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국제비교를 통해 본 일본의 의료비 및 거시경제적 효율성
정형선 한국보건사회연구원 2002 보건복지포럼 Vol.64 No.-
의료제도의 `거시경제적` 효율성은 의료서비스를 위한 지출이 여타 재화에 총역을 위한 지출 수준에 비해 적절한 규모인지에 관한 논의와 관련되며, `미시경제적` 효율성은 의료자원의 투입-산출 비율에 관한 논의와 관련된다. 대체로 한 나라 의료제도의 거시경제적 효율성을 직접적으로 측정해 내는 것은 거의 불가능에 가깝다. 여타 재화와 총역을 위한 지출의 한계효율과 동일한 한계효율을 가지는 의료비 지출규모가 무엇인지는 그 나라 국민 내지 정부의 총의적 판단에 의존하게 되지 객관적인 수치로 단정하기 힘들기 때문이다. 본고에서는 일본 의료제도의 성과를 실질적인 투입-산출 측면보다는 이를 뒷받침하는 `의료비의 흐름`을 관찰, 분석함으로써 일본의료제도의 performance를 보고자 했으며, 특히 국제비교를 통해 함의를 얻고자 시도했다. 이로써 일본 의료제도의 거시경제적 효율성을 살펴보고 그러한 결과가 일본 의료제도의 어떠한 특성에 기인한 것인지도 생각해보고자 한다.
정형선,신정우,문성웅,최지숙,김희년 한국보건행정학회 2019 보건행정학회지 Vol.29 No.2
This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2018 constructed according to the SHA2011, which is a manual for System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analyzing health accounts of OECD member countries. Particularly, scale and trends of the total CHE financing as well as public-private mix are parsed in depth. In the case of private financing, estimation of total expenditures for (revenues by) provider groups (HP) is made from both survey on the benefit coverage rate of National Health Insurance (by National Health Insurance Service) and Economic Census and Service Industry Census (by National Statistical Office); and other pieces of information from Korean Health Panel Study, etc. are supplementarily used to allocate those totals into functional classifications. CHE was 144.4 trillion won in 2018, which accounts for 8.1% of Korea’s gross domestic product (GDP). It was a big increase of 12.8 trillion won, or 9.7%, from the previous year. GDP share of Korean CHE has already been close to the average of OECD member countries. Government and compulsory schemes’ share (or public share), 59.8% of the CHE in 2018, is much lower than the OECD average of 73.6%. ‘Transfers from government domestic revenue’ share of total revenue of health financing was 16.9% in Korea, lower than the other social insurance countries. When it comes to ‘compulsory contributory health financing schemes,’ ‘transfers from government domestic revenue’ share of 13.5% was again much lower compared to Japan (43.0%) and Belgium (30.1%) with social insurance scheme.
Designing an Effective Pay-for-performance System in the Korean National Health Insurance
정형선 대한예방의학회 2012 Journal of Preventive Medicine and Public Health Vol.45 No.3
The challenge facing the Korean National Health Insurance includes what to spend money on in order to elevate the ‘value for money.’ This article reviewed the changing issues associated with quality of care in the Korean health insurance system and envisioned a picture of an effective pay-for-performance (P4P) system in Korea taking into consideration quality of care and P4P systems in other countries. A review was made of existing systematic reviews and a recent Organization for Economic Cooperation and Development survey. An effective P4P in Korea was envisioned as containing three features: measures, basis for reward, and reward. The first priority is to develop proper measures for both efficiency and quality. For further improvement of quality indicators, an electronic system for patient history records should be built in the near future. A change in the level or the relative ranking seems more desirable than using absolute level alone for incentives. To stimulate medium- and small-scale hospitals to join the program in the next phase, it is suggested that the scope of application be expanded and the level of incentives adjusted. High-quality indicators of clinical care quality should be mapped out by combining information from medical claims and information from patient registries.