Yang Xiaolin
Subject Classification Arts, Culture, Education, and Health Administration Law
Provenance China Hospital, Vol. 4, No. 4, 2007, pp. 31-34.
Abstract The identification and sharing of medical risks is a *** problem faced by clinical medicine, health administrative law, civil law and social security law. The comprehensive application of legal methods and evidence-based medical methods can distinguish disease risk, medical tort risk and medical development risk in a more objective way, so that the analysis of medical risk management and attribution of responsibility, the judicial determination of medical torts and the application of social security of medical risk are basically consistent in the identification and apportionment of risk, so as to cope with the risk by technology and system and to avoid the triggering of new risks, and to promote the further development of the comprehensive management of medical risk.
Keywords medical risk; risk identification; risk sharing; social security
Year of writing 2007
Full text
Medical risks need to be dealt with in an integrated governance manner. In governance, identification of medical risks is an important prerequisite and sharing is the key. Only on the basis of identifying risks can we objectively and fairly delineate the rights and obligations of each relevant subject, so that they bear the corresponding responsibilities, thus realizing the synergy of multiple subjects, coordination of various ways, **** with the control, prevention and sharing of medical risks.
1 The concept of medical risk
1.1 Definition of the concept of medical risk from the perspective of hospital management
(1), "diagnosis and treatment process damage," medical risk refers to the uncertainty in the entire process of diagnosis and treatment may lead to loss and disability events. And may occur all the unsafe events, such as medical malpractice, medical errors, medical accidents and complications.
(2), "medical accident damage" medical risk refers to the unintentional, unintended, unplanned medical accidents in the diagnosis and treatment of the patient's body damage, it is not the same as the diagnosis and treatment of medical negligence caused by the medical accident (medical error).
(3), "total loss" Duke University of the United States of America on the definition of medical risk is "the possibility of loss". This loss can be both the harm to the patient, but also the cost of the hospital to suffer claims, including the loss of market share of the hospital.
(4), "fault damage" in the process of medical services, the occurrence of medical errors or negligence caused by the patient's death, disability, as well as body tissue, physiological function and mental health damage and other unsafe events.
The above four concepts of medical risk are of great significance to the management of medical safety in hospitals. In order to provide comprehensive management of medical risk, it is necessary to redefine the connotation and extension of medical risk, so that clinical medicine medical risk control, medical tort civil litigation and social security to apply a unified concept of medical risk.
1.2 Definition of the concept of medical risk from the perspective of comprehensive management
The sociological theory of risk that the basic characteristics of risk is the objective potential, the size of the loss and the uncertainty of occurrence or not. There is basic agreement across fields on the connotation of the concept of risk, that the core essence of risk is uncertainty. However, different research fields have different scopes and focuses, and the definition of the conceptual extents of risk shows significant differences. The focus of defining the concept of medical risk is to clarify its extension, that is, to clarify the scope, nature and content of medical damage, and to make the necessary amendments to the connotation of risk ****ity according to the characteristics of the field.
(1), non-essential medical damage injury epidemiology of injury is defined as injury, where the transfer or interference of energy (mechanical, thermal, electrical, chemical or radiological energy, etc.) exceeds the body's tolerance, resulting in tissue damage, asphyxiation leading to oxygen deprivation and irritation caused by trauma are called injury. According to this definition, the medical damage can be defined as: the diagnosis and treatment behavior caused by the patient's physical injury, mental trauma and the corresponding property damage.
From the perspective of clinical medicine, the patient damage caused by diagnostic and treatment behavior includes two cases: one is the necessary medical damage, and the other is non-necessary medical damage. Necessary medical damage is for the diagnosis and treatment of disease necessarily occurs to the patient with limited damage, such as lumbar puncture, injection damage to the skin, subcutaneous tissue, cancer patients with radiotherapy, chemotherapy and surgical treatment damage to normal tissues and organs, etc.. Non-essential medical damage refers to the damage that does not contribute to the realization of the purpose of diagnosis and treatment, or even the opposite of the purpose of diagnosis and treatment, necessary medical damage is non-essential medical damage if it exceeds the reasonable limit.
Necessary medical damage is determined to occur, doctors and patients can clearly foresee the situation and a limited choice, and sometimes there is no choice, even if the reluctance can only be accepted, which does not belong to the category of medical risk; non-essential medical damage before the occurrence of a potential state, the damage occurs with or without damage to the size of the damage can be predicted, but can not be confirmed ....... >>
Question 2: The definition of medical risk and its characteristics Medical risk to the patient refers to the uncertainty that exists in the entire process of medical services, which may lead to damage or disability events, as well as the possibility of all the top safety things. Medical risk to the hospital is the risk of medical errors or negligence in the process of medical services resulting in unsafe events.
