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The SOE reform in China/周大勇

作者:法律资料网 时间:2024-07-21 23:03:28  浏览:9142   来源:法律资料网
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The SOE reform in China
Zhou Dayong
Summer semester 2003
Europa-University Viadrina,Germany

Abstract:
The essay tries to study the process of the state-owned enterprise (SOE) reform in China. Chinese economic reform resulted in significant influences on all social aspects, SOEs as an especially economic sector suffers a change both in internal management as well in the outside economic environment. I try to discuss in the essay, that the Chinese SOE reform has made large progress, however, SOE can’t conquer many problems by itself, the resolution of SOE lies in elimination of SOE by a further reform including property transition and construction of a fairer market.


Outline
1. History of the SOE reform in China
2. The main problems left in the reform
3. The reasons of SOE problem behind
4. Argue of some reform plans and suggestion
5. Conclusion


1. The history of the SOEs reform in China
1.1 the establishment of SOE
In 1949, the Chinese Communist Party (CCP) came into power in Mainland China. One goal of the CCP was to lead China into a modern socialism society. In economic scale, it meant mainly industrialization. According to CCP’s policy, the form of industrial organization must be based upon state owned enterprises. The state-owned industrial system was set up by two ways. One was the new enterprise after the liberation. At the end WWII, most industrial sectors in China, such as communication network, transportation and power industry were destroyed and had to be rebuilt, at the same time, military industries and financial sector e.g. banking system was directly nationalized from the former control of Gongmin Party. Another way was transformation from the private ownership to state-owned enterprises. The private properties were regulated under state management, in some cases, for instance in commercial scale, the former private enterprises were bought by local government gradually. Till 1952, about 83% of industrial companies were controlled by the state; a socialism economic system was announced established. (Fig 1)
1.2 The reform began from 1978
Until Chinese economic reform began in 1978, public ownership in forms of state-owned and collectivized were only legal ownership of property. In industrial sector, the enterprises were controlled respectively under central or local governments, the latter made decisions for the enterprises, the enterprises were not profit seeking economic entities, they were simply workshops to execute centrally set policies.
In 1970s, the discontent of economic situation accumulated constantly, because the defects of central planning system became obviously more and more. Around 1978, the rural reform took place from grass roots and spread quickly, till 1982, the collectivized people commune had to be abolished. In company with the reform, the free market in a certain degree was developed. At the same time, the problem of lack of autonomy in SOE, which led to low efficiency, was also taken into account. Therefore, from 1978 on, the Communist Party, under the leading of Deng Xiaoping, put hand to solve the SOE problem. From 1978 to 1984, the efforts of the reform concentrated on giving the SOEs more autonomy by allowing them increased authority over the allocation of their profits, and limited production autonomy. The rest profits could be used either to finance increased investments or to pay bonuses to employees. Besides, administrative control over SOEs was decentralized to local governments. But as the prices were still centrally determined and SOEs did not realize the cost of their fixed and working capital, the reforms did not improve much the resource allocation or the utilization of capital. (1)

1.3 Contract is the main form in the second phase.
From 1985 to 1992 was the second phase of the SOE reform. The policy named Zhenqi Fenkai (separating government from enterprises), the central government decided to turn SOEs into truly independent production and management entities, and stipulate that enterprises must take responsibilities for their own profits and losses by means of contracts and leasing. The common practice was: the enterprises sign a manage contract with the responsible authorities. Under the contract, enterprises were not only allowed to retain the extra profits after they had fulfilled the contracted quotas, but also allowed to arrange their own manage including dismiss or enroll personnel. By the end of 1987, about 80% of state-owned industrial enterprises adopted the contracts system. In 1991, over 90% of the previously contracted enterprises signed the second round of contracts. Meanwhile, based on the first round contract practice, the content of the contract was improved; the authority introduced more rational norms to examine the fulfillment of contract. A multiple index system was formed, which included economic efficiency index, development potentiality index and management index etc.
During this period, the practice of shareholding reform appeared as well. This new creature was adopted at first by village enterprises, which come from the former collective enterprises. The village enterprises were always short of capital, so they raised money from the village residents. Along with the reform moved forward from countryside to cities, the shareholding system was also introduced into SOE reform. Early in April 1984 Chinese reform committee organized a seminar to discuss the exploitation of shareholding in SOE reform. That conference drew a conclusion that shareholding system is a rational way to restructure the collective and state owned enterprises in cities. In July the same year, the first shareholding company after Chinese liberation—Beijing Tianqiao department store (shareholding) came onto horizon. Till 1991, there were already 709 state owned enterprises restructured along shareholding system. These enterprises included industrial sector companies, trade companies, also financial enterprises, construction enterprises etc.
Besides, in the second phase of SOE reform, tax system had also a great change. Instead of handing in profit, SOEs paid a certain portion of tax according to their revenue level. The State and local government collected tax separately; this measure was implemented to loose the relation between SOE and local authority.
However, during this period, the SOEs showed their weakness in competition with the new developed private companies, joint venture companies and township and village enterprises, because at one side, the manager of SOEs didn’t get use to do business in a free market, the attitude of waiting, relying on government and begging for help were widespread. At another side, the relationship between government and enterprises became more complicated, because, although under the contract system, the government have no right to interfere in the SOEs management, they still rely on each other: the government need the SOE to have good performance in order to settle surplus labor forces and continue to play a role in maintain the social stability, at the same time, to increase the government’s revenue to deal with the raising infrastructure investment and other expense. The SOE, on the other side, need the protection of the authority, in order to obtain more chance to get loans, subsidizes or orders in government arranged projects. Besides, even though most of direct subsidies form the state have been cancelled, many domestic savings were also channeled into SOEs, because banks had been directed to take up the role of making "loans" to SOEs instead of the state. The total of non-performing loans has grown so large that it started to endanger the banking system. (2)

