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KMID : 1170320170230040045
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Korean Journal of Health Economics and Policy
2017 Volume.23 No. 4 p.45 ~ p.65
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Limit of the National Health Insurance Benefits and Its Policy Alternatives
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Kim Jin-Hyun
Lee In-Young
Kim Jun-Hyun
Seo Dong-Min
Bae Hyun-Ji
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Abstract
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The main purpose of this study is to identify the practical problem of insurance benefit limit policy, related to the Article 58 (2) of the National Health Insurance Act, and suggest its alternatives. The data used in the study was medical claims data-base from the National Health Insurance Service during year 2006~2016. A total of 79,247 cases or 7,671 patients were analysed by descriptive statistics. The analytical method was the cumulative percentage of medical expenses and treatment period for each case, and a logistic regression was applied to estimate the cumulative probability distribution of medical expenses and cases. Results of the analysis showed that 88.4% of all treatment cases were completed within 3 years, 95.6% were within 5 years, and 99.9% were within 10 years. Consequently, we propose to set a restriction period of health insurance benefit within 10 years, and afterwards reduce it from initially 10 years to 5 years and 3 years which is on the bond.
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KEYWORD
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Health insurance, Agreement after accident, Limit of benefit, Third-party payment
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