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의료보험의 정책과제와 발전방향

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Title 의료보험의 정책과제와 발전방향
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Material Type Reports
Author(Korean)

연하청; 박종기

Publisher

서울:한국개발연구원

Date 1983
Series Title; No 연구보고 / 83-01
Pages 533
Subject Country South Korea(Asia and Pacific)
Language Korean
File Type Documents
Original Format pdf
Subject Social Development < Social Welfare
Holding KDI; KDI School

Abstract

This study aims to analyze the factors behind the problems that have been revealed in the early stage of Korea’s health insurance system, and to provide guidelines for the future efforts to expand and improve the system.
Korea’s health insurance system is riddled with a variety of problems, such as insufficient government involvement, lack of clear role division between public and private health institutions, shortage of medical facilities in rural areas and a resulting waste of medical resources. Pressing challenges to address in health and medical sectors include ensuring equitable and balanced access to health care, expanding basic medical services currently not matching the country’s economic development, and dealing with the soaring demands for medical services caused by industrialization and degradation of the environment.
Experiences of many countries show that, under a medical system driven by private medical practitioners, a health insurance system developed in the form of social insurance tends to increase the medical cost burden for the general public. For this reason, health insurance systems should be shaped on the consideration of other health-related institutions as well as the aspect of medical cost financing. In other words, multiple factors must be taken into account in organizing the system, such as internal issues of the health insurance system, its operational aspects, method of assessing and reimbursing medical fees, health delivery system, separation of prescribing and dispensing drugs, income redistribution issues of health insurance, the financial problems of the current system and various possible ways of financing the system.
The current health insurance system implemented in Korea does not reach those in utmost need as the insurance only covers a limited portion of the public admitted on the basis of occupation or residential areas. Tackling this problem requires expanding the range of potential beneficiaries and integrating medical fee charging schemes. The Korean government has to come up with a plan to finance medical costs for elderly citizens, raise the level of health insurance benefits, establish the systems for medical service and health delivery, expand insurance coverage for job changers, and institutionalize access to health insurance at private and public medical institutions. It also must consider lower insurance rates for low-income groups and higher rates for high-income groups to address the equity issues related to insurance premium burdens. Lastly, health insurance policies should be shaped from a long-term perspective. For example, the government should continue to integrate the current small associations into regional collective associations with a long-run view of establishing a national health insurance association.