Characterized by: 1, risk throughout the medical process 2, the lack of proper understanding of both doctors and patients 3, systemic factors leading to risk
Question 3: the definition and characteristics of health insurance What is the definition and characteristics of health insurance Social Security health insurance is the reimbursement of medical expenses, the use of medication with the A, B and C categories, Class A is a little higher than the reimbursement rate of Class B drugs, Class C drugs are not reimbursed, completely out-of-pocket expenses.
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Question 4: What is the meaning of medical treatment? Basic medical insurance is a social insurance system established to compensate workers for the economic losses caused by the risk of illness. Through the employer and individual contributions, the establishment of a medical insurance fund, the insured person is sick after medical expenses incurred by the medical insurance agency to give a certain amount of economic compensation, in order to avoid or alleviate the workers due to illness, treatment and other economic risks. Basic medical insurance is one of the most important types of insurance in the social insurance system, which, together with basic old-age insurance, industrial injury insurance, unemployment insurance and maternity insurance, constitutes the modern social insurance system. China has now established a basic medical insurance system for urban workers, a new type of rural cooperative medical system and a basic medical insurance system for urban residents. Among them, the basic medical insurance for urban workers is based on the payment of basic medical insurance premiums by employers and workers in accordance with national regulations***, and the establishment of a medical insurance fund, whereby medical insurance agencies give certain economic compensation to insured persons who incur medical expenses in the event of illness, in order to avoid or alleviate the economic risks posed by illnesses and treatments among workers. The new rural cooperative medical care and basic medical insurance for urban residents implement a combination of individual contributions and *** subsidies, and the standard of treatment is implemented in accordance with national regulations.
Social insurance issues, you can go to the Cisco Law Firm website for more comprehensive information. On the Cisco website, there are articles on relevant laws and regulations, and the website has a one-on-one counseling service, so you can communicate directly with the lawyers online.
Question 5: Medical device risk refers to The three EU medical device directives:
The European Union to eliminate trade barriers between member states, and gradually established as a unified large market to ensure the free flow of people, services, funds and products (such as medical devices). In the field of medical devices, the European Commission has developed three EU directives to replace the original system of recognition of the various members, so that the provisions relating to the placing of such products on the market are harmonized.
These three directives are:
1. Active Implantable Medical Devices Directive (AIMD, 90/335/EEC), applies to active implantable medical devices such as pacemakers, implantable insulin pumps, etc. The AIMD entered into force on January 1, 1993, with a transitional deadline of December 1994 for the introduction of the AIMD. The transition deadline is December 31, 1994, from January 1, 1995 mandatory implementation.
2. In Vivo Diagnostic Devices Directive (IVD), applicable to blood cell counters, pregnancy testing devices and other in vitro diagnostic medical devices.
3. Medical Devices Directive (Medical Devices Directive, 93/42/EEC), the scope of application is very wide, including in addition to active implantable and in vitro diagnostic devices in addition to almost all the medical devices, such as passive medical devices (dressings, single-use products, contact lenses, blood bags, catheters, etc.); and active medical devices, such as nuclear magnetic **** vibrators, ultrasound diagnostic and therapeutic instruments, infusion pumps, etc. The Directive came into force on January 1, 1995, with a transition deadline of June 13, 1998 for enforcement from June 14, 1998 onwards.
The above directive provides that after the directive is formally implemented, only medical device products with CE marking can be sold in the EU market.
China's medical device manufacturers and exporters must comply with the above directives and affix the CE marking when selling their products to the EU market, otherwise it will be difficult for their products to enter the EU market.
Basic requirements of the Medical Devices Directive
The basic requirements described in Appendix I of the MDD include general requirements regarding design and structure. Depending on the intended use, products must fulfill the essential requirements applicable to them. This must be demonstrated by appropriate tests. If a product fulfills the essential requirements, it fulfills the requirements of the Directive. The easiest way to meet this requirement is to use the harmonized standards developed by the European Committee for Standardization (CEN) and the European Committee for Technical Standards for Electrical Appliances (CENELEC).CEN and CENELEC standards are mostly based on international standards.
EU standards are non-compulsory, as there are often other methods that can be used to demonstrate fulfillment of the essential requirements of their directives. However, the use of harmonized standards gives a great advantage to the manufacturer, as long as the manufacturer's product meets the requirements of the corresponding harmonized standard, it is also considered to meet the essential requirements. It is important to note that the so-called harmonized standards are those European standards that are published in the Official Journal of the European Union.
