• The Monthly Diabetes
• /
• s.259
• /
• pp.68-69
• /
• 2011

최근 보건복지부에서 '당뇨병용제 개정안'을 행정예고 하여 논란이 되고 있다. 건강보험 재정 안정화를 위해 발표된 이번 개정안을 두고 대한의사협회에서 당뇨병용제 급여기준에 대해 정부의 의도를 지적하고 나섰다. 이로 말미암아 복지부와 의사협회와의 대립이 고조되면서 긴장감이 흐르고 있다.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.36 no.4
• /
• pp.654-666
• /
• 2009

우식활성이 높은 어린이와 청소년 전체를 수용할 수 있는 치면열구전색(치아홈메우기) 사업의 확대 재생산을 위한 방안으로 건강보험 급여에 포함하는 정책이 2009년 12월부터 실시됨에 따라 본 연구는 급여화 기준 설정, 상대가치지수 개발 및 수가산정, 소요 재정추계 등, 급여화 운용을 위한 제반사항을 연구, 개발하는데 그 목적이 있다. 본 연구에서는 치면열구전색술의 적응증, 실시연령, 대상치아등에 대해 문헌고찰과 함께 상기 항목에 대한 정책적인 면에서의 검토를 시행하였으며, 치과의사를 대상으로 전국규모의 설문조사를 실시하여 치면열구전색술의 상대가치지수(RBRVS)와 연계한 의사업무량을 산출하고, 행위 기술서를 작성하였으며, 직접 및 간접비용의 세부내역 산출하였다. 도출된 상대가치지수를 바탕으로 예상수가를 산정하였으며 이를 근거로 대상 연령 및 대상치아, 의료 이용율 대비 재정추계 시행하였다. 이와함께 치면열구전색술의 급여화 순조로운 정착을 위한 외국사례 연구, 보험적용추진을 위해 치면열구전색의 유지율 및 비용효과, 예방적 레진수복과의 차등화문제, 재료적 고찰, 대국민 및 시술기관 대상 홍보 사항 등 급여화에 관련된 제반 사항을 검토, 제안하였다.

• Journal of the Korean Society of Radiology
• /
• v.12 no.7
• /
• pp.869-877
• /
• 2018

This study analyzed the current status of MRI (frequency, amount of treatment) based on the history of application of the MRI health insurance benefit standard and health insurance claim data. MRI examinations began as a health insurance benefit in 2005. In 2005, the indications were restricted for some diseases, but coverage for benefits in 2010, 2013, 2016, and 2018 was expanded. In 2021, the Ministry of Health and Welfare decided to apply health insurance for all MRI examinations. From 2010 to 2017, the number of MRI examinations increased by 86.7% in 2017 compared to 2010, and the amount of treatment increased by 53.5%. According to general characteristics, the number of MRI examinations was higher in women than in men. By age, the number of examinations was the highest among ages 70-79. Outpatient examinations were more frequent than inpatient examinations, and the number of examinations in the tertiary hospitals was the highest among the types of hospitals. The number of brain MRI examinations was the highest in each exam site. In December 2013, the standard of MRI was expanded for heart disease and Crohn's disease, the number of cardiac MRI and abdominal MRI examinations increased in 2014 compared to 2013. However, the number of examinations is small and not associate with the disease, it would be difficult to say that it affected the increase in the total number of MRI examinations. To assess health insurance sustainability and policy effectiveness, monitoring will be necessary.

• The Journal of the Korea Contents Association
• /
• v.19 no.1
• /
• pp.660-670
• /
• 2019

The purpose of this study is to elaborate the logical configuration of livelihood benefits for the institutionalized recipients under the renewed custom-tailored benefit system of National Basic Livelihood Security System(NBLSS) and to present appropriate level of benefits in terms of coherency of the system. In July 2015, the NBLSS was reformed to adopt a relative level of benefit standard for the general recipients according to certain amount of ratio of standard median income. However, the benefit for the institutionalized recipients was still based on the cost of necessities of absolute poverty level. It is at this juncture that this study suggests livelihood benefits for the institutionalized recipients reflect standard median income to comply with the reform of the NBLSS. To this end, this study firstly derives basic living items for the institutionalized recipients based on the literature review and FGI. Secondly, it calculates the reflection ratio of livelihood benefits utilizing Household Trend Survey's consumption data under 40%. Finally, it applies equivalence scale of households to adjust the under-represented scale for large size institutions. To continue the reflection ratio method, it is necessary to review the consumption trends and the stability of the reflection ratio periodically.

• Journal of the Korean Society of Radiology
• /
• v.81 no.5
• /
• pp.1053-1068
• /
• 2020

In accordance with the new healthcare policy of government (Moon Jae-In Care) to strengthen health insurance coverage, the National Health Insurance (NHI) coverage of brain magnetic resonance imaging (MRI), brain/neck MR angiography (MRA), and head and neck MRI have been expanded since 2018 in Korea. This article has been reviewed focusing on the "Detailed matter concerning criteria and method for providing reimbursed services in the NHI. Some revisions" regarding reimbursement for MRI, which was revised from October 2018 to April 2020 and is currently in effect. It included the MRI reimbursement system in Korea, recent adjustment of the reimbursement coverage for patients with headache or dizziness, and reimbursement coverage, standard imaging, and radiologic report of brain MRI, brain/neck MRA and head and neck MRI. This article could help radiologists gain knowledge on health insurance to protect the expertise of the radiologist and to play a leading role in the hospital. As the policy changes, detailed matter concerning criteria and method for providing reimbursed services in the NHI may be revised. Therefore, radiologists should update issues related to insurance reimbursement for MRI continuously.

