• Title/Summary/Keyword: 국민건강보험법

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The Violation of Medical law and liability of tort regarding National Health Insurance Service (NHIS) - Supreme Court 2013. 6. 13 Sentence 2012Da91262 Ruling, 2015. 5. 14 Sentence 2012Da72384 regarding the Judgment - (의료법 위반과 국민건강보험공단에 대한 민법상 불법행위책임 - 대법원 2013. 6. 13. 선고 2012다91262 판결, 2015. 5. 14. 선고 2012다72384 판결을 중심으로 -)

  • Lee, Dong Pil
    • The Korean Society of Law and Medicine
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    • v.16 no.2
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    • pp.131-157
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    • 2015
  • NHIS claimed for damages to doctors that by doing the treatment breaching medical insurance criteria caused by doctors, NHIS paid for medicine cost to pharmacy; as a result, the doctors caused the tort to NHIS. Following consecutive rulings afterwards, NHIS also argued that the medicine cost violating medical law or medical treatment expense paid to medical organizations are both the tort in civil law. NHIS claimed for all the damages, and the Supreme Court confirmed this judgment. However, within our national health insurance system, the subject of insurance payment is NHIS and the subject of medical treatment expense are also NHIS since the treatment expense is also insurance payment by asking the treatment to medical organizations. Further, national health insurance law is not made to control the violation of medical treatment cases; therefore, the breach of medical law cannot be covered by illegality of tort in civil law regarding NHIS. If that is the case, in the case that if the patients are treated according to treatment criteria via the doctors delegated the doctors' permission by Health and Welfare minister, NHIS acquired the benefits to remove the duty to give treatment payment to doctors in civil law; thus, even though the doctors have breached the medical law, NHIS does not have any damages. The fact that supreme court confirmed the ruling that the treatment is the tort in civil law towards NHIS is the judgment not counting the benefits of insurance payment as the subject but only considering the fact that NHIS paid to the doctors and this ruling have gone against the principle under civil code section 750. If the doctors have breached the medical law, the case should be sanctioned by medical law not national health insurance law, and the ruling of supreme court is assumed that they have confused both with the principle of national health insurance law and civil law.

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Compensation for Personal Injury and the Insurer's Claim for Indemnity - Focused on the NHIC's Claim for Indemnity - (인신사고로 인한 손해배상과 보험자의 구상권 - 국민건강보험공단의 구상권을 중심으로 -)

  • Noh, Tae Heon
    • The Korean Society of Law and Medicine
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    • v.16 no.2
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    • pp.87-130
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    • 2015
  • In a case in which National Health Insurance Corporation (NHIC) pays medical care expenses to a victim of a traffic accident resulting in injury or death and asks the assailant for compensation of its share in the medical care expenses, as the precedent treats the subrogation of a claim set by National Health Insurance Act the same as that set by Industrial Accident Compensation Insurance Act, it draws the range of its compensation from the range of deduction, according to the principle of deduction after offsetting and acknowledges the compensation of all medical care expenses borne by the NHIC, within the amount of compensation claimed by the victim. However, both the National Health Insurance Act and the Industrial Accident Compensation Insurance Act are laws that regulate social insurance, but medical care expenses in the National Health Insurance Act have a character of 'an underinsurance that fixes the ratio of indemnification,' while insurance benefit on the Industrial Accident Compensation Insurance Act has a character of full insurance, or focuses on helping the insured that suffered an industrial accident lead a life, approximate to that in the past, regardless of the amount of damages according to its character of social insurance. Therefore, there is no reason to treat the subrogation of a claim on the National Health Insurance Act the same as that on the Industrial Accident Compensation Insurance Act. Since the insured loses the right of claim acquired by the insurer by subrogation in return for receiving a receipt, there is no benefit from receiving insurance in the range. Thus, in a suit in which the insured seeks compensation for damages from the assailant, there is no room for the application of the legal principle of offset of profits and losses, and the range of subrogation of a claim or the amount of deduction from compensation should be decided by the contract between the persons directly involved or a related law. Therefore, it is not reasonable that the precedent draws the range of the NHIC's compensation from the principle of deduction after offsetting. To interpret Clause 1, Article 58 of the National Health Insurance Act that sets the range of the NHIC's compensation uniformly and systematically in combination with Clause 2 of the same article that sets the range of exemption, if the compensation is made first, it is reasonable to fix the range of the NHIC's compensation by multiplying the medical care expenses paid by the ratio of the assailant's liability. This is contrasted with the range of the Korea Labor Welfare Corporation's compensation which covers the total amount of the claim of the insured within the insurance benefit paid in the interpretation of Clauses 1 and 2, Article 87 of the Industrial Accident Compensation Insurance Act. In the meantime, there are doubts about why the profit should be deducted from the amount of compensation claimed, though it is enough for the principle of deduction after offsetting that the precedent took as the premise in judging the range of the NHIC's compensation to deduct the profit made by the victim from the amount of damages, so as to achieve the goal of not attributing profit more than the amount of damage to a victim; whether it is reasonable to attribute all the profit made by the victim to the assailant, while the damages suffered by the victim are distributed fairly; and whether there is concrete validity in actual cases. Therefore, the legal principle of the precedent concerning the range of the NHIC's compensation and the legal principle of the precedent following the principle of deduction after offsetting should be reconsidered.

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Substantial Fairness in the Administrative and Judicial Process of Medicine Price Cut in Korea (약가 인하 효력 발생 시점 차이에 따른 문제점과 그 해결방안)

  • Park, Sungmin;Lee, Taejin
    • The Korean Society of Law and Medicine
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    • v.20 no.1
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    • pp.25-43
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    • 2019
  • This study analyzed the problem of the time difference of medicine price cut in Korea according to the administrative and judicial process and sought to present the amendment in the related law to achieve substantial fairness. We considered unfairness of medicine price cut caused by the administrative and judicial process in three situations, the approval-patent linkage system, realistic differences in the practice of administration and suspension of price cut execution. Based on it, we reasoned out the solution to get substantial fairness in the administrative and judicial process of medicine price cut in Korea. Although each step of the administrative and judicial process is lawful and reasonable, the time difference of medicine price cut according to the administrative and judicial process can result in damages or windfall to both of pharmaceutical company and National Health Insurance Service. In the present legal system of Korea, it is unable to be correct. Thus, we present the amendment to correct the damages and windfall when it happens.

Improvement Plan of the Relevant Law to Protect Professional Support and Rights of Artists (예술인의 직업적 지원과 권리보호를 위한 관련법의 개선방안)

  • Noh, Jae-Chul;Kim, Kyung-Jin
    • The Journal of the Korea Contents Association
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    • v.18 no.8
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    • pp.483-493
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    • 2018
  • Through the improvement of the Labor Relations Act, the Social Insurance Act, and the Artists Welfare Act for occupational status and rights of artists, the character of workers, joining exception in the Employment Insurance Act, and applying exception in the National Health Insurance Act and the National Pensions Act should be recognized. For this, the scope of workers should be expanded through the interpretation of the court and legislation of the Labor Relations Act, and supporting range of social insurance should be expanded by applying exception in the National Health Insurance Act and joining exception in the Employment Insurance Act for artists who are currently excluded. Artists' compensation insurance that is an optional entry system and paid entirely by artists need to have effectiveness of the system through insurance support. The Artists Welfare Act also needs to be revised to strengthen legal protection for artists and it is important to secure finances for artists' welfare projects. The standard contract should be mandatory and a career certification system for artists should be established so that artists who need welfare benefits can not be omitted.