국민건강보험의 재정위기 원인분석과 평가 = Evaluation on the Financial Crisis of National Health Insurance

다국어 초록 (Multilingual Abstract)

The objective of this study is to evaluate the recent financial crisis of National Health Insurance(NHI) in Korea. NHI experienced the deficit of 27.8 hundreds billion won in 2001, which is approximately 20% of total expenditures, and thus NHI recorded a reserve shortage of 18.6 hundreds billion won. There are analysed with two types of causes, that is, structural and institutional. The former is explained as the fee-for-service payment, increasing utilization, expanding benefit package, aging, and increasing supplies. The latter is coming from the separation of prescribing and dispensing and the integration of health insurance funds. The financial increment due to separation policy is composed of price effect(44%), volume effect(18%), the combined price and-volume effect(17%), and the remainder 21% is due to decreasing copayment rate. Especially, 36% point of price effect is caused by fee upgrading. This study simulated the financial effects of seperation policy and copayment policy. If the separation policy was not introduced, the reserve of NHI would have been a small deficit of 170 billion won. If the copayment rate has not been decreased, the reserve would have presented a surplus of 55 billion won. This simulation results imply that the separation policy coupled with the reduction of copayment is a main factors caused financial crisis. However, this study would be more valuable if the benefits of seperation policy can be compared with the cost of separation policy.