2010北醫大醫療體系國際醫療專業人才培訓計畫 1
簡正義
簡正義
執行長
執行長
國際醫療中心
國際醫療中心
萬芳醫院
萬芳醫院
2 2010北醫大醫療體系國際醫療專業人才培訓計畫 22010北醫大醫療體系國際醫療專業人才培訓計畫 3
The 1998 edition of Hospital Statistics
published by the American Hospital
Association：
4 2010北醫大醫療體系國際醫療專業人才培訓計畫•
There were 6,021 hospitals in the U.S.
•
5,015 of them were short‐term acute care
facilities.
美國約6千多家醫院。 42010北醫大醫療體系國際醫療專業人才培訓計畫 5
Government hospitals
Private not‐for‐profit hospitals
For‐profit or investor‐owned hospitals
Regardless of ownership, most hospitals are
community hospitals.
• Community hospitals 最多。 • Open system：醫生與醫院分開。 5
Board of Trustees
Executive Administration
The Medical Staff
Nursing Services
Allied Health Services
Clinical Support Services
Administration Support Services
2010北醫大醫療體系國際醫療專業人才培訓計畫 6 62010北醫大醫療體系國際醫療專業人才培訓計畫 7
Select the administration leader of the
hospital and delegate the hospital’s daily
operations and budgeting to the appointed
executive.
Ensure the quality of medical care through
the selection of qualified physicians and by
delegating quality assurance responsibilities
to medical staff.
董事會裡的成員，不是官派的。 7The chief executive officer (CEO) reports to the
governing board and provides leadership in
implementing the strategic goals and decisions
set by the board.
2010北醫大醫療體系國際醫療專業人才培訓計畫 8 82010北醫大醫療體系國際醫療專業人才培訓計畫 9
The physician’s responsibility is to diagnose the
patient’s conditions accurately and to prescribe
the best and most cost‐effective treatment
plan.
• Medical staff有的是一、二十個，有的甚是到百個。 • 大部分是兩年選一次，所有的醫師來選一個首席醫師，底下會有很多團隊去進行 不同的作業。 910 2010北醫大醫療體系國際醫療專業人才培訓計畫
2010北醫大醫療體系國際醫療專業人才培訓計畫 11
Nursing Service, also called patient care
services, is the largest component of the
hospital. Nursing services provide round‐the
clock health maintenance, treatment and
support of the patient.
11
Clinical Laboratory
The radiology Department
Rehabilitation Services
2010北醫大醫療體系國際醫療專業人才培訓計畫 12 檢驗 X光 復健科 122010北醫大醫療體系國際醫療專業人才培訓計畫 13
Pharmacy
Business Services
Accounting
Admitting Services
Information Service and Medical Record
Maintenance
The Human Resources Department
Other Administration Function:
Marketing and Planning、Public Relations、Plant and
material management、 found raising、housekeeping and
security
2010北醫大醫療體系國際醫療專業人才培訓計畫 14 • 大部分醫院為open system，醫生不向醫院拿錢。 • 醫院要求醫師一定要購買醫療糾紛之保險，且至少要達多少價格。 142010北醫大醫療體系國際醫療專業人才培訓計畫 15
Public Health Coverage
Public Health Coverage
Medicare
Medicaid
Private Health Care Coverage
Private Health Care Coverage
Traditional Indemnity or Fee‐for‐Service
Blue Cross & Blue Shield Plans
Health Maintenance Organizations
Managed Care
Others
• 醫師與醫院的保險公司也不一定相同，當糾紛發生時，可能會各護其主。 • Blue Cross等為HMOs(健康維護組織) 找集團，固定費用，然這種制度有Gatekeeper (守門員制度)。 • 社會及私人的保險： 社會→老人及窮人。 私人→公司行號可能會找私人保險來承包全公司的人員，不管看多少每個人收取 的費用是固定的，也因此會有很多限制。 例如一定要先去看家醫科，再看是否有轉介診的必要 1516 2010北醫大醫療體系國際醫療專業人才培訓計畫 • 美國現在的施政是一黨獨大；然歐巴馬推行健保也是相當困難。 • 美國在醫療方面估計花費2.5兆美元。 • 美國的醫療支出佔國內生產總值(GDP)16.6%、臺灣約6%出頭。 • 美國醫療費用逐漸上升，至2020年，美國將會減少約20萬位醫師，醫師缺少嚴重 。 • 楊署長：台灣醫療人才可能會流失，至國外發展 16
2010北醫大醫療體系國際醫療專業人才培訓計畫 17
Definition:
Medical malpractice is professional negligence
negligence
(過失)
by act or omission by a health care provider in which
care provided deviates from accepted standards of
practice in the medical community and causes injury
injury
(傷害) or death to the patient.
