의료기술과 보건정책: 기술 확산과 정책 대안
Technology and Health Policy: Rapid Technology Diffusion and Policy Options in Korea
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보건의료에 있어서 의료 기술의 역할이 갈수록 증대되고 있다. 새로운 고가의료장비, 의약품, 의료시술 등은 건강과 삶의 질을 높이기도 하지만, 그와 동시에 치료의 강도를 증가시켜 의료비용 상승에 기여하기도 한다. 본 논문은 의료 기술의 역할 및 그 확산을 설명하는 이론을 검토하고 이와 관련된 제반 정책 이슈들을 한국을 중심으로 몇몇 OECD 국가의 경우를 포함하여 논의하였다. 한국에서 매우 빠른 의료 기술의 확산은 행위별 수가제와 같은 왜곡된 경제적 유인, 영리를 추구하는 민간 의료공급자들의 행태, 그리고 의료 기술의 도입을 규제하는 정책의 미비와 깊은 관련을 가지고 있다. 이처럼 의료 기술의 빠른 확산이 소비자측 요인보다는 의료공급자측 요인에 의해 크게 좌우되므로 정부 정책 역시 가격 규제, 진료비 지불제도 개편, 의료 기술 도입의 규제, 경제성 평가의 도입, 의료 기술의 안전성 규제 등에 초점을 맞추어야 할 것이다. 나아가 진료비 지불제도 개편이나 경제성 평가의 도입 등과 관련된 이해 집단의 반대에 따른 사회적 비용을 최소화하려는 전략 역시 필요할 것이다.
Abstract
Medical technology has played an increasingly important role in health care. New high-tech medical devices, brand-name drugs and medical procedures contribute to better health outcomes and improved quality of life. At the same time, however, heavy reliance on high-technology medical care results in the increase in the intensity of care and health care expenditure. This paper reviews both theoretical issues associated with the diffusion of medical technology in general and the policy issues of Korea along with a few OECD countries. Korea has experienced a very rapid diffusion of high-tech medical care due to the perverse financial incentive of providers associated with the fee-for-service system, dominance of private for-profit providers of health care, and the lack of regulation on the adoption of medical technology. Since the rapid diffusion of medical technology is driven by providers rather than by consumers, public policy should focus on health care providers such as price regulation, payment system reform, planning and regulation of technology adoption, economic evaluation, and safety regulation. Effective strategy is also in need to minimize the social costs associated with the implementationof payment system reform and economic evaluation mechanism for medical technology, considering the opposition by vested interest groups.
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