CHOSUN

國民健康保險의 財政安定化 方案에 관한 硏究

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Author(s)
姜惠京
Issued Date
2004
Abstract
The national health insurance system is a kind of social security system of which the purpose is to ensure national health care with the intervention of government, and ultimately it aims at realizing healthy lifestyle based on the principle of social insurance. Korean people have much interest In the social welfare policy because they want to keep up with the rapid changing of social environment and prepare for the increasing needs for welfare and medical service.
People`s needs for health care are on the increasing trend, which causes medical sevice cost, insurance premium and benefits to increase. This trend is the worldwide phenomenon including Korea, and advanced countries have been already doing their efforts to reform their health insurance system in order to overcome the financial distress while maintaining equity in using medical services.
The national health insurance system has played a pivotal role for the maintenance and improvement of health care of Korean people, but it has several critical financial problems which are not to be solved whithin the current system such as financial distress, restricted coverage of insurance, the high level of out-of-pocket payment of patients, and the lack of correspondence to the rapidly changing medical needs.
Especially, the current health insurance system has following problems in the financial aspects:
In the side of receipts, the standard reward system which is a method of imposing insurance premium has such demerits as complex structure of contribution, deficiency of equity, and diminution of financial revenue.
In the side of spending, the level of insurance allowance is too high for Korean economic condition, and apportionment system fails to reduce the medical demands and it has inequitable points and fee-for-service system gives both doctors and patients incentives of overdoctoring, overgoing to hospitals and unjust requirement.
The increase of the elderly, the development of medical technology, and the increase of chronic and degenerative diseases related to life style, etc. are major factors ofn the increase of national medical expenses. And the separation of dispensary from medical practices caused the national health insurance to be faced with financial distress.
With the incoming of aging society, increasing expenditure of medical treatment due to frequent diseases of the elderly is a heavy burden. In addition, increases of the numbers of doctors and medical institutions, and utilization of high level medical service cause insurance payment to rise continually.
The restricted coverage of insurance payment could restrain the approach to medical service. In particular, this could restrict the opportunity of the low income bracket to use medical service and this could bring about negative effect on the improvemen of the national health in the long run. Extension of the coverage of insurance payment led to steady increase of medical treatment. The purpose to increase the ratio of cost-sharing is to restrain unnecessary demand for medical service. In the short run, increase of cost-sharing may reduce medical treatment.
The measures for the financial stabilization of the national health insurance are suggested as follows:
The balance of expenditure and revenue is the most important in financial stabilization of the national health insurance. In terms of premiun revenue, it is necessary to develop and apply the imposition system with which the principle of equity of the expenditure of insurance premium should be secured. The national treasury subsidy, which has been given equally to households in local community health insurance, should be grtanted to them according to levels of income or property. In addition, the health charge system which impose a tax to commodities and materials harmful to health such as tobacco and liquor is recommended to be implemented. It is necessary for the goverment to support sufficient financial aid to the national health insurance, for it is expected to take the responsibility for social security.
It is requisite to establish the system of reasonable insurance premium and benefit under long-run consideration of the reformation of expenditure system. The existing imposition system should be changed to comprehensive payment system. It is necessary to utilize DRGs which is a kind of comprehensive payment system. If DRGs would be enforced, there might be additional burden of insurance finance in the beginning because unpaid part of insurance would be paid under existing fee-for-service system. But in the end, this system will help to solve the problems of overdoctoring and unjust requirement, and lead to optimal medical treatment.
For the elderly, preventory medical activities should be enhanced and enlarged.
Such activities can detect the illnesses and diseases of the elderly at the early stage and prevent them from aggravating into critical conditions. With a little expense to these activities, we can save lots of money, for the elderly are prone to critical and chronic diseases. It is also necessary to introduce the national long-term care insurance which is to provide all the necessary health services for the elderly and alleviate the financial burden of the national health insurance by providing a new financial resource exclusively used for the health service of the elderly.
It is required that financial waste should be prevented. The insurance agency mustl strictly inspect the cases of excessive claims of examinations by medical suppliers. The introduction of IC card could prevent unauthorized benefit. For the prevention of unauthorized benefit of institution, the role of insurance company is important. The right and independent role of public insurance company to control receipts and expenses should be strengthened. For the settlement of the separation of dispensary from medical practices, rational management system of insurance medicine price should be introduced.
