[현재위치]: 홈> 오스트레일리아
오스트레일리아 Australia
- "현재 호주의 의료사고에 기인한 손해배상체계는 민사소송에 의한 과실책임주의를 바탕으로 환자가 의사의 과실을 입증해야 하는 민사법체계로 되어 있으며, 상호공제기금(mutual fund)의 성격을 가진 임의가입형 의사손해배상보험에 의하여 의료피해의 배상이 이루어지고 있다. 이를 근간으로 의료분쟁을 비롯한 의료의 제반문제에 대해 시민들이 해결을 호소하고 제도적 장치의 강구를 촉구할 수 있는 독립적인 행정기관인 소비자보호단과 같은 기구가 이를 뒷받침하고 있으나, 현행 제도에서 의료사고를 당한 환자의 입장에서는 쟁송비용, 사안의 복잡성, 쟁송의 지연, 과실입증의 어려움 등의 이유로 환자측의 부담이 높은 실정이며, 이미 1978년 Person 보고서에서는 과실주의에 입각한 사법심사제도를 통한 배상은 의료사고의 피해에 대한 정확한 배상을 하기에 불가능한 방법이라고 밝히고 있어, 현행 사법체계를 통한 의료사고 피해의 구제방식은 환자나 의료진 모두에게 제한된 해결책일수 밖에 없다는 인식이 공유되어 가고 있다. 이러한 체계를 바탕으로 현재 호주에서는 사회보험적 관점에서 좀 더 폭넓은 보장을 위해 무과실로의 전환이 모색되고 배상보험에의 강제가입이 이에 함께 논의되고 있다.
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무과실보장체계로의 개혁은 호주의 의료피해구제제도를 민사적 분쟁에서 사회보장적 차원으로 한 걸음 끌어올리는 전진을 의미한다.
의사를 대상으로 하는 전문직 손해배상보험 및 의료분쟁의 처리방식에 대한 쟁점은 대단히 복잡한 문제로서 의료전문가 뿐만 아니라
의료사고로 인해 고통받는 환자들, 그리고 일반 지역사회 주민 모두의 첨예한 관심대상이 되고 있는데, New South
Wale주 보건성 소비자보호단의 위윈회가 간행한 개혁보고서를 중심으로 개혁의 쟁점을 보면 다음과 같다.
- 첫째는, 의료분쟁소송을 법정에서 제거하고 별도의 의료분쟁재판소에서 다루자고 제안, 비공식적이고 덜 복잡하여 사적인 해결로서 공평한 결과를 가져올 수 있기 때문에 피해가 적은 소액사건의 경우 적합한 접근방법이 될 수 있다. 그러나 결정의 적절성이 심사에 참가하는 전문가에게 달려있다는 점에서 자의적 결정의 위험성이 있고 의료분쟁의 해결에 또 하나의 단계를 만듦으로써 해결지연과 높은 비용을 경감하려는 노력을 무위로 만드는 일이 될지 모른다는 우려가 있다.
- 둘째는 무과실 보상제도(No fault compensation scheme)로 1974년 국가보상법이 입안되면서 외과적, 의료적 합병증과 사고에 대한 보상을 명시하면서부터 무과실 보상제도의 개념이 고려되기 시작했다. 그러나 보상범위 및 기준을 정하는 어려움, 비사법적 조직에 의해 과실유무 결정문제, 의료인의 명성을 방어할 기회박탈 및 상대적으로 사고가 일어나게 된 진료 및 관리과정에 대한 주의를 소홀하기 쉬운 난점들이 검토되었다.
- 셋째, 강제보험제도를 도입하여 기존의 의료방어동맹(Medical Defence Union)과 같은 전문직 손해배상보험
또는 새로운 단일보험자를 조직하여 의료인을 강제 가입하게 하자는 방안에 대해 검토가 활발히 이루어지고 있다. 그러나
현업의료인의 참여, 충분한 보상범위, 의료인의 책임성을 일깨우는 등의 장점이 있으나, 모든 손해에 대해 손해배상을 구하려는
경향을 초래할 수 있으며 의료인이 의료사고위험이 완전히 담보된다
면 재능발휘가 감퇴될지도 모른다는 단점의 이유로 인하여 이 문제는 보상을 무과실로 하는냐 유과실로 하느냐에 따라 달라질 것으로 본다."
- 金美植. 의료분쟁의 합리적 해결방안에 관한 연구/ , 中央大學校 行政大學院 석사학위논문 [2000]
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Adverse events in surgical patients in Australia.
- Kable AK, Gibberd RW, Spigelman AD.
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Int J Qual Health Care. 2002 Aug;14(4):269-76.
- Centre for Clinical Epidemiology and Biostatistics, School of Medical Practice, Faculty of Health, University of Newcastle, Newcastle, New South Wales, Australia.
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OBJECTIVE
- To determine the adverse event (AE) rate for surgical patients in Australia.
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DESIGN
- A two-stage retrospective medical record review was conducted to determine the occurrence of AEs in hospital admissions. Medical records were screened for 18 criteria and positive records were reviewed by two medical officers using a structured questionnaire.
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SETTING
- Admissions in 1992 to 28 randomly selected hospitals in Australia.
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STUDY PARTICIPANTS
- Five hundred and twenty eligible admissions were randomly selected from in-patient database in each hospital. A total of 14,179 medical records were reviewed, with 8747 medical and 5432 surgical admissions.
