The tendency to pursue expensive medical care at the deluxe general hospitals in
metropolitan areas has also increased. This rite change in utilization behaviors has resulted in over-crowding of the outpatient departments with long waiting lines and the rapid increase of the cost of medical -care. Several policy options are under review by the Government to discourage the insured from non-emergency direct visits to general hospitals. The basic strategy would be to establish an insurance health care -delivery system through the introduction of a rationalization concept. A similar method -of health care delivery is already in force -for the recipients of the Medical Care -assistance Program. As a preparation for -such undertakings, MOHSAA commissioned the Korean Institute of Population and Health (KIPH) to study the rationalization of the nationwide health care delivery network based on minimum travel distance from -areas of residence to the nearest medical -service point, coupled with the concept of -optimum resource allocation.
Two different modes of direct social security medical care systems are under -operation at the 13 demonstration projects. For the -voluntary self-employed programs, -medical services are provided directly by ´their own personnel and facilities. They have been operating for: the last 14 years. This pattern was reported to have advantages in maintaining the financial stability of the Class II societies compared with the other T self-employed health insurance societies operating through an indirect pattern of medical provision. 20 For the compulsory self employed program medical services are purchased through the public health center system, which already operates health and medical programs under the direct pattern. This method is reported to achieve a remarkable economy in the operation of health insurance societies. 2l However, it is suffering from shortage of medical manpower and material resources.
The Korean health insurance program has set an ambitious goal of implementing a system of universal coverage by 1988, which will comprise of either three separate programs or one unified program. Despite the difficulties foreseen, there seem to be no better alternatives if the predicament of the non-insured are taken into account, for they have to pay an estimated 57 percent above the insurance fee schedule for the same treatment. Therefore, a simultaneous rationalization of the health service organization is an absolute necessity, and the development of the social security medical care system for the Class II scheme is a strong possibility.
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