The cost of rural health insurance has increased 23.5% per annum for the past five years, which is equivalent to two-fold that of the industrial workers health insurance. Those 136 rural health insurance associations have made a surplus of 101
billion
won by 1993. However, it is problematic that differences in the power of financial solvency among rural health insurance associations become greater. In fact, 8 rural association ran financially red in 1993. The rural conditions expect to be
aggravated
rapidly under the pressure of the Uruguay Round agreement.
The eight policy objectives are set to overcome the impending financial problems. This study recommended that:
① The grants-in-aid be provided to the worthy poor rural associations at the end of fiscal year. The worthy poor rural associations have indicated that those rural associations paying the national average amount of contributions, yet making a
financial
deficit. ② The average net amount of contributions for the rural health insurance be maintained less than that for industrial workers and public officials and private school teachers. It is decided that in the long run the rural farmers and
fishmen pay
contributions according to their financial ability. ③ The benefit period of 180 days per annum be gradually expanded to 365 days within three and six years. ④ The use of high cost technology such as CT and MRI be included under the benefit
package. ⑤
The copayment of the poor be adjusted according to their ability to pay. ⑥ The corresponding preventive health services be included for members of rural insurance like those of other health insurances. ⑦ As to the efficient management, the
optimum
size of rural health insurance associations be pursued to get the advantage of economy of scale effect. ⑧ A change of payment method be considered for correcting the known disadvantages of fee-for-service payment. The DRGs is an example.
Some proposals mentioned above are the same as those made by the National Medical Security Reforming Committee. This study recommends the six stepwise approach to implement the proposals :
① The law be amended in a manner for the government to subsidize rural health insurance for the half of administration costs and that of benefit expenses. About 100 billion won will be reserved from this measure. ② A financial adjustment scheme
be
developed for the assistance to elderly care. From the scheme, about 70 billion won will be reserved in 1996. ③ Another financial adjustment scheme be added for the financial solvency of the worthy poor association. ④ The corresponding raise of
contribution is another potential source in accordance with the raise of insurance benefits. ⑤ (If financially in red still) the organization of a national farmers health insurance is another possibility. ⑥ (Despite these measures, deficit
financing
continuing) the last approach is to switch into the tax system for farmers and fishmen. The author believes that gradual reform can serve people better health. Thus, a stepwise approach is strongly needed in planning the rural health insurance
program.
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