國民健康保險의 財政安定化 方案에 관한 硏究

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.