Stakeholder analysis of no-fault compensation system on medical damages / 中国卫生政策研究

Using stakeholder involvement analysis to analyze the appeal,position,power and role of stakehold-ers involved in the creation of the no-fault compensation system of medical damage,this paper believes that the gov-ernment,including the health administrative department, is the concrete maker and the important facilitator of the policy implementation,which needs to take advantage of the public power to predominate the creation and trial opera-tion of the system;the medical staffs,patients and their families are the direct beneficiary of the policy,but it is nec-essary to ensure the good operation of the system by establishing diversified financing channels and setting reasonable compensation scope. The judicial appraisal institution and the expert group are the important guarantors of the policy implementation,but the authentication system should be unified and the expert group evaluation mechanism should be introduced. The insurance industry is an important propellant of policy implementation, but it needs to increase its participation by taking measures,such as expanding financing channels. The news media has an important influence on the making and implementation of the policy and should be properly guided to play its positive role.

No fault compensation in perinatal medicine in Japan-from results for 8 years

No fault compensation in perinatal medicine has been established to provide aid to patients in the event of disability due to a medical accident during delivery and to strive to resolve disputes quickly that contributes to reduce medical malpractice suit in the field of perinatal medicine. Furthermore, this system is aimed to establish a mechanism that achieves higher quality of obstetric care by analyzing the causes of accidents. This system is operated by Japan Council for Quality Health Care and 99.9% of childbirth facilities in Japan registered with this compensation system. Compensation system has two major functions including compensation and cause analysis and recurrence prevention based on cases. Compensation eligibility is reviewed in the Review Committee at the organization in Japan Council for Quality Health Care and currently 1,717 cases are judged as eligible cases out of 2,250 since 2009. The cause of each eligible case is analyzed in the Cause Analysis Committee one by one. The Cause Analysis Committee has 7 independent subcommittee and each subcommittee members are consistent of obstetricians, neonatologists, pediatricians, midwives and lawyers. Original cause analysis report is sent to childbirth facility and patient's family. Questionnaire survey demonstrated that 73% of childbirth facilities and 65% of patient family were satisfied with the cause analysis report. The number of medical lawsuit in obstetrics and gynecology is significantly decreased compared to those in all medical departments since the compensation system was introduced suggesting that these cause analysis reports may contribute the decrease in medical lawsuits. The major purpose of the Recurrence Prevention Committee is striving to prevent future cases of cerebral palsy and to improve the quality of obstetric care. To accomplish the purpose, the committee routinely collect information from individual cases and analyze quantitatively and epidemiologically. Furthermore the committee choose subject from cases to discuss for future prevention and provide wide public disclosure of the information with recommendation. The committee issued 6 reports until now and these reports have been distributed to childbirth facilities, perinatal medicine-related scientific society and administrative agencies.

A insustentável leveza da culpa: a compensação de danos no exercício da medicina / The unbearable lightness of culpability: the compensation for damages in the practice of medicine

Diante das crescentes dificuldades apresentadas pela responsabilidade civil para lidar com a má -prática médica e com a compensação aos pacientes, muitos advogam a implementação do sistema no-fault , isto é, um mecanismo no qual o paciente é compensado por via de um fundo econômico de socialização do risco, independentemente da demonstração de negligência por parte do médico. Neste estudo comparámos as principais notas do modelo no-fault com o clássico modelo fundado na culpa, com vista a determinar qual o mais adequa do em termos de justiça, melhoria dos cuidados de saúde e segurança do paciente. Concluímos que, apesar de o modelo no-fault trazer muitas vantagens, também envolve sérias dificuldades, riscos e fragilidades. Nomeadamente, é duvidoso que promova a diligência na prestação de cuidados médicos, dado que em regra não se verifica qualquer sanção para o profissional de saúde. Além disso, só pode operar com sucesso em condições mui to concretas, que não se encontram na maior parte das ordens jurídicas. Por conseguinte, não cremos que seja a solução mais adequada, pelo menos quan do implementada como um mecanismo geral para lidar com danos causados por tratamentos médicos.

In face of the growing difficulties presented by tort liability in dealing with medical malpractice and patient's compensation, many advocate the imple mentation of a no-fault system, i.e., a mechanism in which the patient is compensated through an economic fund of risk socialization, in disregard of the demonstration of the physician's negligence. In this study, we compared the main notes of the no-fault model with the classical model grounded in culpability, to determine which one is the most suitable in terms of justice, improvement of health care delivery and patient's safety. We concluded that, despite the fact that the no-fault model carries many advantages, it also involves se veral difficulties, risks and fragilities. In particular, it is doubtful that it promotes diligence in health delivery, since usually the health care professional does not suffer any sanction. Furthermore, it can only operate successfully in light of very particular conditions, not found in the majority of legal orders. Therefore, we do not consider it the most adequate solution, at least when implemented as a general mechanism to deal with injuries caused by medical treatments.

The Issues in Obstetric No Fault Compensation Act and Suggestions for the Improvement / 대한주산의학회잡지

As part of the medical dispute mediation act, no fault compensation legislation was enacted in 2011 and took effect from April 2013 in Korea. According to this law, obstetricians should share thirty percet of the compensation expenses with the government. Although the government argues that this law can contribute to the safe obstetric practice environment, most of obstetricians are concerning about the negative effects that can be exerted by the act, including decline in new OB/GYN residents' applications, dropping number of delivering clinics and hospitals, and ultimately, devastating the obstetric practice in this country. In this review, we summarize the process and issues in no fault compensation. We also introduce no fault compensation system in Japan and compare it with ours. Finally, we will give suggestions for the improvement of the law.

On defects of drug and its law responsibility / 中华医学教育探索杂志

Object to define defects of drug accurately and to initially discuss its law responsibility. Method With comparative study and system thinking,we acquired few scientific recognition of drug’s defects. Result & Conclusion Defects of drug are not equal to negative drug reaction. The former one should be an unreasonable and potential risk which induces no expectant therapeutic efficacy to provide. And its law responsibility could be no-fault liability accompanied by state compensation.

Legal Analysis and Advice on Clinical Trial of Medicine from"Korean Ginseng Bolus Event" / 中国药房

OBJECTIVE:To discuss the necessity of compensation system in clinical trial of medicine in China.METH?ODS:The legal attributes of clinical trial of medicine were analyzed based on the report of"Korean Ginseng Bolus Event"in Haining,the relation of rights and obligations between the subjects and researchers and the current problems in clinical trial in China were discussed.RESULTS&CONCLUSIONS:With the development of clinical trial of medicine in China,laws should be established to enforce compulsory insurance for the subjects and carry out no fault responsibility in order to ensure their legal rights.