to new approaches in medical dispute settlement.

Analysis on the Rate Estimation of Coal Pneumoconiosis Liability Insurance / 中国卫生经济

Objective:To assess the risk of coal pneumoconiosis and measure the gross premium rate of coal pneumoconiosis liability insurance. Methods: Based on the data related to pneumoconiosis risk from published materials in different provinces, it used pure premium method to measure the gross premium rate and made province-specific rate tables of this liability insurance according to risk classification. Results: Rate tables of Chongqing, Shaanxi, Shanxi, Shandong, Henan and Anhui were made according to type of work and form of coal’s ownership. Conclusion: The risks of coal pneumoconiosis among different provinces are very different. It’s necessary to make province-specific rate tables when developing business of coal pneumoconiosis liability insurance for different provinces.

An empirical study of medical liability insurance in Nanjing / 中华医院管理杂志

Medical liability insurance is a latecomer in China,and faced with many challenges ever since.This paper picked medical liability insurance in Nanjing as an empirical study example,as the author analyzed the insurance,underwriting and premiums of medical liability insurance,as well as the insurance programs and claim settlements from 2008 to 2012.In addition to noting problems found in medical liability insurance in Nanjing,the author proposed the roadmap for China' s medical liability insurance,with reference to experiences of overseas medical liability insurance industry.

Mechanism of the medical dispute handling mechanism and its effects in Ningbo / 中华医院管理杂志

"The Provisional Regulations for Prevention and Handling of Medical Disputes in Ningbo" was issued as one of the mayor's instructions. This document advocates such principles as prevention priority, lawful handling, fairness, convenience and people oriented. Ningbo called into play a third party, the insurance claims settlement mechanism, and people's medication mechanism, which facilitated the 4-party cooperation and enriched means for dispute handling. A year of practice proved these efforts as successful in solving disputes, easing doctor-patient conflicts, improving doctor-patient relationship, avoiding loss of state-owned assets, as well as upgrading hospital management and quality of care of the hospitals.

Investigation into the State of Clinical Education and Training for Anma-Massage-Shiatsu, Acupuncture and Moxibustion in Japan-Actual Conditions of Schools for the Visually impaired and a Colleges for General Population- / 全日本鍼灸学会雑誌

[objective] Using a questionnaire survey, we investigated the state of clinical training for Anma-Massage-Shiatsu, Acupuncture and Moxibustion at Japanese acupuncture school training centers (included were schools for the blind and colleges for the non visually impaired) <BR>[DesignandMethods] We sent a 5 point questionnaire consisting of 49 questions concerning the state of clinicaltraining to 121 acupuncture schools in Japan. All these schools are listed in the 2002' List of Colleges published by the Foundation for Training and Licensure Examination in Anma-Massage-Shiatsu, Acupuncture and Moxibustion.<BR>[Results] The response rate was 82.6% (100/121). Ninety-two schools have Acupuncture clinics open to the publicand 7 schools have Western Medical Clinics. Twenty-four percent of the schools in the survey have not registered their acupuncture clinics with the Governor of the Prefecture. Of the schools that responded 93.1% used disposable acupuncture needles, although 85.2% of the schools did not use needles only once, as recommended. While 49.4% (42/85) of the schools reported some adverse events at their clinics, 49.0% of the schools hold a liability insurance. Many acupuncture clinics at schools for the blind were established before the 1930's. During their clinical training, students at these schools are responsible for the majority (93.8%) of the patients' treatments. Clinical fees at these acupuncture clinics were under 525 yen. On the other hand, most of these clinics at acupuncture colleges for the non visually impaired were established in the 1990's after an amendment in the Law. Therapists at these colleges are largely responsible (82.1 %) for clinical treatments during the students' clinical training. Fees at these clinics were between 1576 yen and 2100 yen.<BR>[Conclusion] The state of clinical training for Japanese Anma-Massage-Shiatsu, Acupuncture and Moxibustion education was only elucidated to a small extent. Clinics must improve safety precautions and reassess risk management strategies. Another survey is necessary to define global standards of clinical acupuncture and moxibustion styles. In order to suggest standard policies for clinical management further study is necessary.

Discussion of medical liability insurance / 中华医院管理杂志

Setting up and improving the system of medical liability insurance is the primary direction in and the chief means of dispersing medical risks and settling medical disputes. However, the system currently in use in China is confronted with a number of problems, including, on the theoretical plane, insufficient effective demand by medical institutions, varied understanding of the insurance-covered services by the parties involved, different expected values with regard to the final results of the insurance, and on an operational plane, the legal positioning of the disposition of medical disputes, the relationship between the rights and obligations of the parties involved during dispositions or lawsuits, the comprehension and explanation of certain provisions of the insurance and so on. In order to solve these problems, it is necessary to take such measures as setting up a mechanism for negotiations in the trial period of medical liability insurance, opening up insurance market, implementing the separation of medical administrative liabilities and civil compensation liabilities, and encouraging patients to buy medical risk insurance while developing medical liability insurance The goal is to improve the system of medical liability insurance, harmonize the relation between doctors and patients, and thus build a harmonious society.

On Effective Approaches of Medical Liability Insurance to Relieving Physician-Patient Conflicts / 中国医学伦理学

A fair,just,and credible mediation institution is required to ensure the effective implementation of medical liability insurance,relieve physician-patient conflicts,and protect the legal rights of medical institutions,patients and insurance corporations as well.Medical disputes mediation institution,as the arbitrator of physician-patient conflicts,clarifies the rights and obligations on all parties,including doctors,patients,and the insurance corporations as well,safeguards the legal rights of all parties,standardizes and simplifies the settlement procedure of medical disputes,and provides an effective approach to relieving the conflicts between doctors and patients.

On the Role of Medical Liability Insurance on Relieving Physician-Patient Conflict / 中国医学伦理学

Based on the realistic circumstances at home and successful experiences from abroad,this paper holds the idea to introduce medical liability insurance into medical market to relieve the currently tense physician-patient conflict and analyzes the role and function of medical liability insurance.Meanwhile,some problems and countermeasures are also explained in the functioning process of medical liability insurance.

Research on Several Problems of Compelling Medical Relationship / 中国医学伦理学

Compelling medical relation is one kind of administrative legal relationships. In the process of compelling treatment, when illegal or improper treatment by medical staff hurts patient's body, life or psychology, the country must be responsible for compensation to the patient. To effectively avoid the risk of infection due to compelling medical service, the special liability insurance of medical risk for the medical staff should be set up. Furthermore, the patient is supposed to hold the power of receiving legally free cure.

Construction of ADR Liability Insurance in China / 中国药房

OBJECTIVE:To explore a reimbursement mechanism for adverse drug reactions(ADR)suitable to the condition of China.METHODS:Based on the condition in China,we evaluated the feasibility of applying insurance mechanism into ADR reimbursement from aspects of the development of insurance industry and pharmaceutical industry as well as the characteristics of ADR etc.Meanwhile we put forward some suggestions on the construction and operation of the ADR liability insurance.RESULTS & CONCLUSIONS:ADR liability insurance can help guarantee patients' legitimate rights of life health,settle medical disputes,facilitate the development of pharmaceutical industry and promote ADR reporting and management work.To carry out ADR liability insurance,issues like insurance rate,national policy support and evolving of ADR monitor network should be taken into consideration.