醫療保險 財政安定을 爲한 支拂報償制의 改編에 關한 硏究 = Reform on payment-reimbursement scheme for health care cost containment

다국어 초록 (Multilingual Abstract)

The rapid increase in the health care expenditure has motivated policy makers to search for ways to reduce health care costs without sacrificing the quality of care. The rate of increase will be highly accelerated when full-scale national health insurance covering all the rural and fishery area residents is implemented in early 1989.
One way to reduce, or at least to curve, the rate of increase in health care expenditure in the long run is to have a structural reform.
It is well known that a payment-reimbursement system should try to achieve the following objectives; (ⅰ) promote the efficient production and consumption of services; (ⅱ) provide a level of reimbursement to providers that will maintain their viability; (ⅲ) require minimal administrative costs; (ⅳ)provide for equitable financing from multiple purchasers. With these objectives in mind, this study proposes to change the payment-reimbursement method from the current fee-for-service(FFS) scheme to another type, so called as prepaymet-negotiating scheme.
Changing the health care system as a whole does not mean that everything should be tackled at the same time. A proper strategy is to take one feasible step at a specified time and not undertake more than is necessary. Though there are many things that need to be changed along with refomed payment-rembursement scheme, it may be best to apply a penetration strategy, which reorients only those elements within the total system that are necessary to make room for the initial steps.
This study suggests that it is the reform on payment-reimbursement scheme that should be followed by many other necessary reorientations to achieve proposed public health goals.