건강보험 보험료 부담의 공정성 제고방안 = Raising Equity in Health Insurance Contributions

건강보험 보험료 부담의 공정성 제고방안 = Raising Equity in Health Insurance Contributions

신영석 ; 이준영 ; 윤장호

건강보험 ; 보험료
◈ 보험료부과체계의 변천과정
◈ 현행 보험료부과체계 와 문제점
◈ 현행보험료 부과체계에 대한 문제점
◈ 현행 보험료부과체계의 평가와 개선방안

The budget of the National Health Insurance has increased 12% over the last decade due to rapid population aging, increased income, new technologies, and increasing public demand for coverage expansion. The larger the size of the budget, the heavier the burden bearing on the public. And that burden is distributed among the public through an insurance contribution scheme, which should be equitable and acceptable for all beneficiaries. The contribution scheme of the National Health Insurance in Korea, however, still remains a dual system, even under a single insurer. That is, there are different contribution criteria in determining insurance premiums, eligibilities, etc. for different categories of the insured which are divided into employees and self-employed. While employees pay as premiums a fixed proportion of their income, premiums imposed on self-employed are determined by many variables, such as income, asset, automobiles, sex, and age. Because of this difference in premium-determining standards, the burden bearing on different categories of the insured shows a clear divide. Once a person loses his/her job, automatically being transferred into the self-employed category, even though his/her income has obviously decreased, he/she may have to pay even more premiums than before because of different criteria now being used against his/her assets, not his/her income. Such limitations of the current insurance contribution scheme are increasing public dissatisfaction. Furthermore, as the budget size is expanding at full speed, it's no more possible to maintain a dual contribution scheme. It is no more sustainable, thus a single insurance contribution scheme is urgently needed.
Therefore, this study has explored possibilities of introducing a single contribution scheme under a single insurer system, a scheme that applies the same contribution criteria for both employees and self-employed, taking into account equity, plausibility, and acceptability. Based on the results of an analysis on the ability to pay and contribution criteria of both categories of the insured, using data from the Welfare Panel, it seems too early to apply the same criteria for both categories of the insured now. If the contribution criteria for employees were used for both categories of the insured, it would rather increase inequality. A regression analysis has found that the automobile is not a proper criterion for determining premiums and it turned out that, in general, assets have no direct relationship with the ability to pay premiums. A policy to provide subsidy to those hired at a company with five or more employees, which will be implemented from 2012, will be able to transfer those currently in the self-employed category to the employees category. Also, if those with special occupations such as instructors hired by home-visiting education services companies, currently categorized as the self-empoyed, can be transferred into the category of employees, the ratio of the employee insured will likely increase to 75% from the current 66.2% in a short period of time. Then, it will be possible to implement a single insurance contribution scheme which will impose premiums based on a mix of a fixed amount of basic premium plus total income, including pension benefits, rent, and business income.
Abstract 1

요약 5

제1장 서론 23
1. 연구필요성 및 목적 23
2. 연구내용 및 방법 25

제2장 건강보험료 부과체계 선행연구 검토 31

제3장 외국의 부과체계 및 재원소스별 비교 41
1. 독일 의료보험 재정 41
2. 프랑스 의료보험 재정 49
3. 오스트리아 의료보험 재정 58
4. 일본 건강보험 재정 62
5. 스위스 의료보험 재정 70
6. 영국 NHS의 재정 76
7. 이탈리아 NHS의 재정 80
8. 벨기에 의료보험 재정 85
9. 네덜란드 91

제4장 건강보험료 부과체계 현황과 문제점 103
1. 현행 보험료 부과체계 현황 103
2. 현행 보험료 부과체계의 문제점 107
3. 피부양자 인정조건의 문제점 115

제5장 직장, 지역, 가입자간 소득 및 생활실태 분석 121
1. 분석 데이터 분포 122
2. 통계 비교 분석 결과 132
3. 백분위수 소득계층별 직장, 지역간 생활실태 비교 137
4. 직장가입자의 근로 소득 및 지역가입자의 순사업 소득과 총소득과의 관계 분석 139
5. 이원화된 건강보험료 부과 방식의 형평성 분석 141
6. 형평성 향상 모델 탐구 145
7. 시사점 149

제6장 건강보험료 부과체계 개편방향 153
1. 보험료부과체계 개편의 기본 원칙과 방향 153
2. 새로운 보험료 부과체계 154

제7장 결론 169

참고문헌 173

부록 181
보고서 번호
연구보고서 2011-11
KIHASA 주제 분류
보건의료 > 보건의료 안전망
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