국민건강보험의 임의비급여에 관한 법원 판례 연구 (A Study on the Court Judgment of the Out-of-Pocket Expenses in the National Health Insurance)

서지정보

· 발행기관 : 한국보건복지학회
· 수록지 정보 : 보건과 복지 / 15권 / 31 ~ 61페이지
· 저자명 : 김수열

초록

The out-of-pocket medical expenses have caused conflicts between medical institutions and the Korean government and have led to lawsuits. The Supreme Court consistently holds with its judicial decision upholding the out-of-pocket expenses as ‘deceitful, wrongful practices.’ The administrative court and the high court sometimes adjudicated approvals of the out-of-pocket expenses in consideration of severe diseases, and of obstetrics and gynecology related concerns such as: The low birth rate and low natural childbirth rate from late pregnancy, and pregnant women’s expectations for high quality of care because of the economic growth. Eventually, the Supreme Court authorized limited out-of-pocket expenses, and modified existing precedents in its ruling about patients’ out-of-pocket expenses, in cases of leukemia or blood diseases. However, the criticism about the limited level of out-of-pocket expenses will be great. A large portion of the out-of-pocket expenses will be resolved by expanding the range of payment with guarantee of various medical services but it will not avoid the limitations imposed by the insurance reimbursement practices. Regarding the issue of the out-of-pocket expenses, I think that the policy decision is more important than legal disputes. We need to consider the relationship between the circumstances of the medical community and the health care in the limited financial insurance system. We need to reassess the functioning of the medical institutions, review the medical payment systems, and readjust to reflect the real costs involved in quality care. We have to consider the lack of medical professionals and the real costs of medication transactions and, to provide support in order to reduce the management costs.

영어초록

The out-of-pocket medical expenses have caused conflicts between medical institutions and the Korean government and have led to lawsuits. The Supreme Court consistently holds with its judicial decision upholding the out-of-pocket expenses as ‘deceitful, wrongful practices.’ The administrative court and the high court sometimes adjudicated approvals of the out-of-pocket expenses in consideration of severe diseases, and of obstetrics and gynecology related concerns such as: The low birth rate and low natural childbirth rate from late pregnancy, and pregnant women’s expectations for high quality of care because of the economic growth. Eventually, the Supreme Court authorized limited out-of-pocket expenses, and modified existing precedents in its ruling about patients’ out-of-pocket expenses, in cases of leukemia or blood diseases. However, the criticism about the limited level of out-of-pocket expenses will be great. A large portion of the out-of-pocket expenses will be resolved by expanding the range of payment with guarantee of various medical services but it will not avoid the limitations imposed by the insurance reimbursement practices. Regarding the issue of the out-of-pocket expenses, I think that the policy decision is more important than legal disputes. We need to consider the relationship between the circumstances of the medical community and the health care in the limited financial insurance system. We need to reassess the functioning of the medical institutions, review the medical payment systems, and readjust to reflect the real costs involved in quality care. We have to consider the lack of medical professionals and the real costs of medication transactions and, to provide support in order to reduce the management costs.

참고자료

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