DOI QR코드

DOI QR Code

실손형 민간의료보험의 도입이 국민건강보험 재정에 미치는 영향

Impact of Complementary Private Health Insurance on Public Health Spending in Korea

  • 허순임 (한국보건사회연구원, 국민건강보험공단) ;
  • 이상이 (제주대학교 의과대학 의료관리학교실)
  • Huh, Soon-Im (Korea Institute for Health and Social Affairs Health Insurance Research Center, National Health Insurance Corporation) ;
  • Lee, Sang-Yi (Department of Health Policy and Management, School of Medicine, Cheju National University)
  • 발행 : 2007.06.30

초록

Limited coverage for health care services of National Health Insurance(NHI) in Korea has been ongoing policy issue but additional NHI financing through raising contribution or taxes in order to improve coverage faces substantial obstacles. Private health insurance(PHI) is often considered as an alternative financing source to improve coverage. Recent reform that attempted to stretch the role of PHI allowed life insurance companies to provide complementary PHI, indemnity plan which will pay for uncovered services by NHI and out-of-pocket spending for covered services. Although complementary PHI may relieve financial burden of patients, it may significantly raise NHI spending as well as total health expenditure since little out-of-pocket spending may increase utilization of health care. So far, there has not been enough discussion about concerns of potential adverse effect resulting from extended role of PHI. This study investigated potential increase of NHI spending followed by extension of complementary PHI through sensitivity analysis. The amount of NHI spending for services that would be covered by complementary PHI was calculated using 2005 NHI statistics and expected complementary PHI enrollment rate by age and sex. Expected utilization increases were obtained based on price elasticities$(-0.2{\sim}-0.5)$ from previous studies and expected coverage rate$(50{\sim}80%)$ of complementary PHI and then converted to monetary figures. Because coverage rate of complementary PHI has not been determined yet, we employed the sensitivity analysis using coverage rate of $50{\sim}80%$. Findings demonstrate that additional spending for health care services is expected to be $426{\sim}1,702$ billion won, corresponding amount payed by NHI $298{\sim}1,192$ billion won. In conclusion, since complementary PHI may raise NHI spending significantly, there should be an agreement whether this additional cost would be accountable and acceptable in our society. Potential inefficiency resulting from extended role of complementary PHI should be considered since public and private financing do not operate in isolation and there should be more discussion on proper role of PHI in Korea.

