韓國 醫療保險制度의 問題点 및 改善方案에 관한 硏究 = (A)study on the problems and its solution of medical care insurance system in Korea

다국어 초록 (Multilingual Abstract)

I. Introduction
The purpose of this treatise is to help to establish Medical Care Insurance System appropriate to Korean situation by analyzing the present Medical Care Insurance System in Korea, extracting problems and researching into improvement measures thereto.
In accordance with this, I reviewed Medical Care Insurance System in Chapter 2 and the present situation of Medical Care Insurance System in Korea in Chapter 3. In Chapter 4, I extracted problems and suggested improvement measures thereto in Chapter 5.
Lastly I concluded this treatise by summarizing the results of afore-mentioned review.
II. Outline of the Medical Care Insurance System
In general, the medical care insurance has its own peculiarities different from other insurance systems. These peculiarities will he examined from three aspects: (1) Subjectivity of insurance benefits, (2) determination of insurance benefits, and (3) limitations of insurance benefits. And the structure of medical care insurance system will be considered from three viewpoints: (1) the operating organ, (2) the kinds of insurance benefits, and (3) the burden of expense of the medical care insurance.
III. Present Situation of Medical Care Insurance System in Korea
Our present medical care insurance system can he divided into a medical care insurance system based on the Medical Care Insurance Act and another system based on the Civil Servants and Private School Faculty Medical Care Insurance Act. Here will be discussed and analyzed the present situation of each insurance system, its managing institution, its size and financial conditions, the number of recipients and their rate of participation, the number of medical care institutions, the number of medical examinations, and so on.
IV. Problems of Our Medical Care Insurance System
The problems brought forward through analyzing of our present medical care insurance system are narrow scope of participants, excessive use of medical care institutions by particular beneficiaries, deficiencies in manpower and facilities, concentration of medical care institutions in cities, deficiencies in services provided, unrealistic medical care prices and procedures for payment of medical treatment, necessity to enlarge the designated convalesing facilities, financial problems of the associations, and so on.
V. Reform Measures for the Korean Medical Care Insurance System
Various methods for the efficient management and the perfecting of its contents involve the realization of a regional medical care insurance system, the reasonable management of insurance finances, the improvement in calculating the medical treatment costs and insurance benefits, the expansion of medical care facilities, regulation on medical care distribution systems, and so on.
VI. Conclusion
To develop a medical care insurance system more suited to our reality, the concerned authorities, the insured, the medical care insurance organizations and other related parties must improve the problems and imperfections of the present medical care insurance system, their mutual positive cooperation, with the ultimate aim of accomplishing the national medical care protection.

목차 (Table of Contents)

• 目次
• I. 序論 = 3
• 1. 硏究의 目的 = 3
• 2. 硏究의 方法 및 範圍 = 5
• II. 醫療保險制度의 槪觀 = 6
• 1. 醫療保險의 槪念 = 6
• 2. 醫療保險의 特性 = 7
• 3. 醫療保險制度의 構造 = 9
• III. 우리나라 醫療保險體係의 現況 = 12
• 1. 醫療保險의 體系 = 12
• 2. 醫療保險制度의 現況 = 12
• 3. 公務員과 私立學校 敎職員 醫療保險 現況 = 23
• 4. 各 組合의 財政狀態 = 25
• 5. 療養取扱機關現況 = 25
• IV. 우리나라 醫療保險制度의 問題点 = 27
• 1. 加入對象者의 範圍擴大 = 27
• 2. 醫療保險의 急激한 變化 = 28
• 3. 醫療人力과 施設의 不足現象 = 29
• 4. 醫療機關의 都市集中과「서비스」의 不在 = 29
• 5. 醫療酬價의 適正策定과 診療費請求의 合理化 = 30
• 6. 醫療機關의 擴大 = 32
• 7. 組合의 資金問題 = 32
• V. 韓國醫療保險制度의 改善方向 = 34
• 1. 地域醫療保險의 現實化 = 34
• 2. 保險財政의 合理的 運營 = 35
• 3. 保險給與의 充實 = 36
• 4. 診療報酬의 客觀化 = 38
• 5. 醫療機構의 擴張 = 39
• 6. 醫療傳達體系의 調整 = 39
• 7. 其他의 問題改善 = 40
• VI. 結論 = 42
• 參考文獻 = 44