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건강보험의 관리체계 개선방향(Reform measure on financing management of social heath insurance in Korea)

Related Document
Frame of Image 보험의 통합으로 인해 보험재정에 대한 국가의 책임이 더욱 강조되면 서 국고부담이 증대되어 건강보험의 조직관리의 효율화 뿐 아니라 재정운영의 합리적 방안 마련이 주요 과제로 대두되고 있고 국가의 보험재정 통제의 강화 방안도 주요과제로 제기되고 있다. 이러한 차제에 기획예산처에서 ‘예산시스템 개혁지원사업’의 일환으로 ‘건강 보험의 관리체계 개선방향’에 대한 연구과제를 한국행정연구원을 통해 지원함 으로써 우리나라 건강보험의 재정운영 현황 및 재정안정화 방안을 분석하여 검토하고, 건강보험 재정의 기금화 방안을 포함한 건강보험의 재원조달시스템 의 개편방안과 함께 관리운영체계의 개편방안 등을 종합적으로 검토하여 제안 할 수 있는 기회를 갖도록 한 것은 매우 시의적절하였다고 하겠다. 이 보고서에서 제안한 여러 가지 대안들이 비록 미흡한 측면도 있지만 정책 이슈로 제기되어 종합적이고 체계적인 논의를 거쳐 건강보험정책에 반영되었 으면 하는 마음이 간절하다. 이 보고서를 작성하는 과정에서 많은 건강보험 전문가들의 의견을 청취할
수 있는 기회를 가졌는데 이 기회를 통해 그 분들에게 다시 한번 감사드리고, 이 연구를 위해 여러 측면에서 지원해 주신 한국행정연구원의 박재희 박사와 팀원들에게 사의를 표한다.
2004년 12월 韓國行政硏究院 院長 金 重 養
i
∙차
례∙
제1장 서 론 ······························································································· 1
1. 연구의 필요성 ································································································· 1 2. 연구의 목적 ····································································································· 4 3. 연구방법과 내용 ····························································································· 4
제2장 건강보험의 발전과정과 과제 ······················································ 6
1. 건강보험제도의 성립과 발전 ······································································· 6 1) 건강보험제도의 도입 ················································································· 6 2) 건강보험제도의 발전 ················································································· 7 2. 건강보험의 과제와 문제점 ······························


Full Text
Title 건강보험의 관리체계 개선방향(Reform measure on financing management of social heath insurance in Korea)
Similar Titles
Material Type Reports
Author(Korean)

박재용

Publisher

서울:한국행정연구원

Date 2004-12
Pages 384
Subject Country South Korea(Asia and Pacific)
Language Korean
File Type Documents
Original Format pdf
Subject Social Development < Health
Government and Law < Public Administration
Holding 한국행정연구원

Abstract

This report suggests an effective financing management of social health insurance(SHI) to meet both access to basic care and long-term sustainability, and an efficient administration of SHI related organizations.
The financial soundness had been once collapsed since the introduction of separation policy of prescribing and dispensing, and now the financial balance has been almost recovered in the end of 2004. However, the future of financing cannot be optimistic against the planned expansion of service coverage, income growth, and rapid ageing. The effective insurance coverage is estimated 52 percent of a whole medical cost, but the ruling party announced the coverage should reach 70 percent till 2008.
If this plan would be realized, the contribution rate will be expected to rise from 4.21 percent of income up to 7.61% in 2020. When the government subsidy to SHI is abolished in 2006 as scheduled in the Special Act, the contribution rate will be 8% in 2020. These projections imply SHI must prepare a well designed financing strategy.
The principle for a good financial management is thought to be a well designed combination of a comprehensive access to care, a protection against catastrophic diseases, and an effective control of health care cost.
To accomplish this, the Guaranteed Health Care Package(GHCP) should be established for the basic protection of patients, and the total expenditure accruing from GHCP must be controled for the affordable financing. We suggest the total expenditure should be contained according to 'sustainable growth rate' which is calculated based on the macro-economic growth rate, medical price inflation, changing structure of ageing, and expansion of service coverage, and etc. This kind of cost control mechanism could be successful with the control of increasing provision of doctors and beds and the control of service quality.
Considering a constrained resource in the short stage, a major risk such as catastrophic and disastrous chronic care should be covered, while a minor risk would be recommended to depend on the hand of patients' responsibility like coinsurance and 'deductible'. On the other hand, we suggest the government support the private health insurance take a role to supplement the non-GHCP services, and patients to buy 'Medical Saving Account(MSA)' to prepare in advance against unexpected medical costs.
Tax financing should be reviewed as an alternative. Tax financing would be a solution against the conflict of equitable burden between corporate workers' insurance and residence-based insurance, and an answer to solve the under-reporting problem of income in a large informal sector. However, negative side effects of tax financing should be cautiously reviewed. Moreover the transition from insurance financing to tax financing means that SHI is managed in the framework of government budget, in which the flexibility of financial management will tend to be harmed.
Another suggestion in the way of financial management is the introduction of 'managed competition' under the rule of centralized financing. A reform of administrative system would be recommended such that as the single insurer, National Health Insurance Corporation(NHIC) takes a role of subscription, financing, claim review and reimbursement. The evaluation for medical services should be separated and independently operated like the organization such like
Center for Medical Services(CMS) in USA. Furthermore, we recommend to consider to establish a Bureau of National Health Service as a government agency, and let the National Tax Agency collect health insurance premium or tax. Especially the electronic networking between insurer and providers must be built, and a smart card must be possessed by each policy holder, through which the transparency of medical informations and the efficiency of management will be improved.