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投保医责险:医院更看重保险公司调解医患纠纷

2017-09-21 07:32:12   中国经济网

尽管实际运作中存在一些问题,但整体而言,医责险在化解医患矛盾、构建和谐医患关系方面发挥了较大作用,也出现了一些较为典型的正面案例,可以给保险行业开展医责险业务一些借鉴。

例如,2016年7月28日,贵州某三甲医疗机构为一名60余岁的男性患者实施心血管搭桥术后,患者死亡。负责当地医责险业务的保险经纪公司中汇国际接到医院出险报案电话后,立即协调保险公司服务团队赶赴现场,一方面向患者及家属表明医疗机构已投保医疗责任保险,稳定其情绪。同时,依托该院完整的医疗质量和医疗安全管理体系,第一时间完成了院内专家评估。并且,根据专家评估意见、相关法律以及意外伤害的赔偿标准测算出赔偿价格。在还原事件、提供专业鉴定的基础上,到达现场的保险服务团队与患者家属展开谈判,最终医患双方都接受了9.8万元的赔偿额,而此前患者家属提出的赔偿要求是130万元。

“保险尽早介入,全程参与医疗纠纷调解,保险经纪公司提供专业协助,保险共保体密切配合,是医疗责任保险成功运行的关键要素。”谈到贵州医责险统保项目的经验时,吴玮华如是说。通过保险前置的方式,较好地体现其社会管理功能。

相关数据显示,贵州省自2015年12月18日正式启动医责险以来,至2016年11月30日,全省投保医疗责任险的各级各类医疗机构达7588家。全省签收保费1.24亿元,提供的风险保障总额达220亿元。2016年度,该省医责险共报案732件,完成赔付550件,全省经调解结案率达到90%以上,无一例因医疗纠纷导致的伤医事件发生。今年上半年,贵州全省一级以上公立医疗机构续保率达到98.3%。

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