Research On The Collaborative Governance To Resolve Medical Disputes

In the new century, with the increasing marketization of hospital and the rapid growth of public awareness of rights, as well as the imperfection of relevant systems and regulations, the medical dispute has become a social hot issues in China. What is worse, patients and their relatives, under the agitation of "medical trouble" spontaneously and widely did something to express their dissatisfaction and make a claim such as setting up the hall, placing wreaths, locking the door, putting the dirge and paper money, smashing downtown in the hospital and so on. This action seriously disturbed the normal medical order. Additionally, due to the adverse impact of the medical dispute and the publicity of the consumption of resources, the medical dispute, rather than considered as a more personal question, has become a public issue being a greater negative social effect.The three levels to deal with the dilemma of medical dispute are as followed. First of all, it is more difficult to resolve serious conflicts due to a direct dialogue between doctors and patients. Direct contact between patients and doctors lead to a low degree of mutual trust, mood disorders, and also leads to a situation like "big little more trouble. This requires an objective third-party to help to deal with this dispute. Secondly, a single third-party intervention can not deal with a comprehensive medical dispute. According to the nature of the intervention subjects, third parties can be acted by the government and relevant departments, social organizations, or commercial organizations to carry out a separate intervention. Because of the credibility of the government departments, the special relationship between government and hospitals and some other reasons, however, there are some drawbacks when the government is as a single third party to deal with medical dispute; if the social organization singly deals with the medical dispute, they will face the following difficulties such as the insufficient funding, the smaller overall size, the lack of legal protection and other issues, which it is difficult to realize the sustainable management of medial dispute; due to its natural-profit targeting, weak public order concerns, lack of professionalism and authority and other reasons, if the commercial organizations are considered as an independent third party, it is difficult to get both sides of the conflict recognition. This makes that kinds of organizations to join to deal with the medical dispute becomes an objective need. Third, multi-joint intervention also faces the following questions such as the main functions of the relevant body positioning, coordination mechanisms, the leading sector, operating principles, compensation mechanisms, monitoring and evaluation, and many other issues. This results in that based on summarizing the relevant experience around the country, making a systematic research, then it makes researches and describes the specific content of the multi-agent coordination mechanisms to deal with patient disputes.Facing to the difficulties of dealing with the medical disputes, local governance carried out to explore the social diverse, and then established the conflict resolution mechanisms, which gradually become the consensus of academics and practitioners. However, there are a lot of questions such as what kind of this new mechanism should be, what role the government and relevant departments should play, which way it works, how to achieve effective management of medical disputes. The local governments take kinds of measures to deal with that. But behind these differences, there are also some similarities, such as the fixed jointed parties, mainly parties are both doctors and patients, government health departments, judicial and administrative departments, civil affairs departments, police departments, financial departments, medical mediation organizations, commercial insurance companies. No matter which party is leader, what kind of operational concepts and models to take, these parties will participate in the entire health care system and the process of resolving disputes.Overall, the multi-agent collaborative governance mechanisms of patient disputes mainly include five aspects:Firstly, the dynamic integration of multi-agent collaborative governance. The intentions of different parties to involve in resolving disputes between doctors and patients are divided into the following three categories, one is based on the functions of their administrative power, including judicial and administrative departments, health departments, police departments, insurance supervision departments and other government agencies. Because these parties are responsible for the people’s mediation, medical order, public safety, supervision of the insurance industry and other functions, and then, they are participated in resolving the medical disputes; Another consideration is based on the interest and commitment of certain social responsibility, mainly for insurance companies, they will follow the rule of guaranteed profit " to operate during this process, in the pursuit of interests, to fulfill some kind of corporate social responsibility; the third one is based on social welfare to participate in resolving medial disputes, mainly for NGO and some social academic associations. Administrative power, the interests of power and welfare power are the three main power of dealing with the medical disputes.Secondly, the functions of multiple subjects collaborative governance configuration. The core function of patient disputes collaborative governance are the functions to ease the conflict, the function to resolute the conflicts and benefits compensation. For easing the conflict, the public security departments, doctors committee and hospitals, based on different functions to make the mutual support; for conflict resolution, doctors committee and insurance companies led the conflicting parties to make negotiation; for the interests of compensation, small compensation demands direct negotiations between doctors and patients, the insurance company will be responsible for the large compensation through the mediation process, for some special cases, the government can also use some relief fund to deal with. The assisted functions of medical disputes include:the design capacities, which are responsible by the relevant government departments and the disposal meeting of patient disputes, conflict guide function borne by doctors Commission, the public security departments and hospitals, the conflict transformation functions acted by the government, hospitals, patients and related groups.Thirdly, the implementation of multi-agency collaborative governance body and its functioning. In reality, the medical dispute mediation committee of the country are implementing the function of agency collaborative multi-patient disputes governance, and its nature are the mediation organizations. An administrative department of government leads this organization and regulate the relevant mediation behavior. Its operating expenses are mainly from the financial allocation, and are also from part of the local or corporate funding from the donor community, mainly composed of the principal members of the medical experts, law, psychology, perform registration accepted, mediation law, professional judgments, publicity and, case summary analysis and other functions throughout the years the practice shows that the medical committee tune operation more successful, won widespread praise from the government, the community.Fourthly, the coordination of the multi-agency of medial disputes. In the process of dealing with medial disputes, there are two levels of disagreement:the different views of the involved parties, including taking the rule-oriented or the result-oriented to deal with medial disputes, but also including objects of governance, the scope of governance subject, membership organizations, such as having a different understanding; Secondly, there may be some different views within the medical committee, including the applicability of law, the different understanding on some specific issues such as the dispute about medical malpractice. To ensure the effectiveness of conducting the collaborative governance of medical disputes, we need to make these fundamental objections clear, or develop basic coordination rules. Meanwhile, to prevent the alienation of the medical committee, it needs to establish an effective system of supervision and treatment.Lastly, the use of the collaborative conflict governance of the patient disputes. Medical disputes provide a series of the opportunities of improvement, including focused areas of accident-prone, and the promotion of technological innovation improving hospital management, and other aspects of promoting universal access to medical knowledge and legal knowledge. There are so many explorative practices to deal with interest conflict in foreign countries, including setting " Patient Advocate room" in the hospital,"Patient Learning Center "," ethics committee", and also developed, at the community level, the associations of the specific patient populations, strengthen the professionalism of doctors, a health care committee, public hospitals and doctor’s information, and many other practices. Some parts of the country also established medical dispute case base to make in-depth analysis and training, publish the prevention manual about the cases of medical dispute, and improve the legislation about patient disputes. The collaborative governance mechanisms of medical disputes has a significant meaning to reduce the conflict between doctors and patients. In the face of the new era of dealing with medical disputes, the government should rationally position its functions, take appropriate and effective way to resolve conflict. This attempt to prove that when dealing with the complex disposal or resolve conflicts, the government does not to play in the first line, and also the conflict is not necessarily going to completely dispose cede power in society, in the current transition period, a more appropriate strategy may be that the government takes back support or buys the means of service, builds up the government, social organizations, enterprises and public to participate in and corporate to defuse the conflict platform, and then give full play to the unique advantages of different subjects, thereby promoting to effectively resolve the complex public conflict.