Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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Establishment of Healthcare Delivery System through Improvement of Health Insurance System

건강보험수가제도 개선을 통한 의료전달체계 확립방안

  • Oh, Youngho (Health Care Research Department, Korea Institute for Health and Social Affairs)
  • 오영호 (한국보건사회연구원 보건의료연구센터)
  • Received : 2019.07.02
  • Accepted : 2019.08.02
  • Published : 2019.09.30
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Abstract

Establishing a healthcare delivery system is key to building a cost-effective healthcare system that can prevent the waste of healthcare resources and increase efficiency. Recently, the rapid increase in the national medical expenditures due to the aging of the population and the increase in chronic diseases has raised the question about the sustainability of the healthcare system including the health insurance system. This is why we need to reform the medical delivery system, including the function setting of medical institutions. Accordingly, gradual and practical efforts based on the recognition of reality are needed for solving the problems and improving the medical delivery system. The first effort is to secure policy measures to establish functions and roles of medical institutions which are the basis of the healthcare delivery system, and a systematic medical use system for appropriate medical use. This approach can be achieved through a reasonable health insurance schemes. Without reasonable reform efforts, it will be difficult for Korea's health care system to develop into a system that can provide cost-effective and high-quality medical services that the people want.

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References

  1. Myoung JI, Chung YC. Analysis on management of medical delivery system. Sejong: Korea Institute for Health and Social Affairs; 1991.
  2. Han D, Kim B, Lee Y, Bae S, Kwon S. An evaluative analysis of the referral system for insurance patients. Korean J Prev Med 1991;24(4):485-495.
  3. Lee WC, Kim JH, Lee WY, Park JL, Jo HH, Rim IG, et al. Challenges for establishing a medical delivery system. Healthc Policy Forum 2015;13(4):47-55.
  4. Lee SH. Direction of desirable primary health care reinforcement policy. Healthc Policy Forum 2011;9(3):54-59.
  5. Song KY, Moon OR, Kwon SM, Oh YH, Doh SR, Chung WJ, et al. Development of standard role and functions by classification of medical institutions. Sejong: Ministry of Health and Welfare; 2001.
  6. Oh YH, Jung SE, Yee NH, Kim DY, Lee YJ. An efficient utilization method of health care resources to keep medical expenses at an appropriate level in korea: focused on the attending hospital system. Sejong: Korea Institute for Health and Social Affairs; 2016.
  7. Kim KH. A study on the improvement of outpatient medical care concentration in tertiary general hospitals. Healthc Policy Forum 2010;8(4):106-113.
  8. Oh YH. Improvement ways for health care delivery system. Health Welf Policy Forum 2012;(189):50-67.
  9. Organization for Economic Cooperation and Development. OECD health statistics. Paris: Organization for Economic Cooperation and Development; 2016.
  10. Healthcare Future Planning Task Force Team. The Second Health Care Future Commission deliberation item no. 3, mid-term temporary estimation and economic and social meaning of national health expenditure. Seoul: Healthcare Future Planning Task Force Team; 2011.
  11. Ministry of Strategy and Finance. Long-term financial outlook for 2060. Sejong: Ministry of Strategy and Finance; 2015.
  12. Ministry of Health and Welfare; Korean Institute for Health and Social Affaires. Patient survey. Sejong: Ministry of Health and Welfare; 2002, 2005, 2008, 2010, 2013, 2015, 2016.
  13. Organization for Economic Cooperation and Development. OECD health data. Paris: Organization for Economic Cooperation and Development; 2018.
  14. Organization for Economic Cooperation and Development. Health status [Internet]. Paris: Organization for Economic Cooperation and Development; 2010-2018 [cited 2019 Mar 10]. Available from: https://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT#.
  15. Health Insurance Review and Assessment Service. Statistical index of medical expenses each year. Wonju: Health Insurance Review and Assessment Service; 2002-2017.
  16. Korea Health Industry Development Institute. National healthcare survey. Cheongju: Korea Health Industry Development Institute; 2018.
  17. Health Insurance Review and Assessment Service. Medical fee by topic [Internet]. Wonju: Health Insurance Review and Assessment Service; 2017 [cited 2019 Mar 15]. Available from: https://www.hira.or.kr/dummy.do?pgmid=HIRAA020033000000.
  18. Oh YH. Distortion of medical resources and medical utilization due to collapse of medical delivery system. Healthc Policy Forum 2013;11(3):46-54.
  19. Health Insurance Review and Assessment Service. Policy changes in patient's out-of-pocket costs. Wonju: Health Insurance Review and Assessment Service; 2019.
  20. National Health Insurance Corporation; Korea Institute for Health and Social Affairs. The effect of raising the copayment rate of drug costs for outpatient mild diseases. Wonju: National Health Insurance Corporation; 2015.
  21. World Health Organization. The world health report 2008: primary health care (now more than ever). Geneva: World Health Organization; 2008.