National School of Development, Peking University, Beijing, 100871, China.
People's Mediation Committee in Guangdong, Guangzhou, 510095, China.
BMC Health Serv Res. 2020 Mar 18;20(1):225. doi: 10.1186/s12913-020-5044-7.
Medical litigation represents a growing cost to healthcare systems. Mediation, arbitration, and other alternative dispute resolution (ADR) methods are increasingly used to help solve the disputes and improve healthcare satisfaction. In China, the increasing number of medical disputes has contributed to concern for the safety of physicians and mistrust between physician and patients resulting in ADR processes being established in several provinces in recent years. Our aim was to describe and explain the impact of this new mediation process in the Chinese healthcare system.
Our study investigated mediation practices in China using case-level data from 5614 mediation records in Guangdong Province between 2013 and 2015. We investigated how the resolution success as well as the compensations are associated with the case characteristics using regression analysis.
Among the cases analyzed, 1995 (41%) were solved with agreement through mediation, 1030 were closed by reconciliation, 559 were closed by referring to court and 1017 cases were withdrawn after mediation. Five hundred five Yinao cases were solved with the help of mediators on the spot. We find that mediation solved about 90% of medical disputes under present mechanisms, while more police support is needed to cope with Yinao. The average compensation of mediation is CNY60,200 and average length of mediation is 87 days. Longer time taken to reach resolution and more money claimed by patients are associated with lower resolution success rate (p < 0.01) and higher compensation levels (p < 0.01).
Our results show the performance of mediation mechanisms in China to help solve medical disputes. ADR plays a role in reducing the need for initiating litigation and may ultimately increase satisfaction with the healthcare system.
医疗诉讼给医疗体系带来的成本日益增加。调解、仲裁和其他替代性争议解决(ADR)方法越来越多地被用于帮助解决争议并提高医疗保健满意度。在中国,医疗纠纷数量的增加引起了人们对医生安全的关注,以及医患之间的不信任,导致近年来在几个省份建立了 ADR 流程。我们的目的是描述和解释中国医疗保健系统中这一新的调解过程的影响。
我们的研究使用了广东省 2013 年至 2015 年 5614 起调解记录的案例数据,调查了调解在中国的实践情况。我们调查了调解成功率以及赔偿与案件特征之间的关系,使用回归分析进行分析。
在所分析的案例中,1995 例(41%)通过调解达成协议解决,1030 例通过和解结案,559 例通过移交法院结案,1017 例在调解后撤回。505 起医患纠纷案件在调解员的帮助下当场解决。我们发现,在现有机制下,调解解决了约 90%的医疗纠纷,而需要更多的警察支持来应对医患纠纷。调解的平均赔偿金额为 60200 元人民币,调解的平均时间为 87 天。解决争议所需的时间越长,患者要求的赔偿金额越高,调解成功率越低(p<0.01),赔偿水平越高(p<0.01)。
我们的研究结果显示了调解机制在中国帮助解决医疗纠纷的表现。ADR 在减少启动诉讼的需求方面发挥了作用,并可能最终提高对医疗保健系统的满意度。