The main elements of the basic requirements of the MDD are summarized as follows:
General Requirements
--Must be safe;
--Must be designed and manufactured in accordance with currently recognized process technology;
- -Must perform as intended;
-Must guarantee the safety and performance of the product for the specified lifetime.
-- Must specify appropriate transportation and storage requirements;
Considering the degree of risk that the design and manufacture of a medical device may pose to the human body, medical devices can be categorized into the following four classes:
Class I Low risk
Class Class IIa Low to medium risk
Class IIb Medium risk
Class III High risk
The classification is described as follows:
Class I Low risk, defined as follows:
a. Conveying, storing, or injecting medical devices.
a. Non-invasive devices, except for the delivery, storage, or injection of blood or body fluids
b. Non-invasive devices that come into contact with injured skin for the purpose of stopping exudate
c. Invasive devices for temporary use for up to 60 minutes
d. Invasive devices for short-term use for up to 30 minutes for use in the oral cavity up to the throat and the ear canal up to the eardrum
e. Surgical appliances for reuse
e. Reusable surgical appliances
f. Invasive devices for long-term implantation in teeth
g. Active devices that do not belong to Class II
Non-sterile medical devices, e.g., examination gloves, examination latex gloves, bandages, surgical tables, surgical lamps, prostheses, wheelchairs, motorized scooters, hot/cold compresses, medical devices, etc.
Non sterilizable medical devices, such as: examination gloves, examination gloves, bandages, operating tables, operating lamps, prosthetic devices, wheelchairs, motorized scooters, hot and cold compresses, medical devices...etc.
Sterilization of therapeutic instruments, such as: surgical sterilization gloves, knives, OK bandages ... and so on.
Class IIa Low to medium risk, defined as follows:
a. Non-invasive devices for the conveyance, storage, or injection of blood or body fluids. ...... >>
Question 6: Meaning of Risk There are two broad definitions of risk: one definition emphasizes that risk manifests itself as uncertainty; while the other emphasizes that risk manifests itself as uncertainty of loss. If risk manifests itself as uncertainty, it means that risk can only manifest itself as a loss, with no possibility of profit from the risk, and is a risk in the narrow sense of the word. Whereas risk is characterized by uncertainty of loss, it means that the outcome of the risk may result in a loss, a gain or no loss or gain, which is broadly defined, and financial risk belongs to this category. Risk and return are directly proportional to each other, so generally the aggressive ones favor higher risks in order to get higher profits, while the prudent investors focus on safety considerations.
Question 7: What is the definition of the β coefficient β coefficient is used to measure the nature of the risk β coefficient is a measure of the degree of influence of the risk of a single asset to the risk of the market portfolio, the correlation coefficient is the degree of correlation of the risk of the assets in the asset portfolio
Question 8: the hospital's medical revenues and expenditures, including those Medical revenues, i.e., the hospital to carry out the health care activities of the revenue obtained, including Outpatient income and hospitalization income. 1. outpatient income refers to outpatients to provide medical services income, including registration income, consultation income, examination income, laboratory income, treatment income, surgical income, health materials income, drug income, pharmaceutical service fee income, other outpatient income, etc.. 2. Inpatient income refers to the income obtained from the provision of medical services for hospitalized patients, including bed income, consultation income, inspection income, laboratory income, treatment income, surgical income, nursing income, health materials income, drug income, pharmacy service fee income, other inpatient income.
Medical expenditures, that is, the hospital in the process of carrying out medical services and its auxiliary activities incurred in the expenditure, including personnel expenses, consumption of drugs and health materials, depreciation of fixed assets, amortization of intangibles, extraction of medical risk fund and other costs, excluding financial subsidies and scientific and educational projects income generated by the depreciation of fixed assets and amortization of intangible assets. Among them, personnel expenses include basic salary, performance salary (allowance and bonus), social security contributions and housing fund. Other expenses include office expenses, printing costs, water, electricity, postage and electricity, heating costs, base industry management fees, travel expenses, conference fees, training fees and so on.
Question 9: What do all the numbers on the instrument mean? Is the patient in this situation dangerous? Please understand the professional medical knowledge of friends, help, thank you! It's still hard to judge just by looking at the parameters of the monitor, but what I can tell you is that the first line showing green is the ECG and heart rate, the second line in blue is the pulse oximetry, the third line in yellow is the respiratory rate, and the fourth line in red is the non-invasive blood pressure.
At present, according to the data displayed on the monitor, there is tachycardia, hypoxia (low oxygen saturation and high respiratory rate are indicative of hypoxia) and high blood pressure. The specific cause depends on the patient's condition and examination. But the current oxygen saturation and respiratory rate, if not equipment error must be intervened.