「국민건강보험법」상 의사결정구조의 문제와 개선방안

권오탁(Kwon, Oh?Tak) 한국사회보장법학회 2016 사회보장법학 Vol.5 No.1

현행 「국민건강보험법」 제4조에 의한 건강보험정책심의위원회는 요양급여 기준과 보험료율 그리고 상대가치 점수와 약제 · 치료재료별 요양급여비용, 그리고 부가급여와 가입자의 적용부분에 이르기까지 실질적으로 보험사업의 모든 주요 사항을 결정하고 있다. 국민의 건강보장이라는 헌법적 요청을 성실히 수행하는 방법으로 보험을 선택했음에도 불구하고 그 구체적이고 중요한 사안을 보험자가 아닌 건강보험정책심의위원회가 결정함으로써 사업운영에 대한 책임이 모호해진다. 따라서 건강보험 사업의 주체 간 역할을 명확히 하고 그 기능에 맞는 권한과 책임을 부여하여 보다 충실한 국민 건강보장이 이뤄질 수 있는 체계로의 개편이 필요하다. 정부는 건강보험 사업에 대한 정책을 수립함으로써 향후 건강보험 사업에 대한 예측이 가능하도록 해야 할 것이다. 그리고 그 과정에서 발생되는 문제해결을 위한 조정자의 역할을 수행하고 건강보험 사업이 국민의 건강보장을 위한 제도로 적절하게 운영될 수 있도록 해야 한다. 보험자는 가입자의 의료비 충격을 최소화하기 위해 보험재정 운영의 기술적인 문제를 해결하는 전문가의 역할을 수행해야 한다. 따라서 보험재정 운영에 대한 권한을 부여하고 그에 따른 책임을 져야 한다. 국민건강보험정책심의위원회는 정부의 건강보험 사업을 심의하고 자문하고 건강보험 제도의 발전과 방향, 그리고 원칙에 대한 사회적 논의를 기반으로 구체적인 제도개선 과제들에 대한 전략을 도출하는 기능으로 변경되어야 한다. Under Article 4 of the current National Health Insurance Act, the “Health Insurance Policy Deliberative Committee” is responsible for making all major decisions related to Medical Care Benefit Standards and Insurance Premium Rates, including the determination of the Resource-Based Relative Value Scale, Drug and Medical Supply Benefit Prices, Additional Benefits, and Application for Insurance Coverage. One issue that arises is that this responsibility can become obscured through the operations it carries out in fulfilling its legally mandated duty to ensure the health protection of the public. As a result, it is necessary to reform the current system in order to ensure the health security of the public. This reform should assign clear roles and functions to each of the main actors involved and give each of them authority and responsibility over the respective functions. The government should, by establishing health insurance-related policies, make it possible to predict future health insurance-related activities. The government should also function as a mediator in this process, ensuring that the health insurance service operates appropriately in order to ensure national health security. The insurer should function as technical expert who can solve problems related to the management of insurance financing in order to minimize the impact of medical expenditure of the insured. It follows that the authority of managing health insurance financing should be granted to insurer. The Health Insurance Policy Deliberative Committee’s functions should be changed. Its functions should be to deliberate and provide counsel about the development and future directions of the national health insurance system’s activities, drawing upon current social discussions, in the development of a basic fundamental system.

비대면진료 실행을 위한 법적 쟁점

권오탁,Kwon, Ohtak 대한의료법학회 2022 의료법학 Vol.23 No.3

Due to the COVID-19 pandemic, non-face-to-face treatment was temporarily permitted. A lot of consensus has been formed on the need to continuous non-face-to-face treatment. However, the current 「Medical Service Act」 only permits telemedicine between doctors and medical personnel. On the other hand, as a result of legal interpretation, there is an opinion that non-face-to-face treatment is allowed. But considering the overall legal system, non-face-to-face treatment is not allowed. Nevertheless, we have to consider the reality such as the development of science and technology and the outbreak of infectious diseases. Therefore, it is not advisable to allow face-to-face treatment only. Ultimately, it is necessary to find ways to ensure that non-foce-to-face treatment can be performed in a safe and effective manner. And it should be institutionalized. This is strategically necessary and important. Therefore, we must look over ahead legal issues to be discussed. First of all, the scope, the target disease and the subject of implement have to be clear. Also, structurally, the standards of facilities and equipment must be prepared for non-face-to-face treatment to be implemented. Functionally, communication and information exchange between doctors and patients should be well conducted. In addition, the information protection management system that occurs in the process of non-face-to-face treatment should be materialized. Lastly, the issue of responsibility and cost of non-face-to-face treatment should be decided in detail. When these problems materialize, it can be expected that a safe non-face-to-face treatment environment will be established.

혁신의료기술의 확산과 보건의료제도: 한국의 로봇보조수술 사례

문경준 ( Kyeongjun Moon ),권오탁 ( Ohtak Kwon ),정설희 ( Seol-hee Chung ) 한국보건경제정책학회 2022 보건경제와 정책연구 Vol.28 No.1