1.4 The MES is the key point in the third phase of the reform and the achievements
Form 1993 on, the reform moved into the third phase, the aim called setting up the modern enterprises system (MES). The Third Plenary Session of the 14th Party Central Committee in November 1993 proposed: "It is the inevitable request for market economy to set up modern enterprise system, it is a direction of the SOE reform of China. "This indicates that SOE reform enters a new stage of system innovation. In 1994 the State Council determined to chose 100 state-run large and medium-sized enterprises to launch an experiment to implement restructure along MES. The basic demands of the experiment were to "define right and responsibility clearly, separate government function from enterprise management, and operate scientifically”. Those requirements were in fact the basic characters concerning modern enterprises system. Along the policy of building MES system, and based upon the development of the whole economy, there were many achievements reached in the third phase.
1) By 2000, most large and middle scale SOEs have set up modern enterprise system tentatively. According to the investigation in 2473 enterprises of State Statistics Bureau 2000, 2016 enterprises have restructured, account 81.5%. Among those enterprises, 603 turned to Co., Ltd., accounts for 29.9%; 713 were restructured to limited companies, accounts for 35.4%; the number of solely state-owned company is 700, accounts for 34.7%. As for their management, 82.2% established shareholders’ meeting, 95.1% established the board of directors, and the board of supervisors has been established in 84.5% of enterprises. Therefore, corporate governance structure has already taken shape in SOEs.
2) In this phase, during" the Ninth Five-Year Plan", China began to adjust the state-run economic layout strategically, The idea called Zhuada Fangxiao (to grab the big ones and let the small ones go). The reform for medium and large SOEs focused on fostering a batch of trans-regional, inter-trade, inter-ownership big SOE groups through reorganizing, transforming, uniting annex. In 1997, the number of national large-scale enterprise groups expands to 120. For instance, under approval by the State Council, China Petrochemical Corporation, China Oil and Natural Gas Corporation were predominated to two large groups, whose assets of enterprise group reached in 40 billion dollars, such measure improved the intensification degree and international competitiveness of Chinese petrochemical industry greatly. Another example was in telecommunication market, six major SOE telecom groups (China Telecom, China Mobile, China Unicom, China satellite communication, China railway communication) were predominated. So a new form of competition in field of communication service took shape.
By the end of 2001, national key enterprises add up to 2710, total assets up to 1,280,450 million dollar. Among 179 super-huge enterprise groups, whose business income is over 500 million dollar, there are 165 state-owned or state-holding enterprise groups.
3) During this phase, separating government function from enterprise management was strengthened harder than before. Chinese government started administrative organization structure reform in 1998. Through this administrative restructure, the departments of the State Council reduced from 40 to 29. At provincial level, government departments reduced from 55 on average to 40, about 20% departments were simply. Some departments were cancelled totally. The cancellation of government departments indicated that the SOE stay in the charge of specialized official department manages changed completely. Meanwhile, the administration rank of the state-owned enterprise were cancelled, some administrative approval procedure were simplified.
4) To relieve the social burden of SOEs, re-employment service center were set up to shunt the redundant staff of enterprises. It has been a great difficult problem of the SOE reform from begin on that enterprises are overstaffed. It is an important measure of revitalizing the SOEs to dismiss and distribute workers. In June 1998, the state council required all regions to set up re-employment service center system. National Ministry of Labor and Social Security emphasized that the laid-off worker in SOEs must 100% enter the re-employment service center. The re-employment service center determined to provide serve functions such as grant basic living cost, withhold social insurance, organize job training and launch employment etc. for laid-off worker. The fund, which used for ensuring laid-off worker's basic life and paying the social insurance premium, come from financial budget, enterprise as well as societies (namely form contribution or from laid-off worker themselves), each part bears 1/3 of the whole fund. The re-employment service center provides service for laid-off workers for at longest 3 years. When they can’t reemploy after this period, can still enjoy unemployment compensation or the society relieve according to relevant regulation.
In this reform stage, re-employment service center played a positive role on maintain social stability. From 1998 to the end of 2001, 25,500,000 laid-off workers emerged (Fig 3) in national state-owned enterprises, among them more than 17 million people were reemployed, more than 3 million people retired. However, re-employment service center was only a transitional institute, because the SOE had to still take responsibility to settle down those laid off workers. According to a new policy, all laid-off workers after 2001 are treat as unemployed and have to enter free labor force market.
5) In order to extricate SOE from predicament, especially to resolve the problem of high liability-asset ratio, by December 2000, 580 SOEs began to implement debt-to-share swap, that mean the enterprises’ debt were recalculated as share (enterprises’ equity), so that the interest burden of SOEs were lightened. In the process, most of unperformed loans would be calculated as shares, which would be gathered and supervised by a new state commission-- State-owned Assets Supervision and Administration Commission (SASAC). Till 2001, the total amount of money of debt-to-equity swap account 40,5 billion dollars, and the result was that the average asset-liability ratio of debt-to-share swapped enterprises dropped from more than 70% to under 50%.

