Preliminary study on the application of medical accident insurance at a hospital in Tianjin / 中华医院管理杂志

This paper introduced the development of medical accident insurance at Tianjin Medical University General Hospital. The author summed up the achievements made in practice and analyzed the problems such as low risk awareness of the patients in their low proportion of insurance risk coverage ,lack of normalized industry standards ,and lack confidence. Other problems include the lack of top-level design of the system ,and high difficulty to plan insurance projects. The paper also recommends to strengthen the positive publicity and guidance ,to create a healthy atmosphere of public opinion;to improve the system ,standardize the industry supervision ;and encourage the introduction of policy proposals ,and to perfect the national medical risk sharing and compensation mechanism .

The Deficiency and Perfecting Countermeasures of Medical Accident Insurance in China / 中国医学伦理学

There are many deficiencies of the current medical accident insurance in China. Learning from the foreign no - fault compensation system for medical injury,combining with China's reality,it could be done as fol-lows:establishing a mandatory medical accident insurance system through legislation;bringing premiums into health insurance co - ordination;simplifying the claims process and increasing claims quota;standardizing the sales chan-nels. Medical accident insurance and medical liability insurance complement each other,so that the losses of pa-tients achieve effective relief compensation through insurance,effectively easing the tense relationship between doc-tors and patients.

Cobertura real de la ley de atención de emergencia y del seguro obligatorio contra accidentes de tránsito (SOAT) / Coverage of the emergency health care law and the compulsory insurance against road traffic crashes (SOAT)

Objetivo. Determinar, desde la perspectiva de los pacientes, el grado de conocimiento y de cobertura real de la Ley de Atención de Emergencia y del Seguro Obligatorio Contra Accidentes de Tránsito (SOAT). Materiales y métodos. Estudio transversal de vigilancia activa en los servicios de emergencia de establecimientos de salud (EESS) de tres ciudades del país con heterogeneidad económica, social y cultural (Lima, Pucallpa y Ayacucho). Resultados. De 644 encuestados, 77% negaron conocer la Ley de Atención de Emergencia (81% en Lima, 64% en Pucallpa y 93% en Ayacucho; p < 0,001). Luego de explicarles dicha ley, 46% del total respondió que fueron atendidos bajo los preceptos de la ley. Con respecto al SOAT; en 237 personas (37,2%) los gastos de atención no fueron cubiertos por un seguro (74% Pucallpa, 34% en Ayacucho y 26% en Lima: p < 0,001). De los que contaban con un seguro (SOAT u otro), pero cuya atención no fue cubierta por éste, la mayoría estuvo en Lima (70%), seguido de Ayacucho (30%) y ninguno en Pucallpa. La mayoría (94%) procedió de establecimientos públicos. Las razones incluyeron problemas administrativos (25%), vencimiento del seguro o morosidad en el pago (21%), invalidez del seguro en el establecimiento (18%), no disponibilidad de la póliza (18%), o no cobertura de las lesiones por el seguro (9%). En estos casos, los gastos fueron asumidos por el mismo paciente, familiares o parientes, el chofer o dueño del vehículo, el servicio social del EESS, u otras personas o instituciones. Conclusiones. En este estudio se observó un gran desconocimiento de la Ley de Atención de Emergencia, y una cobertura de atención muy deficiente, pues casi la mitad de atenciones no fueron brindadas de acuerdo a uno o más puntos establecidos por dicha norma.

Objective. The aim of this study was to ascertain, from patients' perspective, the degree of knowledge and the actual coverage of the Emergency Health Care Law and the Compulsory Insurance against Road Traffic Crashes (SOAT). Material and methods. A cross-sectional, active surveillance of emergency wards of selected health facilities in three Peruvian cities (Lima, Pucallpa y Ayacucho) was conducted. Results. Out of 644 surveyed victims, 77% did not know about the law about provision of emergency health care (81% in Lima, 64% in Pucallpa y 93% in Ayacucho; p < 0,001). Following the explanation of what this law entails, 46% reported to have received care according to the law specifications. As for SOAT, the health care related costs of 237 persons (37.2%) were not covered by any insurance scheme (74% in Pucallpa, 34% in Ayacucho and 26% in Lima: p < 0,001). Conclusions. In this study, the lack of knowledge about the provision of emergency health care law was important, and the coverage of care was deficient as nearly half of participants reported not to be treated by one or more of the entitlements stated in such law. Road traffic injuriesrelated health care costs were not covered by any insurance scheme in one of three victims. Improvements on citizens' information about their rights and of effective law enforcement are badly needed to reach a universal and more equitable coverage in the health care of road traffic-related victims.

The Drawbacks of Applying the "Equitable Responsibility" Principle to Settle the Medical Accident and the Measure to Deal with it / 昆明医科大学学报

Objective To discuss the medical treatment responsibility caused by unpredictable harm.Method In medical treatment,the court usually applies the "Equitable Responsibility" principle to settle the medical conflicts caused by unpredictable harm,this poses certain limitations.Result The fact that hospitals being liable for compensation or reparation ignores the mutual risk-sharing responsibility of hospitals and patients.Conclusion To establish the system of medical accident insurance is one of the best measure to solve the medical conflicts caused by unpredictable harm.

An Introduction on the Changes of the Occupational Health and Safety Systems in Germany: from the 19th Century to the Weimar Republic / 의사학

The purpose of this paper is to introduce and summarize the developmental process of the occupational health and safety systems from the 19th century to the Weimar Republic in Germany. The German occupational health system has changed with its unique character reflecting its sociopolitical backgrounds. In the 19th century, Germany, as the aftercoming capitalistic country in Europe, showed a flourishing industrial development. But this industrial development evoked many side effects, including long working hours, bad work environment, frequent occupational accidents and occupational diseases. The health and safety systems for German workers were established under the influences of the political interest groups and the social movement. In 1884 Bismarck made the law of the occupational accident insurance(Berufsgenossenschaft) in order to oppress the movement of socialists and radical workers and to secure his regimes. Then the way to control the work conditions of factories had three paths: technical supervision by the autonomic engineers, factory inspectors from the occupational accident insurance and the governmental factory supervisors. In the Weimar Republic the needs of the protection for both workers and machines were rising and became one of the main tasks of the government. Therefore, in 1925 the law for the occupational diseases was first established and then some occupational diseases were acknowledged as the occupational accidents and insured by the occupational accident insurance. Many factory doctors, factory hygienists, factory engineers and chemists organized the specialists' supervising and consulting groups for the occupational health and safety. And the workers themselves also started to participate in the factory committee in order to guard their own health and interests.