J Korean Med Assoc.  2012 Oct;55(10):978-986. 10.5124/jkma.2012.55.10.978.

The reform of health insurance policy

• Ji YG

• KMID: 2192818
• DOI: http://doi.org/10.5124/jkma.2012.55.10.978

Abstract

The situations of health expenditures in Korea and their causes need to be understood and it needs to be reviewed whether DRG is suitable as an alternative for the payment system. Also, we want to present the problems and alternatives for the additional fee for medical institutions and the 'doctor-selecting' system. The current health expenditures in Korea is relatively low compared to the ones in other OECD countries, but they are rapidly increasing from the main causes of the expansion of long-term care and the increase of expenditures for medicines. When considering the particular situation of Korea, there is a concern that DRG can rapidly increase the health expenditures in a short time. The additional fee for medical institutions has irony in that the national health insurance corporation provides more benefits to the patients using bigger hospitals, and the 'doctor-selecting' system has a problem in that patients cannot actually choose doctors. Korean-specific DRG needs to be developed, the national health insurance corporation should give equal payments, and the 'doctor-selecting' system should be changed into another system. Studies on the empirical analysis on the situations of healthcare insurance and collection of diverse opinions of experts are required. Present promotion project on the healthcare insurance system cannot achieve the objective so the fundamental situations about this needs to be perceived and the alternatives need to be prepared.

Keyword

Health insurance; Payment system; Doctor selecting system

MeSH Terms

Delivery of Health Care
Diagnosis-Related Groups
Fees and Charges
Health Expenditures
Humans
Insurance
Insurance, Health
Korea
Long-Term Care
National Health Programs

Reference

1. Rosenberg MA, Browne MJ. The impact of the inpatient prospective payment system and diagnosis-related groups: a survey of the literature. North Am Actuar J. 2001. 5:84–94.

2. Ministry of Health and Welfare. The reform of payments for selecting a doctor. 2010. Seoul: Ministry of Health and Welfare.