인슈어테크 보험·금융규제 개선을 위한 ‘의료행위’의 해석 방향: 경제규제행정법적 접근을 중심으로

Abstract

The InsurTech industry, through its convergence with smart healthcare, is driving innovation in the insurance and financial sectors. Core services such as real-time health information provided by wearable devices and preventive care management enhance consumer health options while offering insurers new opportunities for risk management. However, despite these industrial potentials, the growth of the InsurTech sector remains constrained by the ambiguity surrounding the definition of ‘medical practice’ in current medical laws. This paper analyzes the concept of ‘medical practice’ as a critical regulatory element in light of the need to foster InsurTech development and regulatory reform. The current medical laws fail to provide a clear definition of ‘medical practice’, leading to blurred boundaries between the roles of medical and non-medical institutions. Consequently, activities like health management services or health information provision, often conducted by non-medical entities using wearable devices, risk being classified as medical practice, resulting in excessive regulatory oversight. In response, the Ministry of Health and Welfare introduced the second edition of the “Guidelines on Non-Medical Health Management Services”, which define medical practice as those requiring medical expertise, involving diagnoses, prescriptions, or treatments, and potentially causing public health risks. While the guidelines permit certain non-medical health services under specific conditions, they rely heavily on case-by-case exceptions and precedent-based definitions, failing to establish clear boundaries between medical and non-medical practice, thereby exacerbating confusion in practice. This paper reexamines the concept of medical practice from an economic regulatory administrative law perspective and proposes a regulatory reform direction for InsurTech services. By applying public interest and public choice theories, the research evaluates how medical act regulations can balance consumer safety and industrial innovation. Based on this analysis, the paper recommends adopting a comprehensive negative regulatory framework. Specifically, non-medical health management services performed under the supervision of medical professionals should be allowed, while only activities lacking credible institutional data or exhibiting diagnostic or prescriptive characteristics should be subject to regulation. Additionally, public health risk considerations should be limited to prevent redundancy with existing definitions and should rely on credible institutional data and medical oversight. This comprehensive negative regulatory approach provides the InsurTech sector with opportunities to expand preventive services without encroaching on the core roles of the traditional medical market. By clarifying the regulatory framework, it also reduces uncertainty for service providers and establishes a foundation for sustainable growth in the InsurTech industry.