요양기관 법적 지위보장을 위한 법정책적 개선방안

Abstract

The health insurance system has developed remarkably over the past three decades. It began as the medical insurance system in 1977. For 12 years since its inception, the old system had focused on expanding the number of its beneficiaries. In 1989, the old system decided to cover self-employed people in urban areas. The same year, it was replaced by a new one, the current health insurance system, to cover all people across social strata. Under Article 40 of the National Health Insurance Act, hospitals and clinics are forcibly designated by the government as institutions of medical treatment and recuperation. The health insurance system is designed to meet the needs of all people for medical services and benefits by raising sufficient funds for insurance coverage. The system of forcibly designating institutions of medical treatment and recuperation, however, ironically paved the way for an excessive distortion of the medical system, considering that it allowed medical authorities to manage and operate the medical system with unilateral control and instruction, instead of rational means. As an example, an “arbitrary exclusion of patients from health insurance coverage benefits in some medicines and treatment” became a big issue between St. Mary’s Hospital in Yeouido, Seoul and a group of leukemia patients in December 2006. The issue still remains a hot potato. Under the current National Health Insurance Act, medical institutions' arbitrary exclusion of patients from health insurance coverage benefits in some medicines and treatment, which are deemed absolutely necessary for certain groups of patients from a medical point of view, constitutes “fraud and deceit,” most of the Supreme Court case summaries have thus ruled. It is, therefore, noteworthy that Justice Cho Dae-hyun of the Constitutional Court directly recently commented on this issue when he presented his view on the constitutionality of an “atopic patient case.” There currently exists a judicial relationship between doctors and their patients under medical contract. Their relationship in this context never changes, although their relationship is affected by administrative authorities' intervention in the payment of medical expenses within the social security framework called health insurance. But national insurance coverage standards are nothing but regulatory rules aimed at attaining the goals of the health insurance system, not binding laws that could deny the effects of medical contracts between doctors and their patients. Now, it is high time to make a well-balanced constitutional interpretation of the trilateral relationship between doctors, patients and the National Health Insurance Corporation. The current doctors' fees are unrealistically low, which has caused discontent within medical circles and institutions. Under these circumstances, it is urgently necessary to increase the doctors' fees to a realistic level. Given the insufficient health insurance coverage funds, I hereby would like to suggest a way to expand tax revenues most realistically: to levy “health tax” as a national tax on the consumers of tobaccos, liquors and oil, substances deemed harmful to the people's health. I would also like to suggest a way to guarantee the legal status of institutions of medical treatment and recuperation legally and systematically : to establish an autonomous health insurance system based on market principles, so that medical staff and institutions can take a more proactive attitude toward their patients.