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MAIN OUTCOME MEASURES
- Measures included the rate of AEs in surgical and medical admissions, the proportion resulting in permanent disability and death, the proportion determined to be highly preventable, and the identification of risk factors associated with AEs.
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RESULTS
- The AE rate for surgical admissions was 21.9%. Disability that was resolved within 12 months occurred in 83%, 13% had permanent disability, and 4% resulted in death. Reviewers found that 48% of AEs were highly preventable. The risk of an AE depended on the procedure and increased with age and length of stay.
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CONCLUSION
- The high AE rate for surgical procedures supports the need for monitoring and intervention strategies. The 18 screening criteria provide a tool to identify admissions with a greater risk of a surgical AE. Risk factors for an AE were age and procedure, and these should be assessed prior to surgery. Prophylactic interventions for infection and deep vein thrombosis could reduce the occurrence of AEs in hospitals.
- http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=12201185&query_hl=22&itool=pubmed_docsum
- http://intqhc.oxfordjournals.org/cgi/reprint/14/4/269
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A comparison of iatrogenic injury studies in Australia and the USA. I: Context, methods, casemix, population, patient and hospital characteristics.
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Thomas EJ, Studdert DM, Runciman WB, Webb RK, Sexton EJ, Wilson RM, Gibberd RW, Harrison BT, Brennan TA.
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Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. eric.thomas@uth.tmc.edu
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OBJECTIVE
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To better understand the differences between two iatrogenic injury studies of hospitalized patients in 1992 which used ostensibly similar methods and similar sample sizes, but had quite different findings. The Quality in Australian Health Care Study (QAHCS) reported that 16.6% of admissions were associated with adverse events (AE), whereas the Utah, Colorado Study (UTCOS) reported a rate of 2.9%.
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SETTING
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Hospitalized patients in Australia and the USA.
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DESIGN
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Investigators from both studies compared methods and characteristics and identified differences. QAHCS data were then analysed using UTCOS methods.
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MAIN OUTCOME MEASURES
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Differences between the studies and the comparative AE rates when these had been accounted for.
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RESULTS
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Both studies used a two-stage chart review process (screening nurse review followed by confirmatory physician review) to detect AEs; five important methodological differences were found: (i) QAHCS nurse reviewers referred records that documented any link to a previous admission, whereas UTCOS imposed age-related time constraints; (ii) QAHCS used a lower confidence threshold for defining medical causation; (iii) QAHCS used two physician reviewers, whereas UTCOS used one; (iv) QAHCS counted all AEs associated with an index admission whereas UTCOS counted only those determining the annual incidence; and (v) QAHCS included some types of events not included in UTCOS. When the QAHCS data were analysed using UTCOS methods, the comparative rates became 10.6% and 3.2%, respectively. CONCLUSIONS: Five methodological differences accounted for some of the discrepancy between the two studies. Two explanations for the remaining three-fold disparity are that quality of care was worse in Australia and that medical record content and/or reviewer behaviour was different.
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A comparison of iatrogenic injury studies in Australia and the USA. II: Reviewer behaviour and quality of care.
- Runciman WB, Webb RK, Helps SC, Thomas EJ, Sexton EJ, Studdert DM, Brennan TA.
- Department of Anaesthesia and Intensive Care, University of Adelaide, Australia. wrunciman@bigpond.com
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OBJECTIVE
- To better understand the remaining three-fold disparity between adverse event (AE) rates in the Quality in Australia Health Care Study (QAHCS) and the Utah-Colorado Study (UTCOS) after methodological differences had been accounted for.
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SETTING
- Iatrogenic injury in hospitalized patients in Australia and America.
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DESIGN
- Using a previously developed classification, all AEs were assigned to 98 exclusive descriptive categories and the relative rates compared between studies; they were also compared with respect to severity and death.
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MAIN OUTCOME MEASURES
- The distribution of AEs amongst the descriptive and outcome categories.
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RESULTS
- For 38 categories, representing 67% of UTCOS and 28% of QAHCS AEs, there were no statistically significant differences. For 33, representing 31% and 69% respectively, there was seven times more AEs in QAHCS than in UTCOS. Rates for major disability and death were very similar (1.7% and 0.3% of admissions for both studies) but the minor disability rate was six times greater in QAHCS (8.4% versus 1.3%). CONCLUSIONS: A similar 2% core of serious AEs was found in both studies, but for the remaining categories six to seven times more AEs were reported in QAHCS than in UTCOS. We hypothesize that this disparity is due to different thresholds for admission and discharge and to a greater degree of under-reporting of certain types of problems as AEs by UTCOS than QAHCS reviewers. The biases identified were consistent with, and appropriate for, the quite different aims of each study. No definitive difference in quality of care was identified by these analyses or a literature review.
- http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=11079217&query_hl=10&itool=pubmed_DocSum
참고 문헌 및 웹사이트
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Weingart, S. N, Wilson, R. M., Gibberd, R. W, Harrison, B. (2000). Epidemiology of medical error. BMJ 320: 774-777
[Full Text] - 金美植. 의료분쟁의 합리적 해결방안에 관한 연구/ , 中央大學校 行政大學院 석사학위논문 [2000]
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http://www.nla.gov.au/ - National Library of Australia
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http://www.austlii.edu.au/ - Australian legal information institute
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