건강보험 재정평가 = Financial evaluation of national health insurance system

건강보험 재정평가 = Financial evaluation of national health insurance system

신영석황도경 ; 남궁은하 ; 최인덕

◈ 건강보험 재정 관련 문제점 검토
◈ 건강보험 장단기 재정 추계 시행
◈ 건강보험의 지속가능성 제고를 위한 재정 관련 안정화 방안 모색

As of the end of year 2010, National Health Insurance (NHI) in Korea is expected to experience short-term deficit of 130 billion Korean Wons. Furthermore, economic and demographic factors are forcing health care expenditure to increase more rapidly. This paper aims to examine the fiscal status of the NHI and policy measures to improve it. The focus of the paper is on the fundamental changes required to achieve long-term fiscal sustainability for the NHI.
The financial evaluation of the NHI reveals that the increase rates of treatment expenditure differ by health care utilization types: Inpatient treatment expenditure (annual average of 15.36%) has increased more rapidly than outpatient (8.48%) or pharmaceutical (11.42%) expenditure has done for years from 2003 to 2009. Analyses to identify levels of contribution for number of beneficiaries, visit days per person and treatment expenditure per visit to the total expenditure were conducted, and the results show that the increased number of beneficiaries contributes 3.93%~6.96%, visit days per person contribute 17.05%~69.35% and treatment expenditure per visit contributes 26.12%~77.77% to increase the total treatment expenditure, depending on the utilization types. As the benefit amount in 2020 is estimated to be over 8,000 billion(Korean wons), policy measures to control rapidly increasing expenditure as well as those to secure finances are needed.
To strengthen the financial sustainability of the NHI, it is advised that the insurance finances be secured by increasing contribution rates, expanding government subsidy and redefining the scope of dependants. A reform of the payment system will strengthen the fiscal foundations of the NHI. For outpatient services, it is considered to promote the global budget payment scheme and phase in gatekeeper system. For inpatient services, it is recommended that DRG(Drug Related Groups)-based prospective payment system be introduced as complementing it with fee-for-service payment system when needed. At last, one of important measures to improve efficiency of health care expenditure under the NHI is to reform the pharmaceutical pricing system. Three reform scenarios are presented in this paper.
제1장 서 론
1. 연구의 배경 및 목적
2. 연구 방법 및 내용

제2장 선행연구 고찰

제3장 건강보험 재정 현황 분석

제4장 진료비 증가요인 분석
1. 진료비 항목별 증가 기여도 분석
2. 진료비증가 추이 분석
3. 진료비증가의 산술적 분석
4. 진료비 증가에 영향을 주는 요인

제5장 건강보험 재정전망 및 평가
1. 건강보험을 둘러싼 환경 변화 전망
2. 재정 관련 논의의 틀
3. 건강보험 재정 관련 문제점
4. 건강보험 재정전망 및 평가

제6장 재정안정을 위한 정책과제
1. 재원 확충 방안
2. 지출 효율화 방안
3. 진료비 지불제도 개편
4. 보험재정 안정을 위한 Built-in Stabilizer 체계 도입

보고서 번호
연구보고서 2010-31-7
KIHASA 주제 분류
사회보장 일반 > 사회보장재정
보건의료 > 보건의료 안전망
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