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KMID : 0378019740170030373
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New Medical Journal
1974 Volume.17 No. 3 p.373 ~ p.392
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A Review on the Activity of Medical Insurance Programs in Korea
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Abstract
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The medical insurance system of Korea was reviewed in comparison with that practiced in advanced nations on the basis of data collected from interview with concerned people and record search of the Pusan Blue Cross Medical Insurance Union and two other model medical insurance unions during a two-week period from August 6, 1973.
In the course of the review, studies were made on problems involved in the current medical insurance system in this country and also suggestions were made to improve and extend its practice in the future:
(1) Prior to the extended application of medical insurance, the medical system should be improved through the establishment of a new supervisory agency, division of labor between medicine and pharmacy, and functional redistribution between various medical facilities and professionals.
Also, more medical facilities should be set up in rural areas to minimize the urban concentration of medical facilities.
(2) The current Medical Insurance Law should be amended to allow the insured persons to freely choose medical institutions and physicians and to enable all the physicians to participate in insured medical practice.
(3) The number of model medical insurance union should be extensively increased from the current four. Simultaneously, the Government´s support and supervision should be strengthened.
(4) Medical care benefit, the major means of medical insurance business, should be increased to the maximum to give reasonable benefit to beneficiaries. This will be essential in attracting more prospective policyholders.
(5) Insurance money issued for child delivery and funeral in nominal in amount under the present system in view of the current commodity prices. Its rate should be increased to a realistic level. At the same time, reasonable measures should be worked out to enable the insurance unions to pay insurance money which they are presently suspending from payment.
(6) The premium rate should be raised to a level comparable with that practiced in advanced nation. The proportion of government subsidies should be increased to 20 per cent or more to help finance the medical insurance activity.
(7) In order not to follow adverse examples set by advanced nations, the currently debated authority to designate medical institutions should be designated through consultation with medical associations. Otherwise, the number of designated medical institutions should be extensively increased for the insured persons.
(8) In determining medical expenses and fees, appropriate consideration should be given to expanding medical facilities and improving the quality of medical personnel. Rates of medical expenses and fees should be uniformized with regional differences taken into consideration.
(9) In the method of expending medical fees, it is very efficient that the merits of capitation system and fee-for-service method should be applied to general practitioner, and salary method be applied to hospital´s medical specialist.
(10) The medical insurance supervisory authority should be unified. To this end, it should be directly operated by the Goverment and be placed under a single supervisory authority in each district.
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