키워드

참고문헌

  1. 김정희, 정종찬, 김성옥. 건강보험 환자의 본인부담 진료비 실태조사. 서울:건강보험공단;2004
  2. 김춘배, 이도성,김한중,손명세.의료보험하에서의 의료수요의 가격탄력성에 관한 실증분석. 예방의학회지 1995; 28(2):450-461
  3. 김한중, 이해종. 전국민 의료보험 실시에 따른 사회전체 순편익 분석, 예방의학회지1989;22(3):398-405
  4. 이상이, 전창배, 이용갑, 허순임, 서남규. 의료의 산업화와 공공성에 관한 연구 :의료산업화를 위한 바람직한 정책방안 모색. 서울: 국민건강보험공단;2005
  5. 이진석, 김헌수, 김재현, 정백근, 강창구. 민간의료보험 실태와 영향 분석. 충북대학교, 건강보험공단;2005
  6. 이진석, 이상이, 정백근, 윤태호, 허순임, 이용갑, 정종찬. 국민건강보장을 위한 국민건강보험과 민간의료보험의 역할 설정방안. 충북대학교, 건강보험공단 2006
  7. 최숙자, 고수경, 김정희, 이상이. 계층화분석법을 이용한 건강보험 급여확대 상병 우선순위 결정. 보건행정학회지 2006;16(1):73-94 https://doi.org/10.4332/KJHPA.2006.16.1.073
  8. Atherly A. The effect of Medicare supplemental insurance on Medicare expenditures. International Journal of Health Care Financing Economics 2002;2(2):137-62 https://doi.org/10.1023/A:1019978531869
  9. Bhattacharya J, Vogt WE, Yoshikawa A, Nakahara T. The utilization of outpatient medical services in Japan. Journal of Human Resources 1996;31(2):450-476 https://doi.org/10.2307/146071
  10. Cherkin DC, Grothaus L, Wagner EH. The effect of office visit copayments on utilization in a health maintenance organization. Medical Care 1989;27(7):669-679 https://doi.org/10.1097/00005650-198907000-00001
  11. Christensen S, Shinogle J. Effects of supplemental coverage on use of services by Medicare enrolles. Health Care Financing Review 1997;19(1):5-17
  12. Colle AD, Grossman M. Determinants of pediatric care utilization. Journal of Human Resources 1978;31(SuppI):115-153
  13. Davis K, Russell LB. The substitution of hospital outpatient care for inpatient care. Review of Economics and Statistics 1972;54(2):109-120 https://doi.org/10.2307/1926271
  14. Feldstein PJ. General report', Report of the Commission on the Cost of Medical Care, Part I. Chicago:American Medical Association;1964
  15. Feldstein MS. Hospital cost inflation: a study of nonprofit price dynamics. American Economic Review 1971;60:853-872
  16. Fuchs VR, Kramer MJ. Determinants of expenditures for physicians' services in the United States ,1948-68. National Bureau of Economics Research Occasional Paper Series, No. 117; 1972
  17. Goldman F, Grossman M. The demand for pediatric care: and hedonic approach. Journal of Political Economy 1978;86(2):259-280 https://doi.org/10.1086/260666
  18. Imai Y, Jacobzone S, Lenain P. The changing Health system in France. OECD Economics Department Working Paper 269; 2002
  19. Khandker RK, McCormack LA Medicare spending by beneficiaries with various types of supplemental insurance. Medical Care Research Review 1999;56(2):137-55 https://doi.org/10.1177/107755879905600202
  20. MeAvinchey ID, Yannopoulos A. Elasticity estimates from a dynamic model of interrelated demands for private and public acute health care. Journal of Health Economics 1993;12(2):171-186 https://doi.org/10.1016/0167-6296(93)90026-B
  21. Newhouse JP, Phelps CE. Price and income elasticities for medical care services. The Economics of Health and Medical Care. New York:John Wiley & Sons; 1974 ch.9:pp 140-161
  22. Newhouse JP, Phelps CE. New estimates of price and income elasticities of medical care services. The Role of Health Insurance in the Health Services Sector. New York:National Bureau of Economic Research;1976 ch. 7:pp 261-313
  23. Newhouse JP, and the Insurance Experiment Group. Free for All? Lessons from the RAND Health Insurance Experiment.Cambridge,MA:Haravrd University Press;1993
  24. Norton EC, van Houtven CH, Lindrooth RC, Normand SL, Dickey B. Does prospective payment reduce inpatient length of stay? Health Economics 2002 Jul;11(5):377-87 https://doi.org/10.1002/hec.675
  25. Phelps CE, Newhouse JP. Effect of coinsurance: a multivariate analysis. Social Security Bulletin 1972a:20-28
  26. Phelps CE, Newhouse JP. Effect of coinsurance of demand for physician services. RAND Research Paper Series, No. R-976-OEO;1972b
  27. Phelps CE, Newhouse Jp. Coinsurance, the price of time, and the demand for medical services. Review of Economics and Statistics 1974;56(3):334-342 https://doi.org/10.2307/1923971
  28. Rosett, RN, Huang L. The effect of health insurance on the demand for medical care. Journal of Political Economy 1973;81(March/April):281-305 https://doi.org/10.1086/260028
  29. Scitovsky AA, McCall N. Coinsurance and the demand for physician services: four years later. Social Security Bulletin 1977:19-27
  30. van Vliet R.C. Deductibles and health care expenditures: empirical estimates of price sensitivity based on administrative data. International Journal of Health Care Finance Economics 2004 Dec4(4):283-305 https://doi.org/10.1023/B:IHFE.0000043759.93644.e0

피인용 문헌

  1. Effects of Private Health Insurance in National Health Care System vol.14, pp.1, 2014, https://doi.org/10.5392/JKCA.2014.14.01.200
  2. The effect of cost-sharing in private health insurance on the utilization of health care services between private insurance purchasers and non-purchasers: a study of the Korean health panel survey (2008–2012) vol.15, pp.1, 2015, https://doi.org/10.1186/s12913-015-1153-0