In order to delete excessive price of medicine, the establishment of collaborative medicine logistics center and construction of total information network for medicine distribution and practical transaction price in real time should be accomplished.
For the efficient management of the health insurance system, it is necessary to introduce the private health insurance system as a scheme to supplement the public health insurance system, and MSA as a scheme to stabilize the finance. The supplementary type is superior to the sustitutive type in the relation between public and private health insurance. As a precondition of the introduction of private health insurance, it is essential to carry out the improvement of public health insurance system at the same time, because it is possible, by doing so, to lessen the adverse effects and to achieve the balanced development of public and private health insurance. MSA will be very helpful for the reduction of the financial burden of the national health insurance, and it can contibute to the reduction of the medical costs by making people save money for their future medical costs.
The measures suggested above are helpful but not complete solution to the financial stabilization of the national health insurance system. Systematic reformation of the national health insurance is required urgently, and it is essential that national consensus should agree on the reasonable levels of insurance coverage, premium and benefit, and appropriate medical service level. The government, the provider and consumer of medical care, and the national health insurance corporation and review agency should make every effort together for the public health security and rational transparent management of public health insurance.
Alternative Title
A Study on the Measures for the Financial Stabilization of National Health Insurance in Korea
Alternative Author(s)
Kang, Hye-Gyung
Affiliation
朝鮮大學校 經營大學院
Department
경영대학원 산업경제학과
Advisor
奇宇傑
Awarded Date
2005. 2
Table Of Contents
제목차례
ABSTRACT = ⅷ
Ⅰ. 서론 = 1
1. 문제제기 및 연구의 목적 = 1
2. 연구의 방법 및 범위 = 4
Ⅱ. 국민건강보험제도에 관한 이론적 고찰 = 6
1. 사회보장제도의 의의 = 6
1) 사회보장의 개념 = 6
2) 사회보험의 의의 및 원칙 = 8
(1) 사회보험의 의의 = 8
(2) 사회보험의 원칙 = 9
3) 사회보험과 국고부담 = 15
(1) 국고부담의 타당성 = 16
(2) 국고부담의 문제점 = 17
(3) 재분배기능과 국고부담 = 18
(4) 개선방법 = 19
2. 건강보험제도의 개요 = 20
1) 건강보험제도의 개념 = 20
2) 건강보험제도의 기능 = 21
(1) 사회통합 기능 = 21
(2) 소득재분배 기능 = 21
(3) 위험분산 기능 = 21
3) 건강보험의 특성 = 22
(1) 강제적용 = 22
(2) 국민 개보험 = 22
(3) 보험료 차등부과 = 22
(4) 균등한 보험급여 = 22
(5) 보험료 납부 및 징수의 강제성 = 23
(6) 단기보험 = 23
(7) 복지권 = 23
4) 건강보험제도의 유형 = 23