2. The main problems left in the reform
After three steps reform, the SOE acquired more autonomy, as we have seen, the whole economic circumstance were also better. But because the reform did not touch the socialism idea from begin on, thus the transition of ownership of SOE was left basically unchanged, the defects of SOE could not changed completely. In the context of China’s economic reforms, there are still a few problems in SOE sector existed and have also a deep influence.
First of all, the interventions from the government still maintained influence in SOE. The administrative relation between enterprise and government is still remaining. Even the Local State Assets management office was established, it belong to the same bureaucratic system like former authorities. It can appoint or remove senior executives of SOEs. If enterprise applies to the broad structure, the directors in broad are appointed by it. The office has also a say in the transfer of holdings, corporate mergers, closures or other major changes to the enterprises, it is also charged with the tasks of clarifying property rights and settling disputes (3) . It seemed that the state assets supervisory takes the place of former authority above the SOEs. Moreover, the local government maintains still strong power in local enterprise, they rely on each other as we discussed above. So long as the enterprises are state-owned, whether they are big groups, stock companies or little entities, it is difficult to shaking off the directly or indirectly control from the government.
Secondly, because of the long tradition, enterprises are still taking responsibilities for their employees in pension, medical areas, therefore the so-called “soft budget constraint” cannot be given up completely. Although we have discussed that the Chinese government has managed to start re-employment plan, SOEs also take a part of the fund to support the plan. Correspondenly, government had to shoulder some failures resulted from the mismanagement of SOEs’ and avoid from their bankruptcy, in order to prevent the enterprise from bankrupcy and thus endanger the social stability.
Thirdly, the management of SOEs has low quality compare with other economic sectors. Though SOEs have produced an average 10% growth rate in the value of industrial output during the period 1978-98, this rate is considerably below the average of other sectors. The problem has two reasons. One of them is lacking of the inner incentive of the managers. The SOE managers are not entrepreneurs in the true sense, but bureaucrats at any rate. Their appointment by the government not basically according to their managerial capability, but based on their rankings in the bureaucratic hierarchy through the politic system. Another factor concerns the supervision within the SOE, it is also lacking in most cases. In practice, the position of supervisor in a enterprise is normally taken by staff within the enterprise and in most cases, the position of president of the supervision committee is taken by somebody within the enterprise, who is under the leadership of the directors and managers in his ranks both at work and in the Party. This system makes it very hard for the supervision committee to fully perform its authority (4) .
Fourth, the high liability-asset ratio is also regarded as a fatal problem of SOEs. It was observed, that during the reform period, the liability-asset ratio of industrial SOEs rose from around 11% in 1978 to approximately 65% in 1997. In as many as one-fourth of industrial SOEs, liabilities have even come to exceed assets; these enterprises are in fact insolvent. The World Bank suggests that in debt restructuring may be necessary for the most heavily indebted enterprises to bankrupt. After the implement of debt-to-share swap, the ratio decreased, but the debtor, in most cases are banks, didn’t collect the loan back, so it made the SOE even harder to get new loan for production. (5)
Furthermore, the whole process of the SOE reform companied by a serials of social problems, in compare to some difficulties such as lack or reserve labor force, ageing of the equipments, the most troublesome is the unemployment in large scales. In addition, in rural areas, millions of flowing population has been produced because of the bankruptcy and low profitability of the township and village enterprise. In urban China there are frequent reports about workers’ unrest. Although until now China still maintain a relative political stability, the menace will not fade away in a short time.

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目前医疗纠纷的法律误区与思考

东南大学法律系 欧运祥


当前,我国的医疗纠纷逐年呈上升趋势,根据2000中国消费者协会的统计,医疗纠纷已成为消费者投诉的第一位问题。一方面,医院对日益增加的医疗纠纷不堪重负,另一方面,患者对于目前的医疗纠纷解决颇有怨言。相对于日益增加的医疗纠纷,当前的医疗纠纷的解决机制明显滞后,这在很大程度上是因为在法律上仍然存在一些误区。笔者结合多年从事医事法律教学实践和医疗纠纷诉讼的实务经验,拟对医疗纠纷理论和实践中存在的问题进行阐述。
笔者认为,目前对于医疗纠纷主要存在以下几个方面的误区:

