home
about the project
Medical news
For authors
Licensed books on medicine
<< Previous Next >>

The concept of compulsory medical professional liability insurance

The validity of the choice of protecting the professional responsibility of medical workers, as one of the prerequisites for successful reform in the field of legislative support of medical activity, is due to a number of reasons, the main of which, according to the author, are:

- uneven efforts of society related to the search for legal remedies for the legitimate interests and rights of patients, on the one hand, and legal protection of the professional responsibility of medical workers - on the other hand. As a result of such a bias, medical workers become a more vulnerable category of subjects of medical and legal relations;

- the entire healthcare system is provided and functions solely through the activities of medical workers, which necessitates close attention to ensuring the realization of their rights and protecting their legitimate interests;

- Doctors, like representatives of other professional groups, are entitled to insurance of their professional liability;

- reforming healthcare, ensuring the exercise of rights and protecting the legitimate interests of patients, naturally leads to an increase in the number of so-called “medical” legal cases, which in turn requires the creation of adequate mechanisms to protect the rights and legitimate interests of medical workers.

One of these mechanisms can be compulsory insurance of professional responsibility of medical workers.

The main goal pursued by the introduction of this type of insurance is to increase the level of social and legal protection of medical workers, optimize the financing system of domestic health care, primarily in the interests of patients, and reduce the fear of medical workers to fulfill their professional duties associated with a high level of risk of presenting with Patient litigation.

As in any other issue, first of all, it is necessary to determine the definition of a concept. Stetsenko S.G. notes that this term should be understood as a special type of insurance in which the object of insurance is the risk of liability of a medical worker to a patient who may be injured as a result of medical care * (29).

According to A.L. Pidde, medical professional liability insurance of medical workers should be considered in the context of the general concept - “doctor’s protection”, which manifests itself in two directions - “professional protection of the doctor as a specialist” and “protection of the professional interests of the doctor as an employee”. It is characteristic that if the first direction is implemented through professional medical organizations (associations), then the second - at the expense of trade unions * (30).

Taking into account the above definitions, and focusing on his own understanding of the problem, the author suggests giving the following definition of this concept. The professional liability insurance of medical workers is the liability insurance in case of harm to the life and health of the patient, when medical workers fulfill their professional responsibilities for providing medical care.

The legal basis for the possibility of implementing this type of insurance are the provisions of the following documents.

1. The Civil Code of the Russian Federation, which determines in article 931 ("Liability insurance for harm") that under a liability insurance contract for obligations arising from damage to the life, health or property of others, the risk of liability of the policyholder or other person to whom such responsibility may be assigned. The person whose risk of liability for harm is insured must be named in the insurance contract. If this person is not named in the contract, the risk of liability of the insured is considered insured. The contract of insurance of risk of liability for harm is considered to be concluded in favor of persons who may be harmed (beneficiaries), even if the contract is concluded in favor of the insured or another person responsible for the harm, or the contract does not say in whose favor it is concluded * (31).

2. The law of the Russian Federation “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens”, which in article 63 (“Social support and legal protection of medical and pharmaceutical workers”) determines that “medical and pharmaceutical workers have the right to insure professional error, as a result of which harm or damage to the health of a citizen not related to the careless or negligent performance of their professional duties "* (32).

3. The law of the Russian Federation "On the organization of insurance business in the Russian Federation" of November 27, 1992, the provisions of Article 4 of which stipulate that property interests may be objects of property insurance, related, in particular, to the obligation to compensate harm caused to other persons (liability insurance ) * (33).

Thus, on the one hand, it can be argued that in order to introduce the professional liability insurance of medical workers into the practice of domestic health care, there is no need to adopt new laws at this stage. The existing base of legal documents is enough to recognize this type of insurance as legitimate.

However, on the other hand, statistics indicate a small distribution of this type of insurance. Among the many reasons for this condition V.I. Akopov and E.N. Maslov distinguish two main reasons:

- inattention of the medical community to the serious problem of medical claims against doctors and medical institutions;

- the extreme poverty of medical institutions, which are not able to not only keep high-level professional lawyers on staff, but also to pay insurance amounts for all state-owned medical workers * (34).

