헬스케어와 보험업법상 쟁점 - 헬스케어서비스의 문제점과 해결방안 -

Abstract

Financial authorities have acknowledged the fact that private health insurance acts as a supplement to the national health insurance and in turn, they have been working on to promote relevant policies. For instance, the launch of public-health-promoting health care insurance products has been promoted by them. Nevertheless, the actual sales of public-health-promoting health care insurance products are facing with various limitations, including the conflicts in interpretation of a definition of medical practices in terms of Medical Service Act, of a scope of insurance business, stated in the enforcement ordinance of Credit Information Act and of a scope of prohibition on the offering of special benefits in Insurance Business Act as well as medical information sharing issues. Therefore, this article proposes the proper direction for the interpretation of a scope of medical practices allowed to be performed by non-medical personnel, and possible amendments to Insurance Business Act. and asserts the necessities of revision of Medical Act in terms of sharing of medical information and of other relevant Acts, including Privacy Act, to allow the use of medical information, of which the permission of its use is granted, within limited boundaries: medical treatment and/or health care. This article also emphasizes the importance of prospective interpretation of a scope of insurance business in order to provide of relevant information on the aforemen- tioned revision to insurance policy holders in need of such information, and states that the development and launching of insurance products using wearable devices could be promoted by limiting or excluding the prohibition of offering of special benefits in association with these devices. Considering that Insuretech would inevitably get active in most of insurance sectors as in health care sectors, the current regulatory system of insurance business, focusing on face-to-face transactions, should be changed to focus on untact transactions and from a positive method to a negative method, which is to allow in principle and to prohibit exceptionally. However, since the amendment of the regulatory system is closely associated with other regulations and Acts, it states that it would be necessary for regulatory authorities to make efforts to simplify and speed up the examination and issuance of relevant permissions, and the revision of existing Acts and/or the legislation of new Acts should be made promptly. It is believed, for example, that the prompt application of the Regulatory Sandbox and of Health Care Service Act could be the foundation from which health care services could develop.