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조병희(CHO Byong-Hee) 한국생명윤리학회 2000 생명윤리 Vol.1 No.2
Severe conflicts took place between civil society and medical doctors, when the government tried to implement the policy of dividing prescription and preparation of drugs between doctors and pharmacists. The conflicts were developed in the 3 aspects, such as between doctors and pharmacists, between civil organizations and medical doctors, and among doctors themselves. Medical doctors argued the tight regulation of pharmacists' illegal prescribing behavior, but their concern was related to their discontents with low fee schedules of the health insurance system. However, the more fundamental feature the conflicts could be found in lowering socioeconomic status of doctors due to the growth of the hospital and pharmaceutical capital. Another factor to lead the conflicts was the growth of civil concern on health affairs and civil organizations' initiative to promote health care reform. Medical doctors were not prepared with handling this civil initiative and were reluctant to accepting their active role in formulating health policies. Thus the conflicts were inevitable.
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건강보험료 체납자에 대한 급여제한 사전통지제도의 효과성 분석
조병희 ( Byong Hee Cho ),유태균 ( Tae Kyun Yoo ),윤성원 ( Seong Won Yun ) 한국사회복지연구회 2013 사회복지연구 Vol.44 No.3
본 연구의 목적은 급여제한 사전통지제도가 건강보험료 체납자의 체납보험료 자진납부에 미치는 영향을 실증적으로 파악하는 것이다. 본 연구에서는 건강보험공단의 전산자료부터2010년 1월 21일에 실시된 제 8차 급여제한 사전통지 대상자 155만 명에 관한 자료를 표본으로 추출한 다음 표본을 체납자집단(사전통지 도달, 사전통지 미도달)과 비체납자집단(비대상 체납자, 차상위)로 분류하고 각 집단으로부터 체납자 규모의 10%에 해당하는 15만 명씩을 최종표본으로 추출하여 분석자료로 사용하였다. 다양한 로지스틱회귀분석모형을 추정한 결과, 급여제한 사전통지제도가 통계적으로 유의한 수준인 체납보험료 납부독려 효과를 가진 것으로 나타났다. 그러나 분석결과의 통계적 유의성과는 별개로 급여제한 사전통지제도의 효과는 매우 제한적인 것으로 나타났다. 연구대상 체납자 중 급여제한 사전통지를 받은 이후 체납보험료의 일부 또는 전부를 납부한 체납자는 직역 차이를 고려하더라도 25% 미만 수준에 불과한 것으로 밝혀졌다. 이처럼 체납보험료 납부율이 저조한 이유는 보험료 체납자 중 상당수가 빈곤으로 인해 보험료 납부능력이 없는 생계형체납자이기 때문이라 판단된다. 이러한 현실을 고려할 때, 건강보험공단이 실시하고 있는 급여제한 사전통지제도나 자진납부기간 운영 등은 일부 체납자에게는 보험료 납부독려 효과가 있으나 대다수의 보험료 체납자들에게는 효과가 없으며 오히려 보험료 체납자의 비용부담을 가중시켜 체납 상황에서 벗어나기 어렵게 만드는 결과를 가져올 수 있다. 본 연구에서는 이러한 연구결과를 바탕으로 급여제한 사전통지제도의 개선을 위한 일련의 정책방안을 제시하였다. One of the challenging tasks of the National Health Insurance Corporation(NHIC). the only public insurance institution administrating the Korea’s compulsory national health insurance(NHI) system, is to make those NHI beneficiaries who fail to make a scheduled monthly premium payment to pay. For this purpose, the NHIC has been using a measure known as ‘Benefit Limit Measure(BLM)’ in which those who miss premium payment for six or more month’s in total are classified as ‘late payer’ and are sent warnings and late payer status notices. If the late payers fail to make a full payment of missed premiums even after receiving the written notices, the NHIC can order a temporary seizure of the late payer’s property until all missed premiums plus interest are paid. Recently, the BLM has been criticized by the public of its cruel nature, and its effectiveness has been questioned because no empirical evidence has been collected. In this study, the authors using the NHIC data set attempted to analyze the effectiveness of the BLM. Those late payers for whom the BLM was administered were compared to those not in terms of the likelihood of paying missed premium payments with a series of logistic regression analyses models. Data analyses results showed that the likelihood of paying one or more month’s unpaid premium of the former group was 14 to 46 times higher than the latter. It, however, was also found that the BLM was only effective to make no more than 12% of the late payers to pay at all. Based on the study findings, the authors made a few recommendations regarding the BLM.