一、关于医患关系的法律属性
医患双方在提供和接受医疗服务的过程中到底是一种什么性质的法律关系?这个问题在理论上一直存在争论。以中国社科院法学研究所梁慧星为代表的民法学家从医患双方的地位、权利、义务出发进行分析,认为医患关系应该是民事法律关系[1]。而众多卫生法学界人士对于医患关系的法律性质提出不同的观点,认为“在医患关系中,由于患者对于医学知识的缺乏,治疗方案完全由医生单方面制定和实施,患者仅仅是处于被动接受的地位…”,因而“完全不符合民法的平等。自愿原则。”。因此,双方的法律地位并不平等,医患关系不是民事法律关系,医患关系不应受民法调整,而应由《医疗事故处理办法》为代表的卫生法来调整[2]。甚至有的司法工作人员也认为“医事法律行为与民事法律行为有本质的不同,应当按特殊的卫生部门法来调整”[3]
医患关系的法律属性直接决定了医疗纠纷的归责和赔偿原则,也决定了医疗纠纷的处理模式,因此,对于医事法律而言,医患关系的法律属性是一个重大的原则问题。
医患关系中,医患双方就医学知识的掌握而言肯定是不平等的,但是否知识和技术上的不平等就必然带来法律地位上的不平等呢?答案自然是否定的。可以说在民事法律关系中,当事人在知识和技术上的不对等性乃是一种常态,但是不能因此而认为当事人在法律地位上是不平等的。如果当事人一方利用自己在知识和技术上的优越地位而主张其在法律地位上的优越性,是法律所不容许的。正是由于医生掌握了医疗技术,构成了患者给付金钱购买医疗服务的基础,双方在此过程中,医务人员掌握了医疗技术,为患者提供医疗服务,患者给付一定的金钱购买这种服务,双方是一种典型的医疗服务合同关系。虽然在治疗过程中,患者相对处于被动接受的地位,但并不能因此而否认双方法律地位的平等性。医生在制定和实施医疗方案时,一般情况下要向患者进行说明,遵守国家的法律法规和操作常规,并且须对患者尽到谨慎合理的注意义务,医生的行为并不是随心所欲的,必须为患者的利益尽到最大的善,否则就要承担相应的法律责任。对于手术、特殊检查和特殊治疗时,尚需征得患者或家属的签字同意方可实施。在目前医疗体制改革的形势下,很多医院推出了患者选医生的制度,患者在医院、医生和医疗方案的选择方面享有越来越多的自主权。
在我国,医事法律关系仍未成为一个独立的法律部门,其法律关系分属不同的部门法来调整,如卫生行政法律关系归属行政法调整,医患关系由于主体之间法律地位的平等性,难以纳入行政法的体系。从上述分析可知,医患双方在医疗服务合同的订立、履行和终止上,完全体现了民法的平等和自愿原则,符合民事法律关系的基本特征,因此应该纳入到民法的调整体系。在国外,医患关系基本都是归属民法调整,有的国家从保护患者的利益考虑,在法律上进一步明确患者的消费者地位,如在美国,患者作为消费者早已成为现实。

二、关于医疗事故鉴定的法律效力
医疗事故鉴定的法律效力问题,历来是一个影响医疗纠纷诉讼的关键问题。目前仍有相当多的人认为医疗事故鉴定结论是处理医疗纠纷的唯一依据,认为“医疗行为经医疗事故鉴定委员会鉴定后认为确实构成了医疗事故的,才可以要求赔偿”。[3]这个观点在卫生界有相当的代表性。
医疗事故技术鉴定,按其法律属性而言,是医疗技术事故鉴定委员会对医疗部门在医疗行为中是否存在重大过失的一种结论,是医疗行政部门对医疗单位进行行政处罚的主要依据,但并不是法院审理医疗纠纷案件的唯一依据。这一点,最高人民法院付院长李国光在《突破民事审判新难点》讲话中对此作过专门阐述:“是否构成医疗事故,不是认定医疗过失损害赔偿责任的必要条件”,“医疗事故鉴定结论只是人民法院审查认定案件事实的证据,是否作为确定医疗单位承担赔偿责任的依据,应当经过法庭质证”。[4]
之所以有人认为医疗事故鉴定结论是处理医疗纠纷的唯一依据,其根本原因乃是将医疗侵权简单等同于医疗事故,认为如果医疗纠纷未被鉴定为医疗事故,则同样不构成医疗侵权,完全混淆两者的界限,实际上两者在法律上存在重大区别。
按照1987年6月月9日国务院《医疗事故处理办法》(以下简称‘办法’)的规定,医疗事故是指医务人员在诊疗、护理过程中,由于医务人员的责任和技术上的原因,造成患者死亡、残废、组织器官的损伤、功能的障碍等严重不良后果的行为。按其发生的原因,又可区分为医疗责任事故和医疗技术事故。按该“办法”第六章的规定,医疗事故的等级按其造成后果的严重程度相应地分为三级:
一级医疗事故:造成病员死亡的。
二级医疗事故:造成病员严重残废或者严重功能障碍的。
三级医疗事故:造成病员残废或者功能障碍的。
从上述办法的规定不难看出,构成医疗事故的,必须是医务人员在客观上造成患者死亡、残废或功能障碍(一般而言是永久性的障碍)的严重侵权后果,同时在主观上存在重大过失方可能构成,否则属于医疗差错或医疗意外,不属于医疗事故的范围。因此,只有构成严重的医疗侵权时才可能构成医疗事故,而一般性的侵权行为被排除在“办法”之外。
国务院之所以仅仅将严重的医疗侵权行为定义为医疗事故,主要是因为医疗事故鉴定的目的所决定的。医疗事故鉴定系卫生行政部门认定和处理医疗事故的依据,构成医疗事故的,医疗行政部门依法要对医疗部门及相关责任人员进行行政处罚,包括医院的降级,直接责任人的降职、记过、开除等。构成犯罪的,要移送司法机关追究其刑事责任。因此医疗事故鉴定主要是医务人员承担行政责任乃至刑事责任的法律依据,不构成医疗事故,则医务人员免除行政责任和刑事责任。因此,从性质上而言,“办法”属于行政法的范畴,至于除医疗事故以外的医疗差错和一般侵权行为,因其不涉及责任人的行政责任,因此不在“办法”调整之内。
医疗侵权行为从性质上而言属于民事侵权行为的一种,按照民事侵权行为的概念:“不法侵害他人非合同权利或者受法律保护的利益,因而行为人须就所生损害负担责任的行为”。[5]医疗侵权行为,是指医务人员在治疗、护理过程中侵害了患者的非合同权利或者受法律所保护的利益的不法行为,不仅包括医疗事故,还包括因诊疗、护理过失使患者病情加重,受到死亡、残废、功能障碍以外的一般损伤及痛苦的医疗差错,以及既不属于医疗事故和医疗差错的一般侵权行为。因此,医疗侵权的内涵和外延均大于医疗事故,两者是包容与被包容的关系。
也许有人会有疑问,医疗纠纷既然不是医疗事故和医疗差错,怎么可能构成医疗侵权呢?这是因为患者权益的范围相当广泛,不仅包括生命权和健康权,而且还包括财产权、知情权、隐私权等一系列权益,而《医疗事故处理办法》并未将后者涵盖在内,所以医疗侵权的范围是也是相当广泛的。只要是医务人员侵犯了患者受法律保护的权利或利益,造成损害后果的,在具备主观过错和因果关系时,便可能构成医疗侵权。例如,精神病医院在对精神患者进行电休克治疗前,按卫生部的《医疗机构管理条例》第三十一第规定,应在术前向患者家属进行解释,征得其家属签字同意后才可实施。如果医院未征求患者家属同意,擅自对患者施行电休克治疗,患者因并发症而造成死亡。尽管医院在诊疗、护理中并无其他过失,电休克的操作完全符合医疗常规,患者出现并发症时抢救措施正确及时,但因为医院未在治疗前对患者家属说明并征得其签字同意,侵犯了患者及其家属对于病症的知情权,同时造成了患者死亡的损害后果,因此构成了医疗侵权,应对患者家属承担赔偿责任。再比如某性病患者到某医院就诊,诊治医生未注意遵守保密义务,擅自将患者的病情向外界散播,侵犯了患者的隐私权。或者医务人员在诊疗护理过程中由于过失造成患者治疗费用增加,或治疗时间的延长,造成患者精神痛苦和财产损失的,就可能要承担精神损害赔偿和财产赔偿责任。上述例子中,医疗单位的行为按照“办法”的规定均没有构成医疗事故,但按照民法有关侵权的法律规定,都构成了医疗侵权,应对患者及其家属承担赔偿责任。
综上所述,医疗侵权和医疗事故在法律上完全是两个不同的法律概念,两者各有不同的构成要件,一起医疗纠纷未被鉴定为医疗事故,不等于不属于医疗侵权,医疗侵权的构成应该完全按照民事侵权的要件来比照,只要是具备侵权的要件,即使不是医疗事故,医疗单位同样须承担赔偿责任。因此,医疗事故鉴定结论不是医疗纠纷诉讼中的唯一证据。

