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건강보험 지불제도의 개편방향

 대한임상보험의학회지, Vol.8(1) : 5~14, 2013 
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In Korea, there are many discussions about payment system of Health Insurance. The discussing points are low level of payment and introduction of bundled payment (DRG like payment, DPC like payment, DPC payment). This paper describes the diagnosis of Korean healthcare system related to payment system, and the directions of payment system for solving the problems of Korean system. The problems related to payment system are long length of stay (LOS), many outpatient visits and low quality of primary care. For reducing LOS, I suggest to introduce DPC payment system. Korea has the payment system that reimburses together doctor's fee and hospital's bill, is different to U.S.A but same to Japan. DPC system has the mechanism of reducing LOS directly. For reducing outpatient visits and improving quality of primary care, I suggest the framework introducing various payment system of outpatient care - gatekeeping systems and patient-centered medical home, etc. Because Korean Health Insurance has a uniform benefit system. And I suggest to introduce the strategy of comsumer's behaviors with changing payment system. The important item in changing payment system is reasonable reimbursement of doctors and hospitals, that the efforts and costs of doctors and hospitals will be compensated regardless of any payment systems. This will be guaranteed to prevent some distorted provider's behaviors and to increase health of the patients and the population.
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1. 연구논문 > 1. College of Medicine > Dept. of Preventive Medicine
Yonsei Authors
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