Abstract: Medical damage appraisal, one of the crucial links in medical disputes, serves as the scientific basis for resolving such disputes and is also one of the major issues in medical dispute complaints. This paper focuses on the dual structure of medical damage appraisal entities, namely the coexistence of medical associations and judicial appraisal institutions, and delves into its formation background, operational drawbacks, and core issues. The study reveals that the dual structure suffers from problems such as unequal legal status, inefficient resource allocation, intensified doctor-patient confrontation, and frequent conflicts in conclusions, leading to practical predicaments such as the lack of neutrality, absence of uniformity, procedural obstacles, and deficiencies in quality assurance mechanisms. Therefore, taking the medical damage appraisal work in Shanghai as a sample, and combining judicial practice with theoretical research, this paper proposes an optimization path oriented towards neutrality, uniformity, and professionalization. It aims to establish a scientific and reasonable system for medical damage appraisal entities, provide theoretical support and practical solutions for resolving the predicament of “difficult and disorderly appraisal”, and facilitate the efficient resolution of medical disputes and the improvement of doctor-patient relationships.

Key words: medical damage appraisal, dual structure, neutrality, uniformity

摘要： 医疗纠纷处理中的重要环节之一——医疗损害鉴定是处理医疗纠纷的科学依据，也是医疗纠纷信访中投诉的热点问题之一。本文聚焦医疗损害鉴定主体的二元结构，即医学会与司法鉴定机构并存的制度形态，深入剖析其形成背景、运行弊端及核心问题。研究发现，二元结构存在法律地位不对等、资源配置低效、医患对立加剧、结论冲突频发等问题，导致中立性缺失、统一性缺位、程序障碍及质量保障机制缺陷等实践困境。故此，本文以上海医疗损害鉴定工作为样本，结合司法实践与理论研究，提出以中立化、统一化、专业化为导向的优化路径，旨在构建科学合理的医疗损害鉴定主体制度，为破解 “鉴定难、鉴定乱” 困境提供理论支撑与实践方案，助力医疗纠纷的高效化解与医患关系的改善。

关键词: 医疗损害鉴定, 二元结构, 中立性, 统一性