三、关于目前医疗纠纷现状的几点思考
医事法律的研究在我国起步较晚,在认识上存在一些误区和争论是必然的,但值得我们警惕的是上述两个误区对有些人而言并非完全是认识上的错误,而是为了维护医疗单位的不正当的部门利益。
部分卫生界人士之所以坚持医患关系不属于民法调整,主要是因为民法关于侵权的赔偿范围和数额都远远高于《医疗事故处理办法》的规定。《医疗事故处理办法》没有对医疗事故的补偿标准做出规定,各地制订的补偿标准从1000元到8000元不等,但总体上维持在3000元到4000元左右。例如按照《江苏省医疗事故处理办法》的规定,一级医疗事故(造成患者死亡)的补偿标准仅为3000元。而如果按照民事侵权的赔偿标准,医院须赔偿患者及其家属的所有直接、间接财产损失以及精神损失费,赔偿数额动辄上万元甚至数十万元。医患关系若不归属民事法律关系,则医疗纠纷自然就可免受民法调整,医疗部门就可以大大降低开支了。
由于我国医疗事故鉴定体制上的缺陷,医疗技术事故鉴定委员会的成员都是由当地医院的医生组成,这样就不可避免地使他们在进行技术鉴定时产生偏袒心理,相当一部分原本属于医疗事故甚至是一级医疗事故的医疗纠纷被鉴定为医疗差错或医疗意外(按照《医疗事故处理办法》的规定,这两种情况均属于医疗部门的免责事项),如果确立医疗事故鉴定结论在医疗纠纷中的唯一证据性,则不构成医疗事故自然就不构成医疗侵权,从而使得患者及其家属在随后的索赔中处于极为不利的地位,医疗部门同样可以降低赔偿的数额了。
以上两种错误观点,从短期上看,医院似乎可以降低赔付数额,而将更多精力投入到医疗服务的改善和提高上,但从长远来看,并不利于医疗事业的发展和我国法制社会的建设。
1、不利于规范医院的服务。虽然我国对于医院进行了一系列的改革,特别是在去年在全国各地开展患者选医生的活动,旨在提高医院的服务质量,但是这还是不能从根本上解决目前医院存在的医务人员的服务质量低下问题。要从根本上解决这个问题,只有理顺医患关系的法律属性,提高患者在医疗服务中的自主权,健全医疗侵权的赔偿制度,真正做到权利和义务的统一,使那些不负责任的医院和医务人员承担起相应的赔偿责任,只有这样,才能提高他们的责任心。否则,对于医疗侵权行为没有有效的制裁机制,难以彻底改变目前医疗部门的服务问题。
2、对国家的法制建设和医院的正常工作造成负面影响。由于医疗技术事故鉴定程序上的暗箱操作,很多患者在出现医疗纠纷后不申请做医疗事故鉴定,直接到法院起诉要求赔偿,法院处理此类诉讼颇感困难。由于医学知识的专业性很强,法官对于医疗行为是否存在过失以及行为与结果之间是否存在因果关系难以做出判断,一些法院不得不求助于司法鉴定。一些患者由于对医疗技术事故鉴定委员会的不信任和对法院诉讼在时间和金钱上的恐惧,往往采取自力救济的方式,出现医疗纠纷后,患者家属就纠集一批亲戚、朋友到医院大闹,对医务人员进行人身威胁或人身攻击,扰乱医院的正常工作,直到医院拿出钱来么私了才就罢,有些医院每年用于私了的钱已经远远大于正常医疗赔偿的数目。
众所周知,医疗行为是一项高风险性的工作,由于医学上仍有很多未知领域,以及患者本身存在相当大的个体差异性,实际上相当一部分患者的死亡、残废和功能障碍并非是由于医务人员的过失所导致,而是由于无法预料和避免的并发症所致,完全属于医疗意外的范围,医院无需承担赔偿责任。但是,在目前医疗赔偿的现有体制下,患者家属出现医疗纠纷不再由有关部门按照法律程序和规定处理,医院承担赔偿责任的前提不是由于自身的医疗侵权,而是由患者家属人数的多少和吵闹的程度所决定,这不能不说是目前医疗纠纷处理的悲哀,也是与那些维护医院的部门利益的人的初衷相背离的。
我国的国情决定了不可能象西方国家那样动辄赔偿数十万元,过高的赔偿数额无疑将制约我国医疗事业的发展,最终会损害患者的利益。但是象目前各地所规定的那样,医疗事故的补偿标准最高不超过8000元,根本不足以弥补患者及其家属的实际损失,在法律上是显失公平的。
上述法律误区,是靠牺牲法律的公正和患者的合法权益来达到减少医院负担的目的,这样最终是得不偿失的,也是与我国建设法制国家的目标格格不入的。
参考文献:
[1] 梁慧星,医疗赔偿难点疑点剖析,南方周末,1999年1月8日第8版
[2] 张赞宁,论医患关系的属性及处理医事纠纷的特有原则,医学与哲学,2000年第4期
[3] 胡志强,论医疗行为的法律界定,中国卫生法制,2000第8卷第2期
[4] ?望新闻周刊,突破民事审判新难点,2000年12月4日第49期,第24页
[5] 张俊浩,民法学原理,中国政法大学出版社,1997年7月,第570页
作者简介:欧运祥,男,33岁,东南大学法律系医事法律教研室讲师,南京三维律师事务所律师。
通信地址:邮编210096,南京市四牌楼2号东南大学法律系 欧运祥