It should be noted that state and municipal medical institutions, which are financed from budgets of various levels, have much less chances to introduce the described type of insurance into practice. Indeed, the expenditure of funds is carried out strictly in accordance with certain articles, among which the costs of insurance of professional responsibility of medical workers are not provided. In this regard, commercial medical institutions and private practitioners are in more promising conditions and already today have the financial and legal capabilities to put medical workers' professional liability insurance into practice.

Despite the fact that there are real prospects for the use of the described type of insurance in private health care, there is currently no increased activity of insurance organizations, and the number of medical institutions (medical workers) that have insured professional liability is very small.

“Typically, the insurance company enters into a contract with the doctor for this type of insurance, after which he is issued an insurance policy, and in the event of an insured event and the doctor presents the insurance policy, the company assumes not only the payment of the claim filed by the patient, but also judicial protection of the interests of the doctor. this company in a contract with a doctor establishes a restriction or the size of payments per one complaint, or the total amount of payments for the period of validity of each policy "* (35).

The motivation of insurers is an important factor in introducing the professional liability insurance of medical workers. In this case, it seems necessary to take into account foreign experience, since the legal regulation of medical activity in general, and professional liability insurance of medical workers, in particular, in industrialized countries has existed for a long time.

In particular, M.N. Maleina notes that a special Union for the Protection of Physicians has been created in England to collect their insurance premiums.
The average English doctor pays about 2% of his income to the cashier of the union. American surgeons pay about 6% of their insurance income to meet patient claims * (36).

Of particular interest is the practice of implementing medical insurance in the United States, a country with one of the highest rates of both financial support for healthcare and its legal support. "In the United States, there are two types of SPOMR (medical professional liability insurance. - A.P.). For the first of these, the insurance company is obligated to pay compensation for all health claims during the year the policy was valid, regardless of the time the policy was submitted. . The policies of the second type provide compensation only for those complaints that relate to damage caused in the same year "* (37).

In the late 80s of the XX century in the United States there was a sharp increase in the number of claims of citizens who were not satisfied with the quality of medical care provided to them. In connection with the increase in the amount of payments, American doctors were forced to increase the costs of insurance of their professional liability.

The average insurance premium of a doctor was then more than 8 thousand dollars a year. Most of the money (in% of the doctor’s annual income) was spent on professional liability insurance by obstetrician-gynecologists (10.3%), anesthetists (8.3%) and general surgeons (6.9%) * (38).

Summarizing the practice of insurance of medical professional responsibility by medical workers in the UK, USA, France, Germany and other countries, the authors of the domestic scientific textbook on this issue conclude that it is urgent to introduce it into domestic practical health care operating under conditions of mandatory medical insurance - medical professional liability insurance of medical workers , in combination with the need to provide for the possibility of compensation for damage in the courts on a voluntary basis, while enhancing the mechanisms for dealing with complaints and claims of patients * (39).

Needs to be analyzed and the possibility of using the principle of “responsibility without fault” adopted in a number of European countries in Russian healthcare. Its essence is that in case of harm in the provision of medical care of inadequate quality, the payment of monetary compensation to the patient does not require the search for specific culprits from among the medical staff. The patient is automatically paid the amount determined by the court.

In Europe, the first law on “liability without fault” was passed in 1986 in Finland. It is noted that the use of this type of professional liability insurance of medical workers, along with other mechanisms, not only protects the rights of the patient in case of their violation, but also helps to prevent these violations * (40).

It is important that the implementation of the described principle contributes to the formation of a unified state policy regarding the need to protect the interests of both patients and doctors.

It seems reasonable point of view Yu.S. Savenko, who claims that "full protection of the rights of patients is possible only if the doctor has protected rights" * (41). Further, in the cited work, the author notes that “meanwhile, the rights of a doctor and the social status of this profession are reduced to an unprecedented level anywhere and never in history” * (42).

The practice of legislative activity in Russia indicates that bills dedicated to the issues under study have been positioned as priority ones for several years.

Back in 2001, when he was chairman of the State Duma Committee on Health and Sports, N.F. Gerasimenko noted that "we should expect the development of new bills, the very appearance of which is predetermined by the ongoing changes in public relations. Thus, a certain advance in the norms on the rights of patients can prompt the State Duma to adopt a law on professional liability insurance for medical and pharmaceutical workers" * (43). Unfortunately, deputies of the supreme legislative body of Russia have not yet embarked on the issue of legislative regulation of professional liability insurance for medical workers.

