Research On Improving Operational Mode Of Medical Liability Insurance In Shanghai, China

[Background]As medical disputes increasing frequency in China, how to resolve medical risk effectively, improve medical risk management, ease contradictions between doctors and patients has become the focus of the Government. Medical liability insurance was begun in Shanghai in October 2002, which established effective medical risk-sharing mechanisms. But medical liability insurance is still at an initial stage, immature development, more obstacles and prominent problem. It is fail to manifest the ability of the medical liability insurance in the establishment of a risk-sharing, incentive and restraint mechanism, to construct harmonious doctor-patient relationship, to ensure legitimate rights and interests of doctors and patients. In this context, this study is discussed problem and countermeasure of operation mode about medical liability insurance in Shanghai.[Objectives and Methods]1. ObjectivesThe objective of the study is to introduce the status, characteristics and problems of medical liability insurance in Shanghai through interviews, surveys, and other methods. Then to give improvement strategies of medical liability insurance in Shanghai combining with health reform requirements.2. MethodsIn the study, researchers collect data and materials by using literature review, secondary data collection and analysis, hospital survey and key informant interview. We refer to success experience about medical liability insurance management mode in foreign and China, to provide a reference for medical liability insurance in Shanghai. We collect the data of 10 years of medical liability insurance in Shanghai, to analysis its development and run situation. Questionnaire and interviews were used to learn hospital’s cognitive and demand on medical liability insurance in Shanghai, such as the need to purchase medical liability insurance, the management mode of medical liability insurance, the rationality of medical liability insurance premium, the effectiveness on sharing the compensation of medical dispute, the process of claims, the problems of medical liability insurance in Shanghai, the recommendation about medical liability insurance.[Results]The study showed that there are three types of medical liability insurance model in foreign:commercial insurance, mutual insurance relying on industries or institutions, national financial security. Its formation and development related to the health systems, financing systems and cultural practices of different countries. In China, it developed relatively short on medical liability insurance. The typical type such as expanded responsibility category mode in Beijing, stressed personal responsibility and risk-sharing model in Shenzhen, stressed market competition mechanism in Ningbo. They have different advantages and disadvantages.As one of the earliest areas to practice medical liability insurance, medical liability insurance developed slowly and regressed in Shanghai. It showed that the insurance rate of hospital and enthusiasm of insurance companies fell. The investigation showed there was up to 95% samples hospital insured in 2011, but more than half of Grade-Ⅲ Hospital unwilling to insured. The annual premium of Grade-Ⅰ, Ⅱ, Ⅲ Hospital was between 8-44 million RMB. There was up to 70% samples hospital believed medical liability insurance could shared part of loss which caused by medical accident or medical disputes, but it was lack evidence on setting and adjusting premium. There was cumbersome about claims measures and insurance companies’ service ability need to improve. It was particularly dissatisfaction for most of Grade-Ⅲ Hospital in this area (The difference were statistically significant between Grade-Ⅰ, Ⅱ Hospital and Grade-Ⅲ Hospital).Sample hospital believed that the reason of services poor and claims difficult was monopoly and the lack of competition.The study showed that there was less than 1% hospital thought medical risks should be resolved by themselves, half of hospitals thought medical risks should be resolved by the Government or society, to raise fund from financial appropriations. Insurance coverage should be widened to doctors in hospitals, which can expand the insurance object, reflected the law of large numbers and enhanced risk sharing. On the financing point, it should be based on the risks of various specialties and different individuals. On the management point, nearly 80% of respondents consider that medical liability insurance should be led by the Government (62.4%) and non-profit.The study showed that the root of the problem about medical liability insurance in Shanghai is that:1) on the object of insurance point, there is a handful of insured object cannot to share medical risk effectively, which is obvious in the Grand-Ⅲ Hospitals.2) on the setting of premium point, the lack of standardized formulation and adjustment of premiums caused dissatisfaction.3) on the management of insurance point, the lack of competition and ambiguous market mechanism.4) on the types of risk point, the lack of follow-up services for the management and sharing medical risks, because of ignoring the hospital’s non-monetary costs in the treatment of medical disputes, which may be one of the most important reason for the Grand-Ⅲ Hospitals unwilling to buy insurance.[Discussion and Suggestions]1) Medical liability insurance has the function of scattering medical risks, safeguarding the legitimate rights of both doctors and patients, building a harmonious doctor-patient relationship, maintaining normal medical order, and guaranteeing the healthy development of medical science. In the new round of deepen reform of medical and health system, the Government of Shanghai need to improve laws and regulations construction, to ensure the welfare of the medical industry, to improve the medical liability insurance system. The government must support and improve laws and regulations, implement compulsory medical liability insurance; 2)to set the premium rates by scientific, to improve the medical risk prevention mechanism; 3) to open up the market and introduce competition mechanism, to offer a wealth of medical liability insurance products; 4) to give full play to the role of the tripartite professional organizations, to enhance the mediation of medical dispute and medical liability insurance cohesion, to reduce investment in time and energy for medical disputes, to strengthen the management of non-monetary medical risk, to ease the contradiction between doctors and patients, to protect the legitimate rights and interests of all parties.