辽阳市城镇居民基本医疗保险办法

辽宁省辽阳市人民政府


辽阳市城镇居民基本医疗保险办法
  辽阳市人民政府令第102号



  《辽阳市城镇居民基本医疗保险办法》业经2008年4月16日辽阳市第十四届人民政府第2次常务会议讨论通过,现予发布实施。

                             市长 唐志国

                             2008年4月28日


  第一条 为进一步完善医疗保险制度,建立覆盖城镇居民的医疗保障体系,保障城镇居民的基本医疗需求,根据有关法律、法规、规章的规定,结合我市实际,制定本办法。

  第二条 在我市城市市级统筹区域(以下简称“城区”)范围内城镇职工基本医疗保险制度覆盖范围以外的城镇非从业人员参加城镇居民基本医疗保险的,适用本办法。

  第三条 本办法所称城镇居民基本医疗保险(以下称“城镇居民医保”),是指在政府及其部门组织下,居民个人和政府按照一定比例承担特定的门诊、住院医疗费用的保险制度。

  第四条 城镇居民医保由政府和有关部门组织实施,遵循低水平起步,重点保障大病医疗需求,逐步提高保障水平,以收定支、收支平衡,参保自愿、参保居民权利义务对等和多渠道筹集资金,与经济发展水平和居民承受能力相适应的原则。

  第五条 市劳动和社会保障行政部门是我市城镇居民医保的行政主管部门(以下称“医保主管部门”),负责城镇居民医保的政策制定、组织实施和监督管理等工作。其所属的医疗保险经办机构(以下称“医保机构”)具体负责承办本统筹区域内城镇居民医保的参保资格审定、费用征缴、医疗费用支付、就医管理等日常工作。

  财政、卫生、民政、教育、公安、残联等部门和单位,在各自职责范围内负责城镇居民医保的有关工作。

  第六条 具有我市城区城镇户籍的居民(以下称“居民”)符合下列条件之一的可以参加城镇居民医保:

  (一)全日制中、小学校(包括中等专业学校)学生和0至18周岁的其他居民;

