보험자 내부경쟁을 통한 효율화 방안 연구
The Enhancement of Fiscal Expenditure Efficiency of NHI with an Adoption of Internal competition
김진수; 최인덕; 박일수; 이기주
Regulated competition; NHI medical expenditure efficiency; Risk assessment
건강보험 내부경쟁을 통해 재정지출 관리 측면에서 운영의 효율성을 기할 수 있는 방안 검토
This paper aims to enhance fiscal expenditure efficiency of NHI through adoption of internal competition. Geographically Weighted Regression (GWR), a local regression analysis which allows the spatial non-stationarity of relationships between variables to be examined, was applied to impose target expenditure on NHI Corporation sub-branches and to reflect each of the branches’ distinctive characteristics. Outcome of the research shows that there exist various contributing factors behind variation of medical costs by regional headquarter or by sub-branch. It is, however, deemed necessary to adopt internal competition to better manage relevant expenditures. Instead of adopting a competition model under full market condition, it is desirable to adopt one under managed or controlled circumstance. Adoption of risk management assessment program activated in countries where multiple insurance agencies are available would be an appropriate alternative. Responsible institutions’ effective management capabilities are required to ensure effective implementation of internal competition. Refurbishment of duties and responsibilities of NHI Corporation and Health Insurance Review and Assessment Service is, thus, necessary. There exist both positive and negative sides when refurbishing institutional functions and duties. Cautious and prudent approaches and decision making are, thus, keys in this regard. It is important to trace and tackle down regulatory or systematic impediments. First of all, it is necessary for Ministry of Health and Welfare, the responsible institution, and NHI Corporation, the implementing institution to strengthen their shoulder-to-shoulder partnership. Under current partnership setting, NHI Corporation is hardly able to function under its own discretion. Its function is within the scope of the implementation guideline and is also under strict supervision of Ministry of Health and Welfare, the responsible institution. Active inter-branch competition was difficult to initiate under such setting. Other countries, on the other hand, have empowered health insurance agencies to fiscally function under their own discretion to some extent. Review in this context is deemed necessary.
Abstract 요 약 제1장 서론 제1절 연구의 필요성 및 목적 제2절 연구방법 제2장 내부경쟁 이론 고찰 및 시사점 제1절 내부경쟁 이론 제2절 국내 내부경쟁 사례분석 제3장 국민건강보험공단 내부 경쟁 현황 및 시사점 제1절 보험자 내부경쟁 현황 제2절 시사점 제4장 주요 외국의 건강보험 내‧외부 경쟁 현황 제1절 대만 제2절 네덜란드 제3절 독일 제4절 스웨덴 제5절 시사점 제5장 내부경쟁 필요성 및 적용방안 모색 제1절 내부경쟁 필요성, 경쟁방향 및 적용 방안 모색 제2절 내부경쟁 적용모형 검토 제6장 결론 및 정책제언 참고문헌 부 록 부록 1. 지역본부별 관할지사(2009년 기준) 부록 2. 기존 지역본부 및 지사평가 지표(2009년 기준)