국민건강보험의 보장률 제고를 위한 비급여 의료비 관리 개선 방향에 대한 연구

Abstract

The private medical indemnity insurance is operated as compensation or subsidiarity for national health service. The private medical indemnity insurance covers all non-payment medical fee except deductable amount, but currently non-payment medical fees are not managed or controlled. The management of non-payment medical fees is closely involved with the improvement of national health service's coverage. In addition, the control on increase of private medical indemnity insurance cost can prevent senior citizens, who necessarily need private medical indemnity insurance, from cancelling the insurance considerably. For effective control and management of non-payment medical fees, most of all, the terminology of medical items and medical treatment should be standardized, and the standardization process of non-payment item codes is urgently required. Besides, it is necessary to collect and manage non-payment items' information of medical treatment and information of net cost. The notification system of non-payment medical fees should be improved for medical institutions to submit non-payment items' information of medical treatment to Health Insurance Review & Assessment Service, so that the price of non-payment treatment and the information of provided amount can be collected and open to public. Price comparison cites for non-payment items should be enhanced, and Health Insurance Review & Assessment Service should be able to identify medical fees by authority even if there is no request from patients. It seems appropriate that Health Insurance Review & Assessment Service should perform examination work for non-payment medical fees. Managing non-payment medical fees is a necessary matter that should be practiced to increase the coverage rate of national health service as high as the average level of OECD countries and to establish and execute sound medical policy.