건강보험 행위료의 환산지수 탄력성에 관한 연구

Abstract

In spite of a financial crisis of National Health Insurance (hereafter, NHI), in recent years, negotiating conversion factor (which represents absolute level of price per one point of medical care) between National Health Insurance Center (hereafter, NHIC) and medical service providers is still a controversial issue. We aim to provide an objective guide for the impact of conversion factor on NHI’s financial budget. This helps the rational negotiation for sustaining NHI’s financial stability and improving the quality of public health. We investigate the health insurance expenditure elasticity of conversion factor. From the perspective of entire medical institution, we find that health insurance expenditure increases, on average, 2.898% per 1% increase in conversion factor. In addition, 44.49%~54.13% of changes in health insurance expenditure relates to the change of conversion factor, which accounts for approximately 1,100 billion won to 1,365 billion won in terms of health insurance expenditure amount. We contribute to prior research in developing prediction models. These models systematically gauge the effect of change in health insurance expenditure on NHI’s financial budget. These models also consider multiple factors such as, macroscopic environment, medical care price, medical care cost, volume of medical service, and medical policy.