The realities of the present time in the Russian Federation testify to the possibility and necessity of introducing compulsory insurance of professional liability of medical workers under the following conditions:

1. Warranties, on the part of the state, of compulsory (at the expense of budgetary funds) professional liability insurance of young specialists who have graduated from higher education institutions during the first 3-5 years of their practical activity.

2. The allocation of a special article for financing the insurance of professional responsibility of medical workers in the budget of state and municipal medical institutions.

3. The definition of professional liability insurance for medical workers as a prerequisite for obtaining a license for the right to practice medicine, both for private practitioners and for employees in state and municipal medical institutions.

4. The urgent initiation of the development and adoption of a federal law on compulsory insurance of the professional activities of medical workers, which would clearly spell out the legal framework, insurance procedure and conditions for compensation for harm caused to the patient’s health by inappropriate medical treatment.

5. Connection to the process of practical implementation of this type of insurance of bodies and institutions participating in the organization of compulsory medical insurance. As one of the options, the management system of the Federal and territorial compulsory health insurance funds or insurance companies can be used.

6. A clear definition of legal approaches to the definition of such concepts as “medical error”, “accident”, “iatrogenic disease”, “defect in the provision of medical care”, which are of great importance in the practice of determining the guilt or innocence of a doctor in one or another adverse outcome medical intervention * (44).

7. Inclusion in the system of control over the implementation of the program of compulsory professional liability insurance - medical associations with a clear definition of their functions and tasks.

Describing the last of these conditions, one should note the solidarity of A. Starchenko, who notes that, “first of all, the protection of the rights of doctors depends on the quality of work of professional medical associations. Associations should guard those hospitals that provide high-quality medical care to the population and fight with those who hack. As soon as the members of associations realize that financial flows go to those who provide quality assistance, a normal legal situation will arise. Then the rights of both will be better protected. second hand "* (45).

The professional liability insurance of medical workers is one of the factors that the problems of legal regulation of medical services for the population have turned from a private task of jurisprudence into an urgent problem of legal regulation * (46). The success of this initiative will largely depend on how thoughtfully and carefully the approach to solving this problem is implemented.

Obligatory insurance of professional responsibility of medical workers will make it possible, equally, to protect the rights and legitimate interests of all subjects of medical and legal relations, to prevent, to a certain extent, violation by medical workers of professional duties and to provide patients with the possibility of gratuitous correction of damage caused to their health.

This, in turn, will allow for less painful reform of the national health care system and to achieve better results with less loss for all subjects of medical and legal relations.
<< Previous Next >>
= Skip to textbook content =

