This study aims to review the effect that certain variables have on the estimation of the financial requirement, the reduction of the burden placed on the government and the demand for healthcare when health insurance is expanded. It also aims to suggest institutional measures to achieve financial stabilization. Medical costs have rapidly skyrocketed across the world in recent years, and many countries are put under an immense financial pressure. Accordingly, many efforts are being made to devise a plan to finance the additional costs, with the healthy and sustainable management of insurance financing as an ever-important policy task. All insurance financing-related decisions need to incorporate economic feasibility, public burden, efficiency and fairness issues, and they are therefore considered an important yet challenging task from a social and economic policy perspective.
It is important to note that insurance financing cannot be run with a single social and economic objective; a balance between a number of financial objectives is to be sought and insurance financing has to be planned and managed methodically. Realistically speaking, the measures needed to achieve the financial stability of local health insurance boil down to the optimization of the insurance premium and its efficient collection, the control of insurance benefits and external financing. The basic policy measures that need to be considered by the existing local health insurance companies within the framework of simultaneously providing insurance for everyone and achieving financial stability are as follows. A local community-based health insurance system needs to be developed and implemented for a nation-wide rollout for the overall management. Everyone should be eligible, with the exception of those who benefit from an occupational health insurance plan, public servants, teachers, and specialized workforce members such as soldiers. The existing arbitrary local health insurance and occupational health insurance would be integrated into the nation-wide rollout of the local health insurance system in its management.
The insurance financing should be considered along with the principle of setting an insurance benefit that reflects the healthcare service supply capacity, as well as the insurance premium set in consensus by the local healthcare service providers, the public and the government. Additionally, subsidies from the central government and other relevant government agencies can be sought, all the while creating a control mechanism designed to prevent the excessive demand expected from the nationwide rollout of the local health insurance system. Sound management of insurance financing also requires that the relevant weight is shared both by individuals and the local community, and that the benefit is set within the limit of the local health insurance’s financing capacity. Small-size (si, gun, etc.) local health insurance based on the residential areas should also be liaised with large-size metropolitan/provincial ones to diversify unavoidable risks, to a certain degree. Lastly, in setting the insurance premium, both the relative income level and the spirit of medical security need to be taken into consideration to further reinforce its function in income redistribution.
The institution of health insurance needs to evolve to best fit the changes in the socio-economic environment of the local community in order for it to further develop and become an important part of the medical security system for its residents. Therefore, local health insurance systems should incorporate the consensus between the healthcare suppliers, consumers and voluntary demand from the residents.
의료보험확대와 재정안정화방안(Health insurance expansion & financial stabilization measures)
서울 : 한국개발연구원
|Series Title; No||정책연구시리즈 / 87-09|
|Subject Country||South Korea(Asia and Pacific)|
|Subject||Economy < Financial Policy|
|Holding||KDI; KDI School|