• Journal of Teachers' Pension
• /
• v.5
• /
• pp.243-282
• /
• 2020

본 연구의 목적은 기준소득월액 상·하한 기준을 체계적이고 심도 있게 분석하여 실효성 있는 개선방안을 제시하는데 있다. 기준소득월액 하한 관련 주요 분석결과는 다음과 같다. 첫째, 현행 사학연금 기준소득월액 하한 수준은 낮은 편이다. 둘째, 기준소득월액 하한은 학교급별, 직능별로 5개의 하한선으로 구분하여 차등화하고 있어 사학연금 가입자간 부담금 및 급여의 형평성 문제가 발생하고 있다. 셋째, 세분화된 하한선으로 인해 사학연금 가입자들의 수용성(수요자) 측면의 문제와 불필요한 행정비용이 발생한다. 넷째, 하한의 연동방식이 부재하다. 또한 기준소득월액 상한 관련 주요 분석결과는 다음과 같다. 첫째, 기준소득월액 상한 기준 중 퇴직연금 등 연금급여 산정 시의 수준은 비교적 적절한 것으로 보이나, 일시금 산정 시의 수준은 다소 높은 것으로 판단된다. 둘째, 기준소득월액 상한은 연금급여 산정 시와 일시금 산정 시 기준으로 이원화 되어 있고, 일시금 산정 시 기준은 다시 교원과 직원으로 구분되어 있어 가입자간 부담금 및 급여의 형평성 문제, 가입자의 수용성 문제 및 행정적 비효율성 문제가 존재한다. 셋째, 상한의 연동방식 변경에 대한 검토가 필요하다. 이에 본 연구에서는 현행 하한선의 일원화 및 국공립 유치원·초·중·고 교사 1호봉인 165만 6천원까지 단계적으로 상향조정하는 방안, 현행 차등화된 하한선의 일원화와 하한 수준의 인상을 별도로 추진하기 보다는 동시에 추진하는 방안의 필요성, 이원화되어 있는 상한기준을 통합하여 일원화하는 방안의 필요성, 상한 및 하한의 연동방식으로 사학연금 전체 가입자 평균기준소득월액 변동률을 고려하는 방안 등을 제시하였다.

• The Journal of the Korean dental association
• /
• v.24 no.7 s.206
• /
• pp.643-644
• /
• 1986

• The Journal of the Korean dental association
• /
• v.30 no.5 s.276
• /
• pp.399-403
• /
• 1992

• Journal of The Korean Ophthalmological Society
• /
• v.59 no.11
• /
• pp.1039-1048
• /
• 2018

Purpose: To evaluate the effects of anti-vascular endothelial growth factor (VEGF) treatment on the healthcare-related finances of patients with age-related macular degeneration. Methods: Changes in health care financing due to newly introduced benefit standards were predicted over the coming 5-year period (2018-2022). We also analyzed the financial impact of scenarios in which agents similar to anti-VEGF, such as the over-licensed drug bevacizumab, were introduced. For this purpose, the future number of patients receiving anti-VEGF treatments was estimated for various scenarios based on National Health Insurance Corporation claims data followed by an estimate of the financial burden. Results: In the case of age-related macular degeneration, the current standard of care (14 times in a lifetime) was maintained in scenario 1. In 2018, the insurance budget for the coming 5-year period was estimated at approximately 440.3 billion won. The insurance cost for that period was estimated at approximately 560.1 billion won under the revised standard of December 2017 (scenario 2). For scenarios wherein, after 2020, similar treatments (scenario 3) and bevacizumab (scenario 4) were introduced, the estimated health insurance costs were 521 billion won and 419.7 billion won, respectively. Conclusions: Health insurance costs are projected to increase substantially due to the elimination of the 14 time pay standard; however, the actual budget will only moderately increase, due to new limitations of visual acuity ${\leq}0.1$ or in case of scarring/atrophic lesions. Clinically similar agents and bevacizumab could be considered as alternatives to anti-VEGF treatment for age-related macular degeneration.

• Korean Journal of Social Welfare
• /
• v.59 no.3
• /
• pp.75-97
• /
• 2007

The purpose of this article is to explore French 'minima sociaux', focusing its scheme, benefit determination rule and its level appreciation. First, on the its structure domain, French 'minima sociaux' presents the plural system in which there is eight categorical benefits and one general benefit. Il is the representation of the intention to guarantee minimum income for the dead zone people out of the social insurance application and also a historical product in different period, by different logic of benefits implementation. Second, comparing nine benefits based on the benefit determination rule, level of benefits for the poor without work ability is higher than one for the poor with work ability. Il represents one polarized perception toward for the poor according to have or not its work ability. Third, comparing level of 'minima sociaux' with relative poverty line, the level of the most 'minima sociaux' is placed under the poverty line. Nevertheless, it must not forget that 'minima sociaux' plays its role as the fundamental alternative for poverty alleviation, but not the only alternative. Fourth and finally, comparing with minimum income guarantee(SMIC in french), level of RMI benefit is estimated merely on the 50% of SMIC. We can consider that it is the result of the interaction of the complex factors, as the limited role of the state toward the minimum income guarantee for the RMI beneficiary and the intervention the logic of status instead of the logic of need, etc..