Beijing News: let insurance companies engage in medical disputes mediation is not afraid to transfer contradictions?


Beijing News: let insurance companies engage in medical disputes mediation is not afraid to transfer contradictions?

Original title: let insurance companies engage in mediation of medical disputes, do not fear "tune" more contradictions? A quick review of the new Beijing News

For medical disputes, insurance brokers can certainly intervene in mediation, but the status of intervention should be stakeholders, not a neutral third party.

Luo Zhihua

Two "people mediators" mediation of medical disputes of hearing impairment, mediation lasted only less than 1 hours, the two sides were dismiss, one year later, the patient's family found that the so-called "people mediator" is the insurance brokerage company personnel.

In response to the Nanjing Municipal Health Planning Commission, the introduction of insurance broking companies, the whole process of participation and witness to the doctor-patient mediation process, is a reform in Nanjing, intended to transfer medical disputes from "hospital to the hospital outside". But in the implementation, the insurance brokerage company sent staff "identity problem", is really a more embarrassing issue to promote this work.

At present, the people's mediation committee of doctor-patient disputes ("medical adjustment Commission") has played an important role in many places and has become an irreplaceable channel to resolve the disputes between doctors and patients. "Medical mediation commission" has played a buffer role between doctors and patients, to avoid direct conflict between the two sides of the dispute, this model is widely advocated, and increasingly towards perfection.

However, the "medical adjustment Commission" has also encountered many challenges in some places. Some patients and family members prefer to choose radical ways to solve the problem, and they are not willing to accept the mediation of the "medical adjustment Commission". There are three main reasons for this phenomenon: first, the efficiency is not high, the mediation time is too long, and the patients can not afford it. Secondly, the mediator lacks professionalism and can not discover the professional loopholes of the medical profession and protect the interests of the patients. Third, whether identity is neutral or not is questioned and it is difficult to get the trust of the patients.

The first two reasons only reflect the insufficient ability of the "medical regulation committee", and many times can be understood by the patient, but the third reasons will affect the credibility and the existence value of the "medical adjustment Commission". Because objective justice is the lifeline of mediation, if the third parties involved in mediation can not even ensure neutrality, mediation will easily appear "pull off the shelf" phenomenon.

In this mediation, the two "people mediators" involved in the mediation were employees of the insurance brokerage firm, and the hospital's medical liability insurance was bought at the company.

This is obviously inappropriate: medical liability insurance only pays for medical accidents or accidents caused by doctors, and does not pay compensation for medical consequences caused by non accidents and non accidents, such as the adverse drug side effects and uncontrollable complications, and the nature of medical consequences will be directly affected to the interests of the insurance company. The employees of insurance brokers will be responsible for mediation, and the interests of the patients will be lost.

Insurance companies believe that insurance brokers involved in mediation have policy basis. In 2017, the fifty-second regulations on the prevention and treatment of medical disputes in Jiangsu province stipulates that after the occurrence of medical disputes, the medical institutions should notify the insurance agencies of the medical liability insurance in a timely manner, and the insurance agencies should send personnel in time to take part in the treatment of medical disputes. But the "basis" is the misreading of the provisions of the law, insurance brokers can certainly intervene in mediation, but the identity of the intervention should be a stakeholder, not a neutral third party. One of the benefits of medical liability insurance is to transfer medical disputes from "hospital to hospital". In fact, the insurance broker is the agent outside the hospital. The agent directly becomes the referee, and it is unavoidable to create the association of "blowing the black whistle".

The role of medical liability insurance should not be underestimated and should be promoted. Promotion of this new type of insurance, so that the responsibility of the hospital does not shirk the buck, the compensation should be given not stingy, which is also conducive to improving the doctor-patient relationship. At the same time, since medical behavior has a direct impact on the income and expenditure of insurance, the insurance broker should of course be involved in medical behavior and medical disputes, but the way to intervene should be in accordance with the identity and responsibility, and to supervise the rationality of the doctor's diagnosis and treatment, which is the responsibility of the insurance company.

People's mediation mode of doctor-patient disputes is worth cherishing, but its value lies not in how many disputes to settle, but in the credibility and efficiency of this mode. Therefore, the mediator should ensure the presence of the third party that does not exist in the interests of the party, and in the process of mediation, the mediation should be disturbed by the stakeholders such as the first and the second parties, so that the mediator can stick to the bottom line of the mediator's identity neutrality, maintain the fair and fair result of the mediation, and attract more patients and family members to choose the solution. Resolve disputes.

Luo Zhihua (Doctor)

Responsible editor: Gui Qiang


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