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최근 10년간 의료분쟁 해결방안의 흐름과 이에 기초한 입법방향 제시

Other Titles
 History of medical dispute resolution in the recent 10 years and the proposal of a legislative direction based on this history (1988- 
Authors
 임강윤 
Issue Date
2002
Description
보건의료법윤리학과/석사
Abstract
[한글]



본 연구는 의료분쟁의 합리적인 해결을 위한 입법방향을 제시하는 데 목적을 두었다.

본 연구를 수행하는 방법으로 문헌고찰의 방법을 택하였으며 제3장과 제4장에서 1988년 이후 현재까지의 학위논문과 의료분쟁조정법안을 검토하였다. 제5장에서는 의료분쟁해결방안에 기초한 입법방향을 검토하였고 제6장에서 결론을 내리는 구성을 취하였다.

제3장에서 의료분쟁해결방안에 주안점을 두고 연구한 15편의 논문을 중심으로 기존 의료분쟁해결제도의 문제점과 그에 대한 해결방안을 유형별로 정리하였다. 기존 제도의 문제점으로는 의사배상책임보험제도의 실패, 대한의사협회 공제회의 실효성에 대한 의문, 의료법상의 의료심사조정위원회의 유명무실화를 들 수 있다. 이에 대한 대안으로는 의사배상책임보험의 재도입, 대한의사협회 공제회의 실효성 확보, 의료심사조정위원회의 활성화, 민사법상의 조정제도활용, 무과실보상제도 도입, 의료사고 보상기금 도입, 의료분쟁조정법 도입, 전문감정제도 도입, 의료소송 전문법원의 설치, 소비자보호원의 이용 등이 제시되고 있다.

제4장에서는 의료분쟁조정법안의 입법추진 경과를 약술하고 법안의 쟁점별 흐름과 논의사항에 대하여 검토하였다. 법안의 쟁점별 흐름은 1994년 정부안, 1997년 국민회의안, 1997년 신한국당안, 1999년 국회 보건복지위원회안, 2001년 보건복지부안을 중심으로 살펴보았다. 주요 쟁점사항으로는 조정전치주의, 무과실보상제도, 형사처벌특례조항, 진료방해 금지, 제3자개입금지, 공제조합에의 강제가입, 국가와 보험자의 구제기금참여를 채택할 것인지의 여부와 조정위원회의 구성문제, 보험제도의 형태로서 민간보험을 채택할 것인지 공제회로 할 것인지에 대한 논의, 의료행위로 인한 피해배상의 범위에 설명의무위반을 포함할 것인지의 여부, 의료관계기관의 정의문제에 대한 논의를 다루었다.

제5장에서 의료분쟁해결방안에 기초한 입법방향을 검토하고 제6장에서는 검토 결과에 따라 결론을 내렸다.

의료분쟁조정법(안)은 의료공급자인 의료인의 의업권이 보장되면서 의료소비자인 환자의 불만을 실질적으로 해결할 수 있는 현실성 있는 방향으로 입법되어야 한다. 즉, 의료분쟁조정위원회는 민간주도의 특수공익법인으로 설립하고, 조정위원회를 상설화된 기구로 하며, 조정위원은 의사, 법조인, 공익대표로 구성하되, 조정부는 진료과목에 맞게 10여개로 구성하여 실질적인 조사와 판단이 이뤄지도록 해야 한다. 조정전치주의를 채택하여 조정에 강제성을 부여하고, 조정위원회에 제출된 증거는 민사소송에서 증거로 원용되는 것이 제한되어야 하며, 피해범위에서 설명의무위반을 배제하며, 불가항력적인 무과실사고 발생시 국가가 보상기금을 조성하여 무과실보상을 하도록 하고, 제3자개입을 허용하여 신속하고 합리적인 분쟁해결이 될 수 있도록 해야한다. 단, 제3자개입을 허용하되 의료기관에서의 난동행위는 엄하게 처벌하고, 배상제도로는 의사배상책임보험을 도입하되 도입시 형사처벌특례조항과 연계하여 의업권 보장이 가능하도록 해야한다. 아울러 의료계가 사실상 사회보험체계내에 편입되어 있는 현실을 감안하여 손해배상액의 최고 한도액를 정하도록 한다. 현재 의료법에 규정된 의료심사조정위원회는 의료법에서 삭제하고, 의료분쟁조정법을 제정하여 의료소비자의 권익보호와 의료인의 의업권이 함께 보장될 수 있도록 해야 할 것이다.



