국민건강보험법의 급여제한에 관한 고찰

Abstract

The objective of National Health Insurance is to promote people's health and improve the social security by providing necessary health insurance benefits for disease, injury, birth, and death, etc. In accordance with regulations of paragraph 1, Article 48 of the National Health Insurance Law, when a person who is eligible to receive insurance benefits falls under one of the following subparagraphs, the Corporation shall not provide any insurance benefit: 1. When he has intentionally or through gross negligence caused a criminal act or intentionally contributed to the occurrence of an accident; 2. When he has intentionally or through gross negligence failed to follow medical care related instructions of the Corporation or the medical care institution. According to these regulations, how to interpret and apply them, it may cause some problems related with insurance benefit which will be paid or not. This thesis will take a look at problems what have regarding the limited­payment reasons insurance benefits in the National Health Insurance. A rapidly ageing population, growing industrialization in modern society, longer life expectancy and various social risk are increasing the demand for insurance care as a remedy. The objective of National Health Insurance Law is to provide fundamental medical care service with low cost to people as much as possible. The National Health Insurance Law will guarantee people's health and income as replacing social risk with insurance. It turns away accident, the nature of insurance as prescribed the limited-payment reasons insurance benefits in the National Health Insurance. This is against both the mens legislatoris and mark legislatoris which is the goal of the country as insurer to promote people's health and happy life. Although some difficulties exist such as financial sector, to appropriate financial resources of the National Health Insurance Corporation. This is against both the mark legislatoris and nature of insurance law. Also in accordance with the provision as above, insured people would be interfered a minimum insurance benefit. It is desirable for insured people to provide health insurance benefits widely as deleting gross negligence, the limited-payment reasons insurance benefits in the National Health Insurance Law.