건강보험법제의 과제와 해결방안

Abstract

In the days of health welfare service in Korea, Health Insurance is important to our society. The reason is that Health Insurance is able to improve and maintain the level of population's health. The one of the hottest problems in Health Insurance is the steep rising fees for benefits because of personal increscent use of medical service, the rising number of people aged 65, the rising coverage rate of health insurance benefit and the improving equity of health insurance. There are many conflicts among doctors and hospitals to provide medical care expenses, patients to receive medical care expenses and government and the third party to manage the Health Insurance. Health Insurance has the challenges to secure the appropriate compensation to medical care service provider such as doctors and hospitals, simultaneously maintain the appropriate medical care expenses, secure the appropriate coverage rate of health insurance benefit and attempt the equity in medical care expenses provision and insurance bills imposition. There are many issues such as the method to collect health insurance fund, compulsory taking up an health insurance, every doctor and hospital's compulsory providing health insurance benefits, monopoly of the third party of health insurance, integration of the National Health Insurance Corporation and the Health Insurance Review Agency, auditing to the Health Insurance, Health Insurance card, patients sharing of the medical cost and payment for health insurance fee in Korean Health Insurance. There is the limit of the traditional legal hermeneutics and fragmentary or individual theoretical legal approach to suggest the desirable solution of Korean Health Insurance Law system to have many issues as above. Law & politics research is the legal research method to suggest the resonable understanding and seeking the measures through various approach, decide and evaluate that the legal methods can be functioned as the optimum system design. The constitutional consideration is important to support the interest coordination because of the shortage of resources. The comparative law research can compare our health care system with those of other countries and seek some desirable alternatives. If we discuss the law system plan in a long time and synthetically from different perspectives, more desirable health care law system can be deducted. Also it is important to enter into a contract on equal terms to concrete health insurance policy issues among doctor, patient and the insurer through reveling the health information. It is demanded to try to find a rational solution to a problem with health insurance through introduction of priori dispute settlement and enlargement of non-judicial settlement.