  (二)男性18周岁以上、59周岁以下,女性18周岁以上、49周岁以下的低保人员、低保边缘户人员、非从业的二级以上重度残疾居民;

  (三)未享受养老金和退休金待遇的男性60周岁以上、女性50周岁以上不属于城镇职工基本医疗保险覆盖范围的居民。

  在校大学生的医疗保障按照国家和省有关规定执行。

  第七条 城镇居民医保基金来源:

  (一)参保居民缴纳的基本医保费;

  (二)市、区政府补贴资金;

  (三)按规定收取的滞纳金;

  (四)基金的利息收入;

  (五)依法纳入医保基金的其他收入。

  第八条 城镇居民年医保费用由居民个人和政府按照下列数额比例共同承担:

  (一)未成年人个人缴纳40元,政府补贴40元。其中低保人员个人缴纳16元,政府补贴64元;低保边缘人员个人缴纳30元,政府补贴50元。

  (二)劳动年龄段内的低保人员、非从业的二级以上重度残疾居民个人缴纳180元,政府补贴120元;劳动年龄段内低保边缘人员个人缴纳210元,政府补贴90元。

  (三)老年居民个人缴纳200元,政府补贴100元。其中低保人员、二级以上重症残疾的老年人个人缴纳80元,政府补贴220元;老年低保边缘人员个人缴纳160元,政府补贴140元。

  参保居民在1个自然年度(学生按学年度计算)内住院医疗费用,统筹基金支付限额为3万元(包括住院和门诊规定病种费用)。

  第九条 符合城镇居民医保条件的居民,应当持下列证明材料到所在社区办理参保登记手续:

  (一)户口簿和身份证复印件各2份;

  (二)近期免冠一寸照片4张;

  (三)低保金额领取证或者低保边缘户救助证;

  (四)残疾人员证。

  无行为能力人、重度残疾人本人不能亲自办理登记的应当由其监护人或者其委托人代为办理。

  社区对居民提交的参保手续应当及时受理并进行审查,材料不齐全的应当当场一次告知居民需要补正的全部内容。材料齐全,符合参保条件的,应当于受理之日起3日内报街道办事处,街道办事处汇总后报区劳动和社会保障部门审批;不符合条件的,应当书面告知居民。

  区劳动和社会保障部门对接收的登记资料应当在7日内进行复核,符合条件的,将有关资料统一汇总并报送到医保机构。

  学生由所在学校统一组织参保登记、信息采集、申报核定及信息变更等参保事宜。

  第十条 参保居民办理参保登记后,应当于每年10月1日至11月30日,持社区发给的《缴费通知书》在指定缴费期内到医保主管部门指定的金融机构一次性足额缴存当期应缴的医保费。

  学生的医保费,由所在学校协助医保机构收取。

  第十一条 医保机构应当于居民缴费截止的30日内,根据有关汇总资料的情况,为参保居民制作《城镇居民医保证》和医疗卡,并通过社区发给参保居民。

  第十二条 本办法实施后迁入我市城区的,可以按照本办法规定参加城镇居民医保。参保缴费2年内不享受政府补贴。

  在异地享受养老金或者退休金待遇的人员,不适用本办法。

  第十三条 参加城镇居民医保的居民,不得同时参加城镇职工基本医疗保险或者新型农村合作医疗。已经参加城镇职工基本医疗保险人员,不得参加城镇居民医保。参加城镇居民医保的居民身份发生变更的,停保后可以参加城镇职工基本医疗保险。

  居民参保后转为其他社会医疗保障形式或者户籍迁出、注销的,该项保险关系自行终止,所缴费用不予返还。

  第十四条 政府补贴资金由市、区两级政府按照5.5:4.5的比例承担。补贴额度可以根据两级财力状况适时进行调整。

  有条件的用人单位可对职工家属个人缴费部分给予适当补助。

  第十五条 政府补贴资金纳入财政预算,并于居民医保费按时足额缴纳后,由市、区两级财政根据医保机构汇集后提供的数据,于30日内按照比例核拨。补贴资金统一划入城镇居民医保统筹基金专户。

  第十六条 居民于取得参保资格之日起3个月内办理参保缴费的,自缴费次月起享受基本医疗保险待遇。

  本办法实施前符合参保条件未在规定期限内参保的,取得参保资格之日起超过3个月后办理参保缴费的,本办法实施后户籍从外地迁入我市并符合初次参保条件的人员,参保缴费后,其待遇等待期为6个月,等待期满后,方可享受医疗待遇。

  第十七条 参保居民不能按时足额缴纳基本医疗保险费的,停止享受医疗保险待遇,再次缴费按照重新参保办理,其待遇等待期为6个月。

  第十八条 参保居民住院和在门诊进行规定病种治疗的,执行国家、省制定的有关药品目录、诊疗项目及服务设施范围等规定。

  第十九条 参保居民患病需要门诊治疗或者住院治疗的,可以在医保主管部门指定的定点医疗机构中自主选择就诊单位。参保居民就诊或者治疗时应当持本人医保证、卡办理登记手续,并由本人或者亲属、监护人在入院登记表上签名。因急诊住院未能及时使用医保证、卡办理住院登记的,应当在24小时内将本人的医保证、卡交定点医疗机构补办住院登记手续。不按照规定使用本人医保证、卡办理住院手续的,其发生的医疗费用不得从医保基金中予以支付。

