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医患关系的风险管理与实证研究:基于中国 1790 例医疗损害责任纠纷诉讼案例

Risk management and empirical study of the doctor-patient relationship: based on 1790 litigation cases of medical damage liability disputes in China.

机构信息

School of Health Care Management, Anhui Medical University, 230032, Hefei, China.

The Second Clinical Medical College, Anhui Medical University, 230032, Hefei, China.

出版信息

BMC Health Serv Res. 2024 Apr 25;24(1):521. doi: 10.1186/s12913-024-10952-x.

Abstract

BACKGROUND

Compensation for medical damage liability disputes (CMDLD) seriously hinders the healthy development of hospitals and undermines the harmony of the doctor-patient relationships (DPR). Risk management in the DPR has become an urgent issue of the day. The study aims to provide a comprehensive description of CMDLD in China and explore its influencing factors, and make corresponding recommendations for the management of risks in the DPR.

METHODS

This study extracted data from the China Judgment Online - the official judicial search website with the most comprehensive coverage. Statistical analysis of 1,790 litigation cases of medical damage liability disputes (COMDLD) available from 2015 to 2021.

RESULTS

COMDLD generally tended to increase with the year and was unevenly distributed by regions; the compensation rate was 52.46%, the median compensation was 134,900 yuan and the maximum was 2,234,666 yuan; the results of the single factor analysis showed that there were statistically significant differences between the compensation for different years, regions, treatment attributes, and trial procedures (P < 0.05); the correlation analysis showed that types of hospitals were significantly negatively associated with regions (R=-0.082, P < 0.05); trial procedures were significantly negatively correlated with years (R=-0.484, P < 0.001); compensat- ion was significantly positively correlated with years, regions, and treatment attributes (R = 0.098-0.294, P < 0.001) and negatively correlated with trial procedures (R=-0.090, P < 0.01); regression analysis showed that years, treatment attributes, and regions were the main factors affecting the CMDLD (P < 0.05).

CONCLUSIONS

Years, regions, treatment attributes, and trial procedures affect the outcome of CMDLD. This paper further puts forward relevant suggestions and countermeasures for the governance of doctor-patient risks based on the empirical results. Including rational allocation of medical resources to narrow the differences between regions; promoting the expansion and sinking of high-quality resources to improve the level of medical services in hospitals at all levels; and developing a third-party negotiation mechanism for medical disputes to reduce the cost of medical litigation.

摘要

背景

医疗损害责任纠纷(CMDLD)赔偿严重阻碍了医院的健康发展,破坏了医患关系(DPR)的和谐。医患关系中的风险管理已成为当务之急。本研究旨在全面描述中国的 CMDLD,并探讨其影响因素,为医患关系风险管理提出相应建议。

方法

本研究从中国裁判文书网——覆盖范围最广的官方司法检索网站中提取数据。对 2015 年至 2021 年期间可获得的 1790 例医疗损害责任纠纷(COMDLD)诉讼案件进行统计分析。

结果

COMDLD 总体呈逐年上升趋势,地区分布不均;赔偿率为 52.46%,中位数赔偿额为 134900 元,最高为 2234666 元;单因素分析结果显示,不同年份、地区、治疗属性和审判程序的赔偿存在统计学差异(P<0.05);相关分析显示,医院类型与地区呈显著负相关(R=-0.082,P<0.05);审判程序与年份呈显著负相关(R=-0.484,P<0.001);赔偿与年份、地区和治疗属性呈显著正相关(R=0.098-0.294,P<0.001),与审判程序呈显著负相关(R=-0.090,P<0.01);回归分析显示,年份、治疗属性和地区是影响 CMDLD 的主要因素(P<0.05)。

结论

年份、地区、治疗属性和审判程序影响 CMDLD 的结果。本文根据实证结果,进一步提出了医患风险治理的相关建议和对策。包括合理配置医疗资源,缩小地区差异;促进优质资源扩容下沉,提高各级医院医疗服务水平;发展医疗纠纷第三方协商机制,降低医疗诉讼成本。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/da1f/11044444/d91040bca631/12913_2024_10952_Fig1_HTML.jpg

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