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의료보험재정 위기(The fund crisis of the national medical insurance) : 원인과 대책(Its causes and counter measures)

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Frame of Image 업 이후 의 증가세를 보인 반면 외래진료비가 의 폭증세를 기록한 것으로 나 타나 외래에만 적용된 의약분업이 재정소진의 직접적인 계기였음을 시사
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한국개발연구원 1
□ 의약분업은 의약품의 오남용을 방지하여 의료비 절감에 기여할 것으로 기대되었으 나 추진과정의 왜곡과 오류로 인해 급속한 재정악화 요인으로 작용 ◦ 의료계와 약계의 반발을 무마하는 과정에서 총의료수가는 누적기준으로 인 상되었으며 원외처방료 조제료 등 일부 항목이 과잉진료를 유발하는 방향으로 인상되었음 ◦ 또한 진료비 억제의 핵심인 지불보상체계의 개혁을 포기한 것도 진료비 앙등에 결정적인 요인으로 작용할 전망 □ 의료보험의 재정안정을 위해서는 우선 의약분업 추진과정에서 발생한 문제점을 시 정하고 장기적으로는 기존에 내재되어 있던 적자요인들을 해소하는 방안도 병행할 필요 ◦ 당장의 지급불능사태를 방지하기 위해서는 국고지원의 확대가 불가피한 측면이 있으나 근본적인 대책과 병행되지 않을 경우 해마다 반복될 가능성이 있으므로 한시적 조치로 국한할 필요 ◦ 보험료 인상 역시 불가피한 측면이 있으나 의약분업 추진과정에서 왜곡 인상된 일부 수가항목의 재조정 진료비심사 강화 전산청구 의무화 등 실효성 있는 지 출억제방안과 병행되지 않을 경우 국민적 동의를 기대하기 어려움 ◦ 가장 근본적인 지출억제 방안은 공급자가 진료의 횟수 및 양에 비례하여 보상 받는 행위별후불수가제 에서 질병의 유형과 정도에 따라 정액을 보상받는 총 액예산제 로 단계적으로 전환하는 것임
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의료보험 재정의 현황 및 전망
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□ 보건복지부의 재정 추계에 의하면 2001년 내 4조 원 내외의 적자 및 조 원 정 도의 적립금 부족이 발생할 전망 표 참조 ◦ 수입 전년 대비 증가하여 조 천억 원 내외에 달할 전망
: 9% 10 4
2 한국개발연구원
표 1> 의료보험 재정현황 및 전망
단위 억 원
: 10
지출 입 계 수기수지 당 △ △ △ 적립금 주 전망치 자료 보건복지부 국민건강보험 재정전망과 대책 국민건강보험관리공단 국민건강보험통계연보 각년도
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Full Text
Title 의료보험재정 위기(The fund crisis of the national medical insurance)
Similar Titles
Sub Title

원인과 대책(Its causes and counter measures)

Material Type Reports




Date 2001
Series Title; No 정책포럼
Pages 14
Subject Country South Korea(Asia and Pacific)
Language Korean
File Type Documents
Original Format pdf
Subject Social Development < Health
Holding KDI; KDI School


□ The rapid drainage of the healthcare budget is attributed to the recent medical reform carried out to promote the separation of hospitals and pharmacies, rather than to internal factors, such as the increase in income levels, population aging, or wage expansion.
◦ This is inferred from the fact that the growth rate of imports has remained more or less unchanged from that of the previous year, whereas expenditure has grown to double that of last year, suggesting that the budget drainage is due to recent policy changes.
◦ The cost of maintaining and operating the medical insurance scheme represents only five percent of the total expenditure, and insurance revenue has reached the same level as that of last year. Therefore, the drainage cannot by fully explained by the integration of medical insurances.
◦ The costs associated with the payment of wages and other expenses explain this year’s surge in spending on medical insurance schemes. However, the costs of hospitalization and treatment increased by only nine percent following the hospital-pharmacy separation, whereas outpatient care costs reported a massive 72-percent hike, strongly hinting that the hospital-pharmacy separation is responsible for the drainage, as the separation mainly impacted the outpatient departments of hospitals.
□ Despite the initial expectations that it would be a cost-effective measure for preventing cases of pharmaceutical misuse and abuse, the separation drained the budget at a remarkable rate, due to problems with the plan’s initiation process.
◦ Total medical fees saw a cumulative increase of 49 percent, which opened the door for potential overtreatment in the form of prescription costs paid outside the hospital and compounding costs.
◦ Abandoning this reform of the reimbursement system, which could have proved greatly effective in offsetting the rise in treatment costs, is likely to cause another substantial jump in medical fees.
□ Financial stability in medical insurance schemes can only be achieved by correcting the errors made in the early stages of the hospital-pharmacy separation and alleviating the internal factors contributing to the deficit.
◦ Expanding government spending is necessary in the short term in order to ensure that the expenses are paid. However, this is only a temporary measure. More effort and a different approach are required to get to the fundamental root of the problem.
◦ Also, increasing insurance fees is unavoidable yet poses a significant challenge, as the public will not support the decision unless conscientious efforts are first made to readjust some of the unreasonable increases in hospital costs, ensure integrity in the validation of treatment costs, make electronic transactions mandatory, and devise realistic cost-reducing plans.
◦ The simplest approach to reducing expenditure is to gradually replace the current fee-for-service (FFS) payment model, where physicians are paid depending on the quantity of care, with a bundled payment system, where the type and severity of illnesses are taken into account when reimbursing physicians.