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조병희(Byong-Hee Cho) 한국보건사회학회 2019 보건과 사회과학 Vol.0 No.51
한국의 의사는 서구의 의사와 달리 의료기관을 소유하면서 성장해왔다. 전문지식의 소유에다가 의료 생산수단까지 소유하고 통제하게 됨으로써 의사들은 의료체계에 대한 확고한 지배구조를 확립했었다. 그런데 1990년 국민건강보험제도가 전국민에게 적용되었고, 이어서 의료시장이 급성장하고 뒤이어서 대형병원들이 설립되어 의료시장을 독과점하게 되면서 의사의 지배에는 심각한 위기가 발생하였다. 대형병원은 집중하는 환자 치료를 위하여 일종의 조립식 치료방식을 개발함으로써 의사의 노동강도를 크게 높인 관계로 의사들은 과로와 소진, 환자와의 교감 제한, 불법적인 진료 권한 위임 등이 발생하였고, 중소병원들은 환자의 부족으로 어려움을 겪게 되었다. 의사들은 자신들의 어려움이 초래된 원인을 병원보다는 낮은 의료수가 때문으로 인식하여 정부를 상대로 불만을 제기해 왔다. 환자들은 의사의 진료에 대체로 만족하는 것으로 보이지만 의사 폭행 등 불안정한 모습을 동시에 보인다. 결국 의료시장의 확대와 기술의 발전으로 의료의 영향력은 커지고 있으나 의사의 의료지배구조는 매우 취약해진 것으로 볼 수 있다. Unlike Western countries, in Korea, doctors established the solid medical dominance over the health care system by owning hospitals and clinics as well as learning highly professional medical knowledge by the 1980s. However, the situation has changed when the government introduced the national health insurance and the big hospitals has been built during the 1990s, which shared the large portion of the health care market. Since a lot of patients were gathered, big hospitals has developed a kind of assembling line of treatment. Doctors became overworked and exhausted. Their communication with patients were limited. Their rights were forced to transfer to nurses, as showed in PA. Small hospitals faced with the shortage of patients. However, doctors thought that the fundamental cause of their hardship were due to low level of health insurance cost, not to big hospitals. Patients showed the positive attitude for the health care services. However, frequently happening violence against doctors implies the lowering trust for doctors. In conclusion, doctors came to lose their dominance in the health care system, even if heath care are getting influential more than before.
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조병희 ( Byong Hee Cho ) 민주사회정책연구원 2001 민주사회와 정책연구 Vol.1 No.-
Kim Dae Jung government has promoted health care reform by implementing such two policies as the integration of health insurance associations and the separation of prescription and preparation of medicines. These policies aimed at increasing equity, efficiency and public participation in the health policy making process. These were the first attempt for health reform in Korea. However, these policies were limited by their narrow scope, insufficient funds, and weak intergovernmental cooperation. By integrating health insurance associations, it was possible to levy the equitable premiums among workers and among the self-employed. However, the equity between workers and the self-employed was not achieved, due to the failure of identifying reasonable sources of income and property of the latter. The separation policy focused on dividing the roles of doctors and pharmacists and removing the drug margin occurring in trading medicines between pharmaceutical firms and hospitals/doctors. However, doctors opposed to this policy strongly and the government changed the contents of the separation policy substantially, resulting in the withdrawal of reform. The chance for public participation was also reduced because of the same reason.
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