  第二十条 参保居民住院治疗发生医疗费用的起付标准按下列规定执行:

  (一)未成年居民在社区医疗机构住院的为100元、在一级医疗机构住院的为200元、在二级医疗机构住院的为300元、在三级医疗机构住院的为500元;

  (二)成年居民和老年居民在社区医疗机构住院的为200元,在一级医疗机构住院的为300元;在二级医疗机构住院的为400元;在三级医疗机构住院的为500元。

  (三)因急诊急救在非定点医疗机构治疗的或者经批准转到外地治疗的为700元。

  参保居民在同一自然年度多次住院的,起付标准不予降低。医疗费用在起付标准以下的,由个人支付。

  第二十一条 精神病、乙型肝炎、肺结核患者在指定的专科医疗机构住院的,不设起付标准。

  第二十二条 参保居民在定点医疗机构住院发生的符合规定的医疗费用在起付标准以上最高支付限额以下的,按照下列比例分担:

  (一)在社区卫生服务机构住院的,统筹基金支付60%,个人负担40%。

  (二)在一级医院住院的,统筹基金支付55%,个人负担45%;

  (三)在二级医院住院的,统筹基金支付50%,个人负担50%;

  (四)在三级医院住院的,统筹基金支付45%,个人负担55%;

  第二十三条 参保居民需要转入上一级医疗机构治疗的,应当经医保机构指定的定点医疗机构办理转诊、转院手续,在转出医院发生的医疗费用,统筹基金支付比例按同等级医疗机构支付比例下降5%。

  第二十四条 参保居民不在市定点医疗机构治疗或者未经批准转入其他医疗机构治疗的,所发生医疗费用不得从医保基金中支付。

  第二十五条 患有门诊规定病种的参保居民,应当到医保经办机构办理规定病种确认、待遇申请、选择就医等手续。城镇居民医保门诊规定病种管理办法由医保主管部门另行制定。

  第二十六条 参保居民有下列情形之一的,就医所发生的费用不予从医保统筹基金中支付:

  (一)在国外或者港、澳、台地区治疗的;

  (二)打架斗殴、自残、自杀、吸毒等违法犯罪和酗酒等行为致伤的;

  (三)交通事故、医疗事故等致伤的。

  第二十七条 城镇居民医保定点医疗机构由医保主管部门按照规定的条件予以确定。被确定为定点医疗机构的,应当于该机构显著位置悬挂医保主管部门发给的定点医疗机构门牌。

  第二十八条 医保机构应当与定点医疗机构就开展城镇居民医保医疗的有关事项签订协议,明确双方的责任、权利和义务。

  定点医疗机构开展医疗工作时,应当向住院的参保居民及时提供当日医疗费用清单明细。

  第二十九条 定点医疗机构应当根据有关部门批准的收费项目收费,并且实行明码标价,不得使用不合格的处方、单据和账表;不得收治冒名顶替人员住院;不得串换病种或者将不属于《诊疗项目》、《药品目录》和《服务设施范围和支付标准》的疾病、药品和服务等列入医疗保险统筹基金支付范围;不得超出患者病情需要进行检查、治疗、用药或者利用工作之便以参保居民名义开药。

  第三十条 参保居民不得将本人的医保证、卡转借他人就医,不得仿造和涂改医保证、卡,违者除追返医疗费用外,停止其医保待遇,2年之内不允许其参加城镇居民医保。

  第三十一条 医保主管部门应当对医保经办机构和定点医疗机构办理城镇居民医保工作和诊疗的情况进行监督、检查,对违反本办法的,应当及时处理。

  参保居民和其他社会成员有权对城镇医保费收支、待遇给付和定点医疗机构医疗服务进行监督,认为有违法行为的,可以向医保主管部门举报。医保主管部门应当及时受理举报,并依法及时调整处理。情节严重构成犯罪的,移送司法机关追究刑事责任。

  第三十二条 城镇居民医保统筹基金实行财政专户管理,专款专用,任何单位和个人不得挤占挪用。

  第三十三条 参保居民中的低保人员、低保边缘户人员,在享受基本医疗保险待遇后的医疗救助问题,由民政部门会同有关部门另行制定办法。

  第三十四条 参加城镇居民医保的同时应当参加超限额补充医疗保险,具体办法另行制定。

  第三十五条 城镇居民医保的筹资标准、政府补贴标准、统筹基金起付标准、最高支付限额和支付比例的调整,由医保主管部门根据上一年度医保基金筹资和运行情况适时提出调整意见,报市政府批准后执行。

  第三十六条 2008年当年首次参保的18周岁以下的非从业城市居民、成年居民及老年居民,参保时间为7月1日至9月1日,医疗保险费按照当年的1个季度收取,从2008年10月1日起享受1个季度的城镇居民医保待遇(住院治疗起付标准减半)。在校学生首次参保缴纳4个月城镇居民基本医疗保险费,并同时预交下一年度医疗保险费,待遇标准按全年统筹基金最高支付金额的1/3计算,住院治疗起付标准减半。

  第三十七条 白塔区、文圣区、宏伟区、太子河区范围内的城镇居民医保基金由市级统筹。

  辽阳县、灯塔市、弓长岭区的医保办法由该县(市)区自行制定。

  第三十八条 本办法自2008年7月1日起施行。




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