Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
권호 표지
DOI QR코드

DOI QR Code

Priority-setting in Expanding the Basic Benefit Package in Korean Health Insurance Scheme

건강보험 기본급여의 우선순위

  • 정형선 (연세대학교 보건행정학과) ;
  • 김주경 (연세대학교 보건행정학) ;
  • 이규식 (연세대학교 보건행정학) ;
  • 신의철 (가톨릭의대예방의학교실)
  • Published : 2004.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Universal health insurance normally requires a basic benefit package, whose design intersects with almost all other aspects of the health insurance debate. Despite its central importance, basic benefit package has not received the analysis it deserves in Korea. The issue of how to decide which health services should be delivered and to whom has been a matter for consistent policy debate. Many industrialized countries observed in this study have been dealing explicitly or implicitly with the basic benefit package. The methods vary from having a specific positive list of services (Bismarkian countries) to the use of guidelines (Beveridgian countries). The purpose of this paper is to form the underlying principles and process for determining what is included or left out by getting accurate and representative responses from health-related personnel. Mail survey is used. Economic burden for treatment, seriousness of disease and urgency of treatment are ranked at the first three priorities. Services that had been suspended because of financial crisis in health insurance scheme in 2001 were selected as items which should firstly be expanded into coverage. Diagnostic test against heart disease and vaccination were also selected as items which should additionally belong to the list of covered services.

Keywords

References

  1. 김용익, 이평수, 조홍준. 건강보험 재정설계 연구. 서울 : 국민건강보험공단2000.
  2. 박종연, 한만호, 김재연, 서남규. 건강보험제도 발전을 위한 국민 인식도 조사연구. 서울 : 국민건강보험공단2003.
  3. 배상수. 근거 중심 보건의료정책 수립: 보건의료서비스의 우선순위결정과 보건목표 설정. 건강보장연구 2001;통권(4)
  4. 이석구, 신의철, 이무식. 무료예방접종사업의 효율적 추진을 위한 업무개발과 정보관리 방안 연구. 서울 : 국립보건원2003
  5. 정형선, 이재현. OECD 기준에 따른 국민의료비의 추계를 통해 본 의약분업 전후 우리나라 의료비의 구조변화. 보건경제연구 2003;19(2).
  6. 최병호, 신윤정, 신현웅. 질병위험 보장성 강화를 위한 건강보험 본인부담 구조조정 방안. 서울: 한국보건사회연구원2003.
  7. 건강보험연구센터. OECD 국가의 의료보장제도, 서울건강보험연구센터:2003.
  8. 국민건강보험공단. 건강검진.암검사 사례연구-해외출장보고서-. 서울국민건강보험공단2003.
  9. 厚生統計協會. 保險と年金の動向. 2001
  10. Barker C, Green M. Opening the debates on DALYs. Health Policy and Planning 1996;11:179-183. https://doi.org/10.1093/heapol/11.2.179
  11. Blumstein JF. The Oregon experiment: the role of cost-benefit analysis in the allocation ofmedicaid funds. Social Science and Medicine, 1997;45(4):545-554. https://doi.org/10.1016/S0277-9536(96)00395-4
  12. Burls A. Public participation in public health decision cited from Bradley DP, Burds DA. Ethics in Public and Community Health, Routledge(NY):2000.
  13. CNAMTS
  14. Cumming J. Core services and priority-setting: the New Zealand experience. Health Policy 1994;29:41-60. https://doi.org/10.1016/0168-8510(94)90006-X
  15. Deber R, et al., The public/private mix in health care, parts 1 and 2. Ottawa: national forum on health. 1995. and (20 January 2002).
  16. Dunning Committee(Government Committee on Choices in Health Care). Government committee on choices in health care. 1992.
  17. Harrison S, Hunter, DJ. Rationing health care. 1994.
  18. HMSO(DOH). Priority setting. 1995.
  19. Kassenaztliche Bundesvereinigung, Grunddaten zur Vertragsätztlichen Versorgung in der Bundesrepublik Deutschland. 1999.
  20. Locock L. International perspectives on priority-setting in health care cited from Bradley DP, Burds DA. Ethics in Public and Community Health. Routledge(NY);2000.
  21. Loning Committee(NOU). Setting Priority Again. 1997.
  22. National Advisory Committee on Core Health and Disability Support Services. Core services. Wellington. (1993c)1994/95.
  23. New B. Defining a package of health care services the NHS is responsible for: the case for. British Medical Journal 1997;314:503-505. https://doi.org/10.1136/bmj.314.7079.503
  24. Oregon Health Services Commission. Prioritization of health services: a report to the governor legislature. 1991.
  25. Oregon Health Services Commission. Prioritization of health services: a report to the governor and the 72nd oregon legislative assembly. 2003.
  26. OECD. Towards high-performing health system. Paris:OECD;2004.
  27. Schrijvers AJP. Health and health care in the Netherlands. Utrecht:De Tijdstroom;1997.
  28. Swedish Parliamentary Priorities Commission. Priorities in health care: ethics, economy, implementation. 1995.
  29. UK Department of Health. Government response to the first report of the health committee, Session 1994-95 Priority Setting. London:HMS;1995.

Cited by

  1. Measuring the Burden of Disease in Korea vol.22, pp.3, 2007, https://doi.org/10.3346/jkms.2007.22.3.518