국내 의료계에서 시행 중인 금전적 인센티브 제도의 윤리적 쟁점들
Ethical Considerations on the Financial Incentive Systems at Hospitals in Korea
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초록
국내의 많은 병의원에서 시행 중인 인센티브 제도는 대부분 진료수입에 따른 성과급의 형태이다. 이런 인센티브는 과잉진료를 하도록 유인하고 의사-환자 간의 신뢰를 무너뜨림으로써 의사의 직업전문성을 위협한다. 또한 조직문화에 부정적인 영향을 미치며, 진료영역을 왜곡시킬 수 있다. 저자들은 4가지 사례를 통해 이를 분석하고, 바람직한 인센티브가 가져야 할 조건을 제시했다. 바람직한 인센티브의 조건들은 환자에게 해악이 가지 않아야 하며 이를 위해 안전장치를 두어야 하고, 수익이 아니라 진료의 질이 목표가 되어야 하며, 조직화합을 해칠 만큼 금액이 과도해서는 안 된다. 무엇보다도 인센티브에 대한 논의를 수면 위로 끌어올리는 것이 중요하다.
Abstract
Many hospitals in Korea offer financial incentives to doctors based on the income they generate for the employers. These incentives encourage over-treatment and threaten professionalism by eroding the trust between physicians and patients. This article presents four cases that illustrate how these incentives can have adverse effects on institutional culture and pervert the delivery of medical services. This article also proposes the following guiding principles for an improved system of incentives: it should be designed with mandatory safe-guards to avoid harmful effects on patients; the overall purpose of the incentive system should be to improve the quality of medical care rather than to increase the income of hospitals; and the amount of money individual doctors can receive through financial incentives should remain modest so as to preserve institutional integrity. This article aims to promote more widespread discussions concerning the problems related to the incentive systems used by hospitals in Korea.
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