The concept of compulsory medical professional liability insurance

  1. Social (compulsory) health insurance
    The history of social health insurance dates back to the 1880s, when the first system was introduced in Germany by Chancellor Bismarck. Of the various types of insurance schemes, this is most reminiscent of a tax-based financing system. But, unlike a tax-financed healthcare system, the people covered by it are entitled to a certain package of services in exchange
  2. Article 76. Professional non-profit organizations created by medical workers and pharmaceutical workers
    1. In order to realize and protect the rights of medical workers and pharmaceutical workers, develop medical activities and pharmaceutical activities, promote scientific research, and resolve other issues related to the professional activities of medical workers and pharmaceutical workers, these employees have the right to create professional volunteers
  3. Статья 74. Ограничения, налагаемые на медицинских работников и фармацевтических работников при осуществлении ими профессиональной деятельности
    1. Медицинские работники и руководители медицинских организаций не вправе: 1) принимать от организаций, занимающихся разработкой, производством и (или) реализацией лекарственных препаратов, медицинских изделий, организаций, обладающих правами на использование торгового наименования лекарственного препарата, организаций оптовой торговли лекарственными средствами, аптечных организаций (их
  4. RIGHTS, RESPONSIBILITIES, RESPONSIBILITY AND SOCIAL PROTECTION OF MEDICAL WORKERS
    In the days of the USSR, the implementation of medical activities was protected by departmental barriers. With the democratization of the Russian state and society, pathologists and other pathological anatomical service employees (PAS) were poorly prepared for the legal regulation of their professional activities. The Fundamentals (Law of July 22, 93, No. 5487-1) establish that one of the tasks
  5. The specifics of the professional activity of a medical worker, his professionally important qualities
    Medical activities are carried out in the following areas: diagnosis, treatment and prevention of diseases - and requires the skills to formulate a diagnostic, therapeutic and preventive task. This process, as a rule, is carried out in the conditions of variability of the initial data (symptoms and syndromes can appear and disappear, combine in different ways), lack of time (with
  6. The specifics of the professional activity of a medical worker, his professionally important qualities
    Medical activities are carried out in the following areas: diagnosis, treatment and prevention of diseases - and requires the skills to formulate a diagnostic, therapeutic and preventive task. This process, as a rule, is carried out in the conditions of variability of the initial data (symptoms and syndromes can appear and disappear, combine in different ways), lack of time (with
  7. Статья 72. Права медицинских работников и фармацевтических работников и меры их стимулирования
    1. Медицинские работники и фармацевтические работники имеют право на основные гарантии, предусмотренные трудовым законодательством и иными нормативными правовыми актами Российской Федерации, в том числе на: 1) создание руководителем медицинской организации соответствующих условий для выполнения работником своих трудовых обязанностей, включая обеспечение необходимым оборудованием, в порядке,
  8. The problem of responsibility in the scientific heritage of S. L. Rubinstein and its development in the concept of personal responsibility as a property of the subject of life
    Во всех этических и правовых учениях ответственность рассматривается в связи с философской проблемой свободы. Однако часто она решается абстрактно и ставится в зависимость от ответа на вопрос: можно ли вообще человека считать свободным в своих действиях? Свобода и необходимость – это две философские категории, выражающие взаимоотношения между деятельностью людей и объективными законами
  9. Статья 73. Обязанности медицинских работников и фармацевтических работников
    1. Медицинские работники и фармацевтические работники осуществляют свою деятельность в соответствии с законодательством Российской Федерации, руководствуясь принципами медицинской этики и деонтологии. 2. Медицинские работники обязаны: 1) оказывать медицинскую помощь в соответствии со своей квалификацией, должностными инструкциями, служебными и должностными обязанностями; 2) соблюдать
  10. Статья 77. Особенности подготовки медицинских работников и фармацевтических работников
    1. Практическая подготовка лиц, получающих среднее, высшее и послевузовское медицинское или фармацевтическое образование, дополнительное профессиональное образование, обеспечивается путем их участия в осуществлении медицинской деятельности и фармацевтической деятельности в соответствии с образовательными программами и организуется: 1) на базе структурных подразделений образовательных и
  11. Медицинские работники и фармацевтические работники, медицинские организации
    Медицинские работники и фармацевтические работники, медицинские
  12. Social and Health Insurance
    To insure - to protect from something unpleasant, undesirable, to protect, to ensure safety. Insurance - a way to reduce (prevent) material losses from risk situations by paying contributions to an insurance organization that undertakes to indemnify for possible damage in specially agreed cases. Insurance is an independent link in financial
  13. BASIS OF HEALTH INSURANCE
    Медицинское страхование (МС) – это система экономических отношений, предусматривающая создание специального фонда и использование его для возмещения ущерба факторов медико-социального риска. Факторы медико-социального риска: - болезнь - несчастный случай - потеря трудоспособности - материнство - смерть. Цель МС: гарантированность гражданам получение медицинской помощи при
  14. Medical insurance in the Russian Federation
    The development of medical insurance in modern Russia has received legislative support in the form of the Law "On Health Insurance of Citizens in the Russian Federation" adopted in 1991. According to Article 6 of the Law, all citizens of Russia have the right to: - compulsory and voluntary medical insurance; - choice of medical insurance organization; - the choice of treatment and prevention organization and
  15. Чатное (добровольное) медицинское страхование
    Доступ к медицинскому обслуживанию в системе частного медицинского страхования определяется свободным выбором и способностью платить. Лица, которые могут позволить себе платить взносы строго с учетом риска заболеть, заключают договор о страховании с частной страховой компанией. Частное медицинское страхование основано на том, что в принципе за плату можно застраховаться на любой случай, однако
  16. Mixed social / private health insurance systems
    In most countries, medical systems are rarely purely social or private, and most often they include aspects of both. There are various forms of mixed systems in which some services are funded on a solidarity basis, while others are funded by additional private contributions. Examples include medical care societies in Zimbabwe and medical care systems in South Africa,
Medical portal "MedguideBook" © 2014-2019
info@medicine-guidebook.com