Samples distributionin this questionnaire survey
To better understand the current doctor-patient relationship and the mechanisms by which hospitals respond to medical incidents, 22 medical institutions in Shanghai were randomly selected to conduct a questionnaire survey. Of which, 10 were secondary hospitals and 12 were tertiary hospitals (table.1). As shown in table 1, 22 hospitals were distributed in different regions of Shanghai, including 8 hospitals from urban, 10 from suburb and 4 from suburban combination. Meanwhile, in this questionnaire survey, we selected 1689 medical staff and 1342 patients to conduct questionnaires among different groups (table.1).
Investigation on the occurrence of medical malpractice and the way of compensation
Following, we did a survey on the current situation of medical disputes in those 22 hospitals. The results of the questionnaire survey showed that 9.47% of the surveyed medical staff had personally experienced medical disputes (Fig.2A). As for medical accidents, 3.61% of medical staff had ever had one (Fig.2B). In case a medical accident happens, the main way of compensation is the negotiation between doctor and patient, accounting for 61.24%, followed by the medical liability insurance, accounting for 14.38%. Surprisingly, only 3.13% of the compensation events were covered by medical accident insurance (Fig.2C).
Investigation on the purchase of medical accident insurance
In view of the low proportion of medical accident insurance in medical accident compensation, we investigated the purchase of medical accident insurance in 22 hospitals. The results revealed that only five (22.73%) institutions had purchased medical accident insurance among the 22 hospitals surveyed in this survey (Fig.3A). Regarding the insured, two (40.00%) of them covered all employees of the hospitals, two (40.00%) covered only medical staff, and one (20.00%) covered only nurses (Fig.3B). As for the source of insurance premiums, three (60.00%) of them were borne by the hospital and medical staff in a certain proportion, one (20.00%) was borne by the hospital, and the other (20.00%) was borne by the medical staff (Fig.3C). Among the institution not purchasing medical accident insurance, 10 were willing to purchase in the future. Among them, five (50.00%) were willing to cover all medical staff, three (30.00%) were willing to cover only the medical staff in high-risk departments, and two (20.00%) were willing to cover all employees in the hospital (Fig.3D). In terms of the source of funds, five hospitals (50.00%) thought that the hospital and medical staff could share in a certain proportion, three hospitals (30.00%) thought that both doctors and patients could share in a certain proportion, one hospital (10.00%) hoped that the medical staff would bear it personally and one hospital (10.00%) thought that the patients would bear it personally (Fig.3E). From the perspective of the benefits rooting in promoting and implementing of medical accident insurance, 15 hospitals believed that medical accident insurance could help to reduce medical disputes, 14 hospitals believed that medical accident insurance could help to guide patients to carefully choose treatment methods, and 11 believed that the financial risks caused by surgical accidents could be transferred (Fig.3F).
Investigation on cognition of medical accident insurance
From the above survey, we knew that the rate of the purchase and application of medical accident insurance was very low under the existing circumstances. Therefore, we conducted another survey on the attitude of the doctor-patient relationship and the cognition of medical accident insurance among medical staff and patients.
For the doctor-patient relationship, a small number (24.63%) of medical workers thought that it was very harmonious, nearly half of them think it is relatively harmonious, accounting for 48.02%, and 20.67% thought it was tense (Fig.4A). However, in patients, the vast majority thought that the doctor-patient relationship was harmonious, accounting for 77.87%, and only 1.94% of the patients thought that it was disharmonious (Fig.4A). In the hierarchical analysis of demography, statistical significance (P < 0.05）were presented between cognition of doctor-patient relationship and most parameters, such as age, education background, professional title and department of the medical staff, whether in medical staff or patients (table 2).
Regarding the degree in understanding the medical accident insurance, only 21.85% of the medical staff knew it, 64.00% heard of it only without knowing the specifics, and 14.15% had never heard of it. Among patients, the proportion of patients who understand medical accident insurance was slightly higher than that of medical staff, accounting for 33.98% (Fig.4B). In addition, there was a statistical significance in the perceptions of medical accident insurance between medical staff and patients (P < 0.001). In the hierarchical analysis of demography, statistical significance (P < 0.05）were presented between the degree of understanding the medical accident insurance and merely some parameters, such as gender, age and professional title in medical staff, as well as hospital area, education background and annual per capita income in patients (table 3).
Subsequently, we analyzed the willingness of people to purchase medical accident insurance in both medical staff and patients. The results showed that 58.26% of medical staff was willing to buy, 32.80% were uncertain, and 8.94% were unwilling to buy (Fig.4C). Among those who were unwilling to buy, 37.75% thought that it was of little significance to alleviate medical disputes, 33.77% had no purchase awareness, and 18.54% thought that the cost was too high (Fig.4D). Among the patients, 45.16% were willing to buy, 16.02% were unwilling, and 38.82% were not sure whether to buy (Fig.4C). Among the patients who were unwilling to purchase, 36.74% had no purchase awareness, 20.00% said that there were not many actual benefits to them after purchasing, and not knowing how to buy and thinking that the cost is too high accounted for 17.21%, respectively (Fig.4D). In addition, there was a statistical significance in the willingness of people to purchase medical accident insurance between medical staff and patients (P < 0.001). In the hierarchical analysis of demography, statistical significance (P < 0.05）were presented between the willingness of people to purchase medical accident insurance and most parameters, such as gender, age, education background, professional title / annual per capita income and department of the medical staff, whether in medical staff or patients (table 4).
As some respondents thought that the purchase cost of medical accident insurance was too high, we set five levels of payment amount and analyzed their acceptance. The results showed that 30.75% accepted below 100 yuan, 27.44% accepted 100-200 yuan, 16.38% accepted 200-300 yuan, 15.02% accepted 300-500 yuan, and 10.40% accepted 500 yuan or more among medical workers (Fig.4E). In patients, it was similar to medical staff, accounting for 27.42%, 26.97%, 15.71%, 17.13%, 12.78% respectively (Fig.4E). Hence, no statistical significance was established in the amount of contributions acceptable for medical accident insurance between medical staff and patients (P = 0.102). In the hierarchical analysis of demography, statistical significance (P < 0.05）were presented between the amount of contributions acceptable for medical accident insurance and some parameters, such as gender, education background and professional title in medical staff, as well as hospital area, education background and annual per capita income in patients (table5).