• 의료법학
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• 제8권2호
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• pp.119-164
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• 2007

Improving the formal objection system regarding reviewing medical expenses requires authority and confidence in the aspect of well-functioning the health insurance review and assessment system, legally and appropriately. The purposes of improvement of the formal objection system should aim for protecting the people's right of health. On handling the formal objections, the disputes of the rights should be settled economically and promptly by fairness, specialty, and objectivity in the health insurance review and assessment administration. Therefore, in order to promote the administrative specialty of health insurance, the formal objection committee needs to be organized independently and guaranteed expertly. Under the current formal objection system, however, the organization of committee lacks right-relief function, recognition and public relation as a health insurance appeal system, and related professional man powers. It is also analyzed that there are several controversial points, such as mass deliberation to the formal objection committee and its conference procedure. As a measure of improvement, it is analyzed that the committee needs to be organized independently with a proper number of professional man powers. The strict deliberation procedures and the prohibition of the decision-making by non-conference are also required to be empowered. The formal objection procedure provides the beneficiaries and the claims legitimately, so that it secures the legal relations on the health insurance system. Therefore, on the conference process of formal objection, the expert and guaranteed protection should be provided promptly, and its procedures to the appellants should also be assisted kindly.

• 의료법학
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• 제7권2호
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• pp.219-268
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• 2006

In July 1989, Korea had achieved the national medical insurance system comprehensively covering the whole population since its inception of 12 years before, and subsequently the plural medical insurers had integrated to the unique health insurer system in July 2000. But there yet remain some problems to be improved under low contributions rates and poor benefit packages, especially the shortage of assuring beneficiaries' rights. The Health Insurance Appeal System is composed of a two-tiered system of committee. The Formal Objection Committees built in the National Health Insurance Corporation and in the Health Insurance Review Agency respectively examine the formal objections to the decisions of the Corporation, or the Review Agency. And the Dispute Mediation Committee built under the command of the Minister of Health and Welfare reviews the protests against the decisions on the formal objections by each Formal Objection Committee. To cope with the appellant in relation to the administration on the qualification of the insureds, contributions, and insurance benefits etc, is found to be unsatisfactory. There's the reason of poor function on right-relief caused by the loose composition of the Appeal Committee, the deficit of people's recognition and P.R., the lack of professional manpower and the Committee's independency, and time lag in making decisions and so on. Consequently the Appeal System should be improved to secure the rights-relief function, to empower the professionalism of the Appeal Committee, to strengthen P.R. for the beneficiaries, to build up the staff's proficiency through training, and to develop the quality of administrative services.

• 융합보안논문지
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• 제15권1호
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• pp.105-113
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• 2015

이 연구는 신변보호사 자격제도의 발전을 위하여 그 동안 실증적으로 연구되어지지 않았던 신변보호사 자격시험 응시자들을 대상으로 신변보호사 자격시험 응시 중 자격제도에 대하여 갖고 있던 인식을 조사한 연구이다. 이를 통하여 신변보호사 자격시험에서 나타난 제 문제들을 질적분석 방법을 이용하여 파악하였다. 연구 결과는 다음과 같다. 첫째, 신변보호사 실기평가위원의 기술평가 능력 향상 모색이다. 둘째, 영상판독 시스템의 도입이다. 셋째, 모든 자격시험 점수 및 이의제청 내용 공개화이다.