의료공급체계; 의료전달체계; 지불제도; CCO(Coordinated Care Organization); 보장성; 부과체계; 총액계약제; 의료의 질 향상
진료비 규모가 사전에 예측가능하도록 지불제도를 개편하되 이의 원활한 시행을 위하여 의료공급 및 잔덜체계를 동시에 개선할 수 있는 체계 구축
The Korean National Health Insurance (NHI), Korea's public health insurance, has made a great stride since its introduction in 1977. Despite its remarkable growth in both quantitative and qualitative terms, the coverage and financial structure of NHI have been criticized. Korea's public health insurance was found to have covered only 62.2% of total health expenditure in 2008, a figure way below the OECD average of around 80%. Estimated to have spent KW35 trillion in 2010 alone, the National Health Insurance (NHI) is financially at grave risk with its reserves of as little as KW880 billion as of the end of 2010. To make matters worse, many experts are taking issue with the NHI’s reimbursement method. Ever since it was implemented, the NHI has reimbursed based on a cost-incurring fee-for-service method. The annual rate of increase in fee-for-service has been kept under 3%, but many finger the costly fee-for-service reimbursement approach as one of the factors responsible for increasing health insurance benefits by 15% every year. Whether the level of fee is appropriate also remains an issue of constant contention. Providers claim that the fee level is set far too low for the world-class quality of services they provide. Consumers on the other hand feel that the services they get are overly priced. The current fee reimbursement contract, which since 2008 has been made based on provider type, is also a matter of unending dispute. Problems also abound when it comes to the question of how insurance premiums should be collected. A few rounds of reform took place over the recent years, whereby in 2000 the National Health Insurance Corporation was made the only insurer and in 2002 its financing underwent unification. Yet, the rate of premium applied is vastly different for employees and the self-employed, which has become the subject of increasing public complaints. Against this backdrop, this study suggests new paradigm of health care system integrating health care delivery, reimbursement, financing, system and resource allocation all together through Coordinated Care Organization adopting at Oregon Health Plan in U.S.
제1장 서론 제1절 연구 필요성 및 목적 제2절 연구내용 및 방법
제2장 보건의료체계의 환경변화 전망 제1절 저출산 고령화 제2절 저성장과 재정 여건 악화 제3절 만성질환 증가 제4절 보장성 확대 욕구 증가 제5절 보건산업의 미래 트랜드
제3장 보건의료체계의 현황 및 문제점 제1절 의료공급체계 제2절 의료전달체계 제3절 진료비 지불제도 제4절 제도의 지속가능성 제5절 기타
제4장 미국의 Coordinated Care Organization 검토 제1절 최근 미국 메디케이드 개혁 동향 제2절 CCO의 역사적 배경 제3절 CCO의 구성 요소 제4절 CCO와 MCO의 주요 차이 제5절 CCO와 ACO의 주요 차이 제6절 사례 연구: Health Share of Oregon
제5장 보건의료체계의 New Paradigm 제1절 OECD 국가들 속에서 보건의료 관련 우리의 현재 위상 제2절 보건의료체계의 향후 과제 제3절 보건의료체계 New Paradigm을 위한 제안