이 논문은 로봇보조수술 사례를 통해 우리나라에서 혁신의료기술이 도입되고 의료보장제도인 급여에 포함되기까지의 과정 전반에 걸쳐 보건의료 제도적 측면에서의 현안과 과제를 파악하기 위해 시행되었다. 이를 위해 신의료기술의 도입 체계를 고찰하고, 로봇보조수술 시행현황을 각 단계별로 분석하였으며, 혁신의료기술의 도입 및 시행 과정에서의 정책의제를 분석하였다. 이를 위해 관련 법령, 국내외 기존 문헌 고찰을 시행하였다. 또한 로봇보조수술의 시행현황을 분석하기 위하여 건강보험청구자료, 의료자원 신고자료, 의료기관을 대상으로 한 실태조사 자료, 의료장비 제조회사로부터 확보한 자료를 이용하였다. 신의료기술이 의료현장에 사용될 때는 신의료기술평가, 급여 결정, 수가 설정, 사후관리 단계를 거친다. 로봇보조수술은 2006년도에 비급여 대상 항목으로 지정되어 시행되기 시작하였으며, 2018년도에 총 21,761 건의 수술이 시행되었다. 일부 수술은 안전성과 유효성에 대한 근거가 부족하였다. 적응증별 로봇보조수술의 시행 건수의 비중은 적응증에 따라 0.9%에서 66.5%로 파악되었다. 로봇보조수술의 진료비는 적응증에 따라 개복수술 진료비에 비해 1.28~7.85배 높았으며, 복강경 수술 진료비에 비해서는 1.15~3.30배 높은 것으로 나타났다. 현재 시행되고 있는 로봇보조수술이 사용되는 시술의 종류를 건강보험 행위 급여·비급여 목록표의 분류번호를 기준으로 하면 총 45개 이상의 수술에서 시행되고 있었다. 로봇보조수술의 사례 분석을 통해 신의료기술의 의료보장 적용을 위해서는 지속적인 신의료기술 평가 수행과 평가 결과에 대한 엄격한 해석, 급여 적용 시 명확한 급여기준의 설정과 가격산정, 지속적인 사후관리 등 도입부터 시행에 이르는 전 단계에 걸친 관리가 필요함을 제시하였다. This article aimed to identify the issues and challenges to be taken into account when introducing innovative health technologies into Korea’s NHI coverage in the aspects of regulatory framework. focused on the analysis of the robot-assisted surgery(RAS) use. We examined each stage of the diffusion process of new healthcare technologies in policy terms. And we analyzed the implementation status of RAS and drew challenges faced by the healthcare system to respond to the diffusion of cutting-edge technology. For this, we reviewed related laws and regulations, reports, and articles. The implementation status of RAS was analyzed using the Korean National Health Insurance Claims Data, medical device status data, the data of the Korea Case Payment System, survey data, and statistics obtained from a medical device company. In Korea, the new technologies should be taken the process of nHTA, coverage determination, price setting, and post-management to be used in clinical care. RAS was designated as a non-benefit service in 2006 and 21,761 RASs were implemented as of 2018. Some RASs didn’t have sufficient evidence on the safety and clinical effectiveness. The proportion of robotic methods of the surgery is 0.9% to 66.5% depending on the indications. The cost of RAS was 1.15~3.30 times higher than the cost of laparoscopic surgery and 1.28~7.85 times higher than the cost of open surgery. The RAS was performed in over 45 operations. We could conclude that the management of new technologies has to be implemented strictly ranging from approval to using them are needed.

모잠비크 해상 이산화탄소 대염수층 저장을 위한 지질학적 조사

윤준일(Junil Yoon),김기홍(Kihong Kim),박승수(Seungsoo Park),권오탁(Ohtark Kwon) 한국가스학회 2023 한국가스학회 학술대회논문집 Vol.2023 No.11

소프트웨어 비용 산정을 위한 공수견적 알고리즘

권오탁,권영직 대구대학교 과학기술연구소 1994 科學技術硏究 Vol.1 No.-

This paper is a man-month algorithm for software development cost estimation from an order. This alogorithm refects upon programmer's capability, software complexity, programming technique, size of project team, program size.

아동치과주치의 시범사업 소개 및 효과분석을 위한 기초 연구

윤여진,채송이,권오탁,강경림 건강보험심사평가원 2021 HIRA RESEARCH Vol.1 No.2

아동 건강전담의 시범사업 운영 모형

강경림,예례미,이정은,권오탁 건강보험심사평가원 2022 HIRA RESEARCH Vol.2 No.2

코로나바이러스감염증-19 대응을 위한 국가별 재정지원 방식 고찰: 의료기관에 대한 재정지원을 중심으로

이정은,김주영,한주희,권오탁 건강보험심사평가원 2023 HIRA RESEARCH Vol.3 No.2

Korea initially adopted a policy of universal hospitalization for all confirmed cases of coronavirus disease 2019 (COVID-19) irrespective of symptoms, to prevent the spread of coronavirus in the absence of vaccines and treatments. However, this approach led to a shortage of beds to accommodate patients with COVID-19. To address this shortage, the government compensated those medical institutions that provided beds. This study reviewed the compensation methods and levels in Korea and foreign countries during COVID-19 pandemic to create a sustainable financial support system for future infectious disease situations. The study results are as follows: (Korea) The mortality rate of patients with COVID-19 is about 0.1%, and total expenditure due to COVID-19 is about 22.7 trillion won. (Japan) The mortality rate of patients with COVID-19 is about 0.2%, and total expenditure due to COVID-19 is about 106 trillion won. (Germany) The mortality rate of patients with COVID-19 is about 0.4%, and total expenditure due to COVID-19 is about 72 trillion won. (Taiwan) The mortality rate of patients with COVID-19 is about 0.4%, and total expenditure due to COVID-19 is about 7.8 trillion won. Many experts worldwide predict the occurrence of a large-scale infectious disease like COVID-19 in near future. This study is expected to serve as evidence for creating a sustainable financial support system in the event of a future infectious disease situation.