Nakajima K, Keyes C, Kuroyanagi T, Tatara K
Department of Social and Environmental Health F2, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita-shi, Osaka 565-0871, Japan.
JAMA. 2001 Mar 28;285(12):1632-40. doi: 10.1001/jama.285.12.1632.
Medical malpractice claims and dispute resolution systems have been examined in Western societies for their impact on the quality of care and efficient compensation for injured patients. However, little is known about the Japanese malpractice environment because claim information has been closely guarded. Based on data from the Japanese Supreme Court, the Ministry of Health, Labor, and Welfare (formerly the Ministry of Health and Welfare), and the Japan Medical Association (JMA), which provides malpractice insurance to 43.5% of Japan's 250 000 physicians, we review Japanese malpractice liability systems and the frequency of claims during the last 30 years. Annual premiums for physician professional liability insurance are relatively low (454 dollars-491 dollars). Although the frequency of claims in Japan is lower than that reported in the United States, England, and Germany, the number of claims is increasing in Japan. According to publicly available data from the Japanese Supreme Court, the annual number of medical malpractice suits filed in district courts has increased from 102 in 1970 to 629 in 1998 (from 0.09 to 0.25 per 100 physicians). The proportion of awards greater than 89 dollars 300 increased from 13.6% in 1976 to 65.4% in 1987. Among JMA members, claims increased 31% from 1987 to 1999, but the frequency of claims has remained at approximately 0.3 per 100 JMA members. The JMA's professional liability program offers a nonbinding out-of-court review of claims that is faster and less expensive than judicial resolution (a few months with no attorney required vs 35 months and attorney fees), but is a poor means of deterrence or discipline. Since JMA data represent only 43.5% of Japanese physicians, generalizations cannot be made about all Japanese physicians and institutions. The lack of data on all claims hinders adequate evaluation of dispute resolution methods, development of appropriate risk management activities, and proactive education for Japanese physicians.
西方社会已对医疗事故索赔及纠纷解决系统进行了研究，探讨其对医疗质量以及为受伤患者提供有效赔偿的影响。然而，由于索赔信息一直受到严格保密，人们对日本的医疗事故环境知之甚少。基于日本最高法院、厚生劳动省（前身为厚生省）以及日本医师协会（为日本25万名医师中的43.5%提供医疗事故保险）的数据，我们回顾了日本过去30年的医疗事故责任制度及索赔频率。医师职业责任保险的年保费相对较低（454美元至491美元）。尽管日本的索赔频率低于美国、英国和德国所报告的频率，但日本的索赔数量正在增加。根据日本最高法院公开的数据，地方法院每年受理的医疗事故诉讼数量已从1970年的102起增至1998年的629起（从每100名医师0.09起增至0.25起）。赔偿金额超过89300美元的比例从1976年的13.6%增至1987年的65.4%。在日本医师协会成员中，1987年至1999年期间索赔增加了31%，但索赔频率一直保持在每100名日本医师协会成员约0.3起。日本医师协会的职业责任计划提供了一种不具约束力的庭外索赔审查，比司法解决更快且成本更低（无需律师只需几个月，而司法解决则需35个月且有律师费），但作为威慑或惩戒手段效果不佳。由于日本医师协会的数据仅代表43.5%的日本医师，因此无法对所有日本医师和机构进行概括。缺乏所有索赔的数据阻碍了对纠纷解决方法的充分评估、适当风险管理活动的开展以及对日本医师的积极教育。
