他山之石－美國和澳洲執行「公開揭露」機制之經驗與啟示

A Comparative Study of the "Open Disclosure" Policy in the United States and Australia: Lessons for Taiwan

10.6288/TJPH2012-31-03-01

林東龍(Dong-Long Lin)；陳郁雯(Yu-Wen Chen)

公開揭露 ； 醫療不良事件 ； 醫療傷害 ； 由上而下 ； 由下而上 ； Open Disclosure ； Medical Adverse Event ； Medical Injury ； Top-down ； Bottom-up

台灣公共衛生雜誌

31卷3期（2012 / 06 / 01）

205 - 216

繁體中文

歐美先進國家陸續採行公開揭露機制，以公開、分析，以及學習的態度處理醫療不良事件，期待降低醫療訴訟成本和不良事件再發生的可能性。美國是最早實施公開揭露機制的國家，澳洲則在整體政策發展的最為完整。因此，本文希望藉由耙梳美澳兩國公開揭露制度的發展歷史與現況，思索該制度對台灣建構醫療不良事件處理機制的啟發。從美澳兩國經驗來看，本文建議有二：第一，衛生主管機關應規劃執行大型醫療不良事件流行病學研究，促使醫療體系正視醫療傷害問題；第二，結合多元的社會行動者建立配套的社會立法和推動教育宣導，使台灣朝公開揭露醫療不良事件的目標邁進。

In Europe and North America, a few developed countries have gradually implemented an ”open disclosure” mechanism characterized by openness, analysis, and learning in dealing with adverse medical events, so that the cost of medical litigation and the reoccurrence rate of adverse medical events can be decreased. The United States was the earliest country to implement an open disclosure mechanism, while Australia has developed the most comprehensive policy. This paper reviewed the histories and current status of the open disclosure mechanism in the United States and Australia to derive implications for constructing a disclosure mechanism for adverse medical events in Taiwan. Two suggestions were made after a review of the two countries' experiences. First, the dominant Department of Health should plan and conduct large-scale epidemiologic research on adverse medical events to force the medical system to face the issue of medical injury seriously. Second, social action supporters in various areas should be mobilized to propose comprehensive social legislation, promote education, and advocate for Taiwan to move toward the goal of dealing with adverse medical events with open disclosure.

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