(1) 운영형태에 따른 분류 = 24
(2) 위험담보에 따른 분류 = 28
Ⅲ. 외국의 의료보험제도 = 31
1. 영국의 의료보험제도 = 31
1) 관리운영체계= 31
(1) 개요 = 31
(2) 국민보건서비스 조직 = 32
(3) 의료전달체계 = 33
(4) 진료보수 지불제도 = 34
2) 의료보험 급여 = 34
(1) 의료서비스의 종류 = 34
(2) 지역보건서비스 = 36
3) 최근 동향 = 37
2. 미국의 의료보험제도 = 39
1) 관리운영 체계 = 39
(1) 개요 = 39
(2) 공적의료보장 = 40
(3) 민영의료보험 = 42
2) 재원과 보험급여 = 44
(1) 재원 = 44
(2) 보험급여 = 45
3) 최근 동향 = 45
3. 독일의 의료보험제도 = 47
1) 관리운영체계 = 47
(1) 개요 = 47
(2) 적용대상 = 48
(3) 관리체계(1996년 현재, 동독 포함) = 48
2) 재원 = 50
(1) 보험료 부과제도의 기본원리 = 50
(2) 보험료 부과대상 소득 = 51
3) 최근 동향 = 53
4. 일본의 의료보험제도 = 58
1) 관리운영체계 = 58
(1) 개요 = 58
(2) 건강보험 = 58
(3) 국민건강보험 = 59
(4) 공제조합 = 60
(5) 건강보험조합연합회 = 61
2) 보험재정 = 61
(1) 보험료 = 61
(2) 국고보조 = 62
(3) 관리운영기구 = 62
3) 최근 동향 = 63
5. 외국의 의료보험재정 안정화 대책 = 68
Ⅳ. 국민건강보험재정의 현황과 문제점 = 70
1. 우리나라 국민건강보험제도의 발전과정 = 71
1) 임의보험사업기 (1963-1977) = 71
2) 사회보험 확장기(1977-1989) = 73
(1) 직장의료보험조합의 확대과정 = 74
(2) 공무원 및 사립학교 교직원 의료보험 확대과정 = 75
(3) 지역의료보험 시범사업기 = 76
3) 전국민의료보험기 (1989-1998) = 76
4) 통합의료보험기 (1998-현재) = 78
2. 우리나라 국민건강보험재정의 운용방식 = 82
3. 건강보험제도의 개황 = 85
1) 건강보험적용 대상 = 85
2) 건강보험공단의 업무 = 86
3) 건강보험재정의 추이 = 87
4. 건강보험재정 수입부문의 현황과 문제점 = 90
1) 건강보험재정 수입부문의 현황 = 90
(1) 보험료 수입 = 90
(2) 국고지원금 = 95
(3) 자산운영 수입 = 96
(4) 기타징수금 보험조정 수입 = 96
2) 건강보험재정 수입부문의 문제점 = 97
(1) 보험료의 저부담율 = 97
(2) 국고지원율 감소 = 97
5. 건강보험재정 지출부문의 현황과 문제점 = 98
1) 건강보험재정 지출부문의 현황 = 98
(1) 보험급여비 = 98
(2) 건강검진비 = 100
(3) 관리운영비 = 101
(4) 타기관 지급계정 = 102
(5) 기타지출 = 102
2) 건강보험재정 지출부문의 문제점 = 102
(1) 의료기술의 발전과 의료공급의 증가 = 102
(2) 행위별수가제 = 104
(3) 인구고령화와 노인의료비의 증가 = 105
(4) 의료서비스 수요증가 = 111
(5) 보험급여범위의 확대 = 114
(6) 고액진료비 증가 = 117
(7) 의약분업 시행 = 124
(8) 의료보험 통합 = 127
Ⅴ. 건강보험재정의 안정화 방안 = 129
1. 건강보험재정수입 확충 방안 = 129
1) 보험료 징수율 제고 = 129
2) 보험료의 적기인상 = 130
3) 국고지원의 증대 = 131
4) 의료저축계정(MSA)의 도입 = 133
5) 추가재원의 발굴 = 135
2. 건강보험재정지출 효율화 방안 = 138
1) 본인부담제도의 개혁 = 138
2) 진료비 지불제도의 변경 = 140
(1) 포괄수가제(DRGs) = 140
(2) 진료비총액 계약제 = 143
3) 의료공급의 효율화 = 144
(1) 의료제공방식의 개편 = 145
(2) 차 의료의 합리적 강화 = 146
(3) 인구구조의 변화에 따른 대응체계 구축 = 147
(4) 의료공급의 적정수준 유지 = 150
(5) 약제비 사용의 적정화 = 152
4) 진료비 심사 기능 강화 = 153
5) 보험수가 인상 억제 = 154
6) 노인의료비의 부담 개선 = 154
(1) 예방적 차원의 시스템 도입 = 155
(2) 공공보건의료기관의 기능 강화 = 156
(3) 저소득노인의 의료보험 본인부담금 경감 = 156
(4) 의료급여제도의 확대 개편 = 157
(5) 국가의 노인복지 예산 확충 = 157
3. 보험관리체계 혁신 = 157
1) 경쟁방안 = 157
2) 의료보장의 다양성과 경쟁성 강화 = 159
3) 민영의료보험 도입 = 159
Ⅵ. 요약 및 결론 = 162
참고문헌 = 168
Degree
Master
Publisher
朝鮮大學校 經營大學院
Citation
姜惠京. (2004). 國民健康保險의 財政安定化 方案에 관한 硏究
Type
Dissertation
URI
https://oak.chosun.ac.kr/handle/2020.oak/1415
Appears in Collections:
Business > Theses(Master)(경영대학원)
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