독일과 프랑스의 지불제도 고찰과 시사점-보건의료체계와 의료개혁의 맥락을 중심으로 = The payment reform of hospital services in Germany and France

다국어 초록 (Multilingual Abstract)

This study aims to investigate the payment reform of hospital services in Germany and France with Social Health Insurance(SHI) system. We focused on the characteristics of health care system that has highly institutionalized rules and practices and health care reforms that are specified by strong administrative tradition and established rules in SHI. Economic turbulence in late 1970s is generally considered to mark the end of unbounded welfare state expansion. Health care systems tend to develop their adaptive responses to problem pressure on health expenditures. Germany and France have specific SHI systems, which encounter different and specific problems. Following a relatively similar trajectory in neoclassical era since 1980s, two systems have gone through important changes. Both countries implemented global budget for cost containment and diagnosis-related groups (DRG) for improving efficiency. The payment reform is characterized the German case as renewed management adhered to self-governance through collective corporatist commitments and the French case as more management capacity through agency under strong state control. The issue of rising health expenditures due to progress in medical technology and aging population would be at the core of national debate in Korea in future, Both projection of growth of health expenditure and deficit financing of the National Health Insurance call for payment reform. DRG　is expected to allocate resources more efficiently than current fee-for-service, it would be also useful to develop global budget.

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