|
KMID : 1234820140150010123
|
|
Korean Society of Law and Medicine
2014 Volume.15 No. 1 p.123 ~ p.164
|
|
|
The Legal Effect of Criteria for the Medical Care Benefits and The Illegality Determination on Violation of Criteria for the Medical Care Benefits on Outpatient Prescription - A Commentary on Supreme Court Judgment 2009 Da 78214 Delivered on March 23, 2013 -
|
|
Hyun Doo-Youn
|
|
|
Abstract
|
|
|
|
Under the new system of ’Separation of pharmaceutical prescription and dispensing’ in Korea, which was implemented in 2000, physician could not dispense a medicine, and outpatient should have a physician’s prescription filled at a drugstore. After pharmacist makes up outpatient’s prescription, National Health Insurance Service(NHIS) pay for outpatient’s medicine to pharmacist, except an outpatient’s own medicine charge. And NHIS only pay for outpatient’s prescription fee to physician and, physician doesn’t derive profit from dispensing medicine in itself. Nevertheless, if physician writes out a prescription with violation of ’Criteria for the Medical Care Benefits’, NHIS clawed back the payment of outpatient’s prescription and medicine from the physician or the medical institution which the physician belongs to. In the past, NHIS’s confiscation was in accordance with ’the National Health Care Insurance Act, Article 52, Clause 1’. But, since 2006 when the Supreme Court declared that there was no legal basis on the NHIS’s confiscation of outpatient’s medicine payment, NHIS had put in a claim for illegal prescriptions on the basis ’the Korean Civil law, Article 750(tort)’. So, Many medical institutions filed civil actions against NHIS. The key point of this actions was whether the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits constitute of the law of tort. On this point, the first trial and the second trial took different position. Finally the Supreme Court acknowledged the constitution of the law of tort in 2013. In this paper, the author will review critically the decision of the Supreme Court, and consider the relativeness between the legal effect of Criteria for the Medical Care Benefits and the constitution of the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits as the law of tort.
|
|
|
KEYWORD
|
|
|
National health insurance, Medical care institution, Health Insurance Review & Assessment Service (HIRA), National Health Insurance Service (NHIS), Criteria for the medical care benefits, Outpatient prescriptions, Off-label use, Unlawful non-reimbursable treatment, Separation of dispensing and prescribing function, Imperative law, Unjust enrichment, Tort
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|