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KMID : 0904520070220010067
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Health and Medical Sociology
2007 Volume.22 No. 1 p.67 ~ p.95
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An Analysis of the Dynamic Process of Setting Fees for Medical Services
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Choi Hee-Kyung
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Abstract
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This article purports to analyze the dynamic process of setting fees for medical services in the National Health Insurance. Internal documents from the Ministry of Health and Welfare and National Health Insurance Corporation as well as the in-depth interview data of decision makers concerned were employed.
The analysis of the decision-making process for medical fees(2000~2007) indicates that: The insured officially joined the Health Insurance Policy Committee, the main institution of setting fees for medical services, as the Payer Group, The Supplier Group and the Payer Group were all dissatisfied with the structure of the Committee, where the Public Interest Group handled the situations. Inside and outside the Committee, the representative groups strove for their own purposes with different strategies. Owing to distrust among the representatives, it was hard to reach an agreement on a research method for a rational level of fees. Instead the political negotiation or a compulsory vote was employed for a solution, The government appeared to have difficulty in achieving its long-term health care policy goal in terms of setting medical fees, in spite of its leading role between the Supplier Group and the Payer Group.
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KEYWORD
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NHI(National Health Insurance), Health Care Policy, Fees for Medical(&, Pharmaceutical) Services
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