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KMID : 1138920080070010015
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Health Insurance Forum
2008 Volume.7 No. 1 p.15 ~ p.27
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Health Insurance Financing Stabilization Strategy: Rationalization of Expenditure by the Reform of Reimbursement System
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Kam Sin
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Abstract
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Payment and reimbursement system has an effect on the medical service provider’s treatment behavior, and Korea’s payment and reimbursement system is mainly based on the fee-for-service reimbursement system. Although the fee-for-service system has received positive evaluations from a qualitative standpoint because it encourages the doctor to provide high-quality services as it reimburses him/her considering each of the services provided, it also has many problems including increasing the amount of treatment causing an increase in health care cost. A desirable payment and reimbursement system would ensure an adequate level of quality and accessibility, restrain excessive health care expenditure, and make the level of national health care cost to be reasonable, but Korea’s current payment system based on the fee-for-service is far from that, so a reforming of the payment and reimbursement system is required. Although it is extremely difficult to find the best system that satisfies the interests of all the acting parties of health insurance: namely, citizens (medical service consumers), medical service providers, and insurers, effort must be made to reach a reasonable balance. Moreover, an efficient payment system that ensures high quality health care as well as accessibility must be introduced in order to maintain the substantiality of the national health insurance system. To this end, there is the need for the current retrospective reimbursement system based on fee-for-service to be changed to the prospective reimbursement system such as case payment or capitation system, and in the medium to long term, a global budget system that manages medical service costs with a total target in place needs to be devised.
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KEYWORD
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health insurance financing stabilization strategy, retrospective reimbursement system, prospective reimbursement system
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