Wikipedia Medical malpractice：提供之照護無符合標準，造成病人受傷及死亡，即為醫療過 失。 17
The party： Plaintiff (原告)
Defendant (被告)
Elements of the case:
1.A duty was owed : patient‐doctor relationship
2.A duty was breached : standard of care
3.The breach caused on injury.The breach of duty was a
proximate (直接原因) cause of the injury.
4.Damages
2010北醫大醫療體系國際醫療專業人才培訓計畫 18 Wikipedia Damage=錢，表示受傷之後，可能無法工作而造成之損失。 182010北醫大醫療體系國際醫療專業人才培訓計畫 19
Jurisdiction (裁判權)
Discovery (發見)
Interrogatories (詰問)
Depositions (証明)
The plaintiff has the burden of proof to prove all
elements
Verdict (判決) : judgment of the court. Losing party –
new trial, appeal
Wikipedia 國際醫療的病人要來之前，要清楚台灣的法律可能不一樣，以後如果有糾紛要告 的話可能不是在美國而可能是在台灣。 這也是美國很多醫生、保險公司要病人不要到國外就醫的原因，如果產生糾紛時 會相當難處理，可能無法獲得協助。 19
Expert Testimony
Damages: may include compensatory and punitive
damages.
Statue of limitation
•Vary in different states in U.S. between 1 and 4 years with
exceptions in same states for minor.
•In Canada, 2 years ~ 3 years
•In U.K., 3 years
2010北醫大醫療體系國際醫療專業人才培訓計畫 20 Wikipedia • 在審判過程兩方都會請很多專家到庭上講、作證。 • 事情發生之後多少時間可以告你，英國大概是三年，美國不一定，要看是哪一洲 。 • Punitive damage 費用可能高達百萬元 (一般可能為二十幾萬)。 202010北醫大醫療體系國際醫療專業人才培訓計畫 21
Selection of the jury
Opening statements (the plaintiff first followed by the
defendant)
The plaintiff’s case
The defendant’s case
Closing statements
The judge’s instructions to jury
Jury deliberations
The jury’s verdict
21
Nearly 50% of malpractice trials were against surgeons.
Nearly 33% of malpractice trials were against non‐
surgeon.
Plaintiff won 27% of cases.
25% of practicing physicians sued annually.
50~65% physicians sued at least once during their
career.
80.4% of payment reports were against physicians.
2010北醫大醫療體系國際醫療專業人才培訓計畫 22 W.D. April 23, 2009 222010北醫大醫療體系國際醫療專業人才培訓計畫 23
73% settled malpractice claims involve medical error.
97% were associated with injury; of them, 73% got
compensation (賠償)
63% were associated with errors; of them, 73% got
compensation (average $521,560)
37% were not associated with errors; of them, 28%
got compensation (average $313,205)
• 97%的病患因醫療錯誤而得到賠償。 • 37%非醫療錯誤，而其中28%會獲得賠償。 美國之醫療糾紛議題，恐將影響未來醫療費用 232010北醫大醫療體系國際醫療專業人才培訓計畫 24
• 我們一定要做好風險管理，最好的管理是，如JCI，但是不管如何，做多做久了了 多少都會出現問題。
• 臺灣的醫療糾紛最大問題就是民意代表之問題。
2010北醫大醫療體系國際醫療專業人才培訓計畫 25
