이 논문은 의료기관 측에 대한 의료사고배상책임보험 가입 의무화와 관련된 쟁점을 살펴보고 바람직한 제도 도입 방안을 제시하고자 한다. 「의료사고 피해구제 및 의료분쟁 조정 등에 관한 법률」 제정(2011.4.7. 제정, 2012.4.8. 시행) 당시 ‘의료사고배상책임보험 의무가입’의 대안으로 ‘손해배상금 대불제도’가 도입되었으나, 동 제도의 보장적 기능의 미흡 등 의견에 따라 보험가입 의무화 논의가 재점화되었다. 현행 손해배상금 대불제도는 의료사고로 인한 손해배상금 지급의무가 있는 자의 사정으로 인해 손해배상금이 원활히 지급되지 못할 경우 한국의료분쟁조정중재원이 피해자에게 금원을 우선 지급한 후 손해배상 의무자에게 구상권을 행사하여 상환받는 구조로, 손해배상금 지급에 있어 최후의 보장적 기능을 수행하고 있다. 그러나 대불제도는 법원이나 한국의료분쟁조정중재원 등 공적 분쟁해결기관의 종국적 결정이 이루어지지 않은 상태에서는 이용할 수 없음에 따라, 당사자 간 자율분쟁해결 등을 이끌어낼 수 있는 기금의 부재라는 공백을 의료사고배상책임보험이 일정부분 메울 수 있다는 주장이 제기되고 있는 것이다. 이에 본고에서는 의료사고배상책임보험을 다양한 각도에서 검토하여 합리적 제도 도입방안을 마련코자 하였다. 검토 결과, 의료사고배상책임보험의 기대효과는 일부 인정되나 현행 손해배상금 대불제도와의 부분적 기능중복이나 사회적 낭비 가능성 등이 우려됨에 따라, 보험 가입만을 강제하기보다는 그 대안으로 ① 결손처분액에 대한 정부 측 재정지원, ② 책임보험 및 손해배상준비금 적립제도, 공탁제도 등을 함께 신설, ③ 의료사고배상책임보험 또는 공제조합 가입 시 형사처벌특례제도 적용을 고려하는 것이 바람직해 보인다.

This article reviews issues regarding compulsory medical liability insurances on the side of the medical institution, and suggests preferable introduction of the scheme. When the Act on Remedies for Injuries from Medical Malpractice and Mediation of Medical Disputes was enacted (enforced in April 2012), the Advances for Damages Scheme was introduced as an alternative to compulsory medical liability insurance. However, there have been continued controversies over the compulsory insurance arising from objections, such as the inadequate security of the existing scheme. For a person who is obliged to pay damages for medical malpractice, where such an occasion occurs, such as temporary difficulties in payments, the payment for damages is not readily available. In the Advances for Damages Scheme, the Korea Medical Dispute Mediation and Arbitration Agency (KMDMAA) provides money in advance for a victim of medical malpractice, and exercises the right to demand reimbursement against the person obliged to pay damages. Accordingly, the scheme faithfully serves as a final security in the payment for damages. However, the scheme is not available in situations where a final decision is not made by public dispute resolution agencies, such as a court or the KMDMAA. Under the circumstances, it is claimed that medical liability insurance can partly fill an institutional gap in the absence of financial resources, which could make it possible to autonomously settle disputes between both related parties. In this regard, this study explored the insurance eligibility of medical liability insurance by making a comparative examination of the Advances for Damages Scheme and medical liability insurance from various perspectives. As a result, medical liability insurance was regarded as an insufficient system for fully replacing or supplementing the current scheme, considering the functional overlap compared to the Advances for Damages Scheme, the practical uncertainty of social costs, the difficulty in compensation of the outstanding amount of damages, and the declining public nature of the KMDMAA. However, as the expected practical benefits of the transfer of public dispute resolution agencies and the autonomous settlement between the parties were regarded as positive effects, they are considered to be the qualitative aspects. Accordingly, an independent research was necessary. As an alternative to compulsory medical liability insurance, the study presented three measures: ① the governmental financial support for deficiencies; ② the establishment of accumulation or deposit for damage indemnification reserve; and ③ the application of special criminal punishment to the cases of entering medical liability insurance or mutual aid associations.