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KMID : 1142920190030010155
Public Health Affairs
2019 Volume.3 No. 1 p.155 ~ p.164
How to reach agreement on appropriate reimbursement level through the insurer-run hospitals
Shin Dong-Wook

Abstract
Everybody agrees on the premise that there should be appropriate reimbursement to the providers for the medical service provided. However, in reality, there has been intense conflict on the actual level of reimbursement between the government/insurer and provider every year. National Health Insurance Services has the plan to establish additional insurer-run hospitals to make more accurate estimation of ¡®cost¡¯ of medical service. However, a study using the data from the current insurer-run Ilsan hospital showed that current reimbursement level is only 69.6% of cost, and financial data of Ilsan hospital during recent years show net loss of 10 billion won from the medical service provision every year. This data was not even reflected on recent decision on the reimbursement level. Agent problem can also occur in public area, and there is need to establish public governance which can ensure transparency and responsibility. Making more insurer-run hospitals can be helpful to improve the representativeness of the data, but the results would not be acceptable to stakeholders. Therefore, to improve the acceptability of the ¡®cost¡¯ derived from the insurer-run hospitals, they should be able to provide appropriate quality of medical service with the reimbursement only (i.e., without additional financial support) under the same conditions and regulations as the private hospitals. If insurer-run hospitals can act as a standard medical facilities, it can improve the acceptability of the reimbursement level and regulation from the private providers.
KEYWORD
Appropriate reimbursement, Cost, Insurer-run hospital, Ilsan hospital
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