醫療糾紛的直接受害者為看診醫師及受診病患，間接受害者包括該醫師家屬、該病患家屬及因為醫師心灰意冷致退出杏林，醫療可近性受影響的潛在病患。換言之，每一個人都會受到醫療糾紛的直接或間接影響。有鑑於今日醫療糾紛問題層出不窮，本論文試圖從法律與風險管理的角度出發，介紹美國賓夕法尼亞州採行的醫療糾紛風險分散機制，供我國參考。 美國賓州主要採行的醫療糾紛風險分散機制，乃要求醫師投保責任保險和加入醫療照護普及和減少錯誤基金(MCARE Fund)。該基金係做為保險金不足時的第二道防線，亦即當醫療糾紛發生時，先由保險人支付保險金，當賠償金額超過保險金時，再由MCARE Fund來支付。如此將可保障被害人之完整受償權，也減輕保險人之負擔。再者，賓州開放金融市場，使醫師有較多種風險分散工具可供選擇，例如風險自留團體。除了事後的填補外，賓州也致力於事前損害的防止，以病人安全通報網路，強制蒐集並整理發生的醫療傷害事件，供醫師做未來之借鏡。而賓州所採行的提出許可證書制度，更有效減少了醫療糾紛的訴訟量，減少醫病雙方在訴訟中所耗費的時間和費用。 以我國法院判決分析的結果觀之，醫療糾紛訴訟判決醫師敗訴僅約一成，但在該些判決中，醫師須負擔賠償金額百萬元以上的卻有半數以上，對於醫師而言應屬事故發生頻率低，幅度大的風險，適合以保險分散之。立委曾提出強制醫療責任保險法草案，但未通過立法，內容也尚有改善空間。衛生署與財團法人醫策會成立的病人安全通報系統，某程度也能有效發現醫療傷害成因。風險自留團體與提出許可證書制度則均有其可取之處，但衡量我國經濟和法治發展與美國有異，均須做足配套措施後，始能於我國施行。

隨著近年醫療糾紛日益增加，民刑事訴訟程序冗長，醫病雙方長時間煎熬，醫病關係日益惡化，導致防禦性醫療盛行。本研究從醫療責任切入，討論醫療爭議及現行處理途徑與方式，現行醫療責任保險之發展，簡介外國醫療責任保險概況。探討我國實施強制醫療責任保險之可能性。 本研究試圖以多階層醫療風險處理模式，以達有效處理醫療糾紛事件之目的。該模式將建立強制醫療責任保險以提供基本補償及簡化賠償機制，推動醫療機構責任保險以行政手段加強民眾保障，限定賠償金額避免高風險急重症專科無人從事，提倡醫師專業責任保險分散風險，引進醫事審議仲裁機制縮短醫療糾紛審查及賠償程序。 期以多面向分層處理醫療糾紛及其賠償問題，建構安全的醫療制度，避免防衛性醫療的盛行及司法資源的浪費。 / With the growing number of medical malpractice cases and the lengthy process of both civil and criminal litigation procedures in recent years, the torture has been agonizing and worsening the relationship between physicians and patients. The very situation results in the prevalence of defensive medical treatment. This research deals with the problem from the viewpoint of medical liability, discusses the current methods of handling medical disputes and explores the development of current medical liability insurance. An overview of the situation in other countries is presented to investigate the possibility of implementing mandatory medical liability insurance in Taiwan. This research attempts to establish a multi-level mode to effectively resolve medical risks. This mode will contribute to a lot of functions including enforcing mandatory medical liability insurance, supporting a fundamental compensation and simplifying the process of damages claiming. Furthermore, the mode will also serve to promote the medical liability insurance of medical institutions and in turn enhance the protection for the common public with administrative measures. In addition, the mode intends to restrict the upper limit of damages in order to remedy the serious phenomenon that no doctors are willing to practice in the high-risk medical departments, which is expected to distribute the medical risk of all the doctors. It will also introduce a medical arbitration mechanism to shorten and accelerate the procedure of medical reviewing and damages claiming in handling medical malpractice cases. We hope, with the establishment of such a multi-level mode, a sound and wholesome medical system can be constructed and the overflowing defensive medical treatment and waste of judicial resources can be avoided.