건강보험 지불보상제도에 대한 새로운 제안:‘고정비-변동비’의 형태의 도입

Abstract

This paper proposes a new method to reimburse providers, considering the cost structure of providers. Even though the costs are composed of fixed costs and variables costs, the current reimbursement system for the providers is basically fee-for-service system, in which total payment(revenue of providers) is unit price times quantity in principle. Thus the providers are exposed to the variability of the profit, and perverse incentive for over-treatment under the current reimbursement system. Providers with low activity level incur huge losses while providers with high activity level can earn enormous profits. The new proposed reimbursement system makes use of the fact that the total costs are made up of two components - fixed costs and variable costs. Instead of setting one unit price for the services, reimburse the providers with two stage payments - fixed part and variable part. Under this system, the variability of the providers' profit is lowered and also the incentive to overtreat is reduced, leading to Pareto improvement.