공･사보험 연계에 대한 법적 연구 - 정보교류를 위한 법 개정 방향을 중심으로 -

Abstract

Among Korea's health insurance systems, the National Health Insurance (NHI), a public insurance system, and private health insurance (HSI) and automobile insurance have contributed to reducing the burden of medical expenses and securing the right to health, but as they are operated separately by different organizations, various inconsistencies have arisen between the systems, resulting in insurance financial leakage. Exploring the mutually beneficial relationship between the accidental death and disability insurance and the national health insurance, which has been enrolled by the majority of the population and has actually grown into an important pillar of national health security, is essential for the sustainability and quantitative and qualitative development of the national health security system. This paper examines specific problems such as insurance financial leakage that are occurring in the field due to the different claim, examination, and payment systems of each insurance system, and discusses the social costs. The problem of insurance leakage is a factor that worsens the finances of not only the National Health Insurance but also all insurance related to medical institutions, such as workers' compensation insurance, automobile insurance, and accidental medical insurance. To solve this problem, it is necessary to establish an information exchange system between public and private insurance while considering the purpose of each insurance system and the interconnectedness between them. This study examines specific insurance finance leakage problems caused by the lack of information exchange between public and private insurance, and examines the contents of the public-private insurance linkage bill proposed in the National Assembly for each issue and suggests revision directions. Although various studies have emphasized the need to establish a public-private insurance information exchange system, there is a lack of discussion on the legal review and revision of the law. This article examines specific cases arising from the lack of information exchange between public and private insurance and suggests ways to revise the law as a prerequisite for improving the system. It is hoped that the legal foundation for the exchange of public and private insurance will be systematically created to eliminate the blind spots in the existing legal system and find a solution for both insurance companies to coexist and solve social problems through the exchange.