--------------------

핵심되는 말 : 의료분쟁, 의사배상책임보험.

[영문]

The purpose of the present study is to propose a direction of legislation for the reasonable resolution of malpractices.

The present study was performed through the literature study, and degree theses and the medical dispute arbitrary law since 1988 are reviewed in chapters 3 and 4. The direction of legislation based on the terms of settlement of the medical disputes is reviewed in chapter 5, and the conclusions are drawn in chapter 6.

In chapter 3, the problems of the existing systems of resolving medical disputes and solutions are sorted out based on 15 theses that examined resolution processes of medical disputes. The problems of the existing systems of resolving medical disputes are as following: failure in the physicians' liability insurance system, ineffectiveness of the mutual aid committee under the Korean Medical Association, and the name sake existence of the medical dispute review and arbitration committee in the medical law. The proposed measures for resolving these problems include

the reintroduction of the physicians' liability insurance, securing of the effectiveness of the mutual aid committee under the Korean Medical Association, activation of the medical dispute review and arbitration committee, utilization of the arbitration system according to the civil law, introduction of no-fault

compensation system, introduction of a malpractice compensation fund, introduction of the medical dispute arbitration law, introduction of the expert evaluation system, establishment of a court specializing medical disputes, and use of the Korea Consumer Protection Board.

In chapter 4, the progress of pursuing legislation of the medical dispute arbitration is summarized and the history of each agenda in the law and items of discussion are reviewed. As for the history of proposals, this paper reviews a proposal by the government in 1994, a proposal by the National Congress for New

Politics in 1997, a proposal by the National Assembly's Health and Welfare Committee in 1999, and a proposal by the Ministry of Health and Welfare in 2001. The main items of consideration in the present study are establishment of compulsory arbitration, the no-fault liability system, a special clause on criminal punishment, the prevention of interference of medical practice, the prevention of the involvement of a third party, the compulsory enrollment in a mutual aid insurance, whether the government and insurers would choose to participate in a relief fund, the issue of the arbitration committee composition, the discussion on whether to choose a private or mutual aid insurance system, whether to include the violation of the doctor's duty to explain the patient conditions to a patient in the range of damage compensation, and the discussion on the definition of medicine related facilities.

The direction of legislation based on the method of resolving medical disputes is discussed in chapter 5, and the conclusions based on the review are made in chapter 6.

The medical dispute arbitration law has to be legislated in a realistic direction where the right to practice medicine by the suppliers, i.e., doctors, have to be guaranteed and at the same time, complaints by the consumers, i.e., patients, can be actually resolved. In other words, a medical dispute arbitration committee needs to be established as a special public company lead by private citizens, with the arbitration committee as a permanently established organization. The members of this committee should include doctors, lawyers, and representatives of the public, and the arbitration departments should include divisions to represent 10 medical departments. In addition, procedures within the arbitration departments should be based on actual investigations and judgement. Arbitration should be made compulsory so that each medical dispute would be arbitrated before going to the court. The use of the evidences submitted to the arbitration committee in civil suits should be limited. Physicians should not be liable for the violation of the physician's duty to explain the patient conditions to a patient. The government needs to establish a compensatory fund for those non-fault accidents that occurred beyond anybody's control. It should also allow the participation of a third party to expedite

reasonable resolutions of medical disputes. While the involvement of a third party should be allowed, those causing disturbance at a medical facility should be punished severely. As for the system of compensation, the physicians' liability insurance should be introduced, but at the introduction, the doctors' right to

practice medicine should be protected related with the special item of criminal punishment. At the same time, considering the reality that medicine is incorporated within the social insurance system, a maximum limit should be set for the amount of liability. The current medical review and arbitration committee defined in the medical law needs to be annulled, and by amending the medical dispute arbitration law, the consumers' right to receive medical services and the physicians' right to practice medicine should be protected as well.
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Appears in Collections:
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 2. Thesis
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/137769
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