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KMID : 0362720100480010006
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Journal of the Korean Dental Association
2010 Volume.48 No. 1 p.6 ~ p.11
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The direction of reforming the country’s health insurance system
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Lee Soo-Ku
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Abstract
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Amid the rapid transitions in both local and international markets, the Korean dental industry is facing more challenges than at any time in its history. This paper tried to address some of the key issues faced by the industry as well as the policy issues and direction of implementation that the Korean Dental Association (KDA) is expected to tackle. First, the direction of reforming the country’s health insurance system was examined with emphasis on the expected changes in and improvement of the fee-forservice reimbursement system (FFSRS) and medical reimbursement system (MRS). With FFSRS, the most urgent issue would be ameliorating the current lop-sided, unreasonable reimbursement system that prevents suppliers from voicing their opinions. To help achieve that goal, the limited authority and responsibility of the president of National Health Insurance Corporation (NHIC) as one of the contract-making parties must be clarified. In addition, the functions of NHIC’s Health Insurance Finance Committee must be restricted; at the same time, the panel organization of the Health Insurance Policy Review Committee needs to be reformed to embrace greater democracy. As with MRS, the government is considering a block budget bill to help promote efficiency in employing and managing the health insurance fund. Policymakers must understand that the implementation of such proposal could exacerbate an already dire situation. Improving MRS requires meeting the following preconditions: (a) the structurally vicious cycle of small charge-small salary needs to be resolved, and a certain percentage of fee raise must be guaranteed on a yearly basis to help adjust the fee system to a more realistic level; (b) the supply-and-demand balance in producing health care professionals must be improved including the prevention of oversupply of doctors, nurses, etc., and; (c) institutional strategies must be provided to enhance the quality of medical care and ensure academic advancement in health care
disciplines.
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KEYWORD
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Korean Dental Association (KDA), The fee-for-service reimbursement system (FFSRS), National Health Insurance Corporation (NHIC)
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