건강보험 행위료의 환산지수 탄력성에 관한 연구 = A Study on Health Insurance Expenditure Elasticity of Conversion Factor

다국어 초록 (Multilingual Abstract)

In spite of a financial crisis of National Health Insurance (hereafter, NHI), in recent years, negotiating conversion factor (which represents absolute level of price per one point of medical care) between National Health Insurance Center (hereafter, NHIC) and medical service providers is still a controversial issue. We aim to provide an objective guide for the impact of conversion factor on NHI``s financial budget. This helps the rational negotiation for sustaining NHI``s financial stability and improving the quality of public health. We investigate the health insurance expenditure elasticity of conversion factor. From the perspective of entire medical institution, we find that health insurance expenditure increases, on average, 2.898% per 1% increase in conversion factor. In addition, 44.49%~54.13% of changes in health insurance expenditure relates to the change of conversion factor, which accounts for approximately 1,100 billion won to 1,365 billion won in terms of health insurance expenditure amount. We contribute to prior research in developing prediction models. These models systematically gauge the effect of change in health insurance expenditure on NHI``s financial budget. These models also consider multiple factors such as, macroscopic environment, medical care price, medical care cost, volume of medical service, and medical policy.

참고문헌 (Reference)

1 김학주, "정부의 수가규제정책이 건강보험에 미치는 영향" 한국사회복지정책학회 (23) : 253-268, 2005

2 김진수, "건강보험 중장기 재정전망과 정책과제: 2008～2030" 국민건강보험공단 2007

3 신영석, "건강보험 재정평가" 한국보건사회연구원 2010

4 사공진, "건강보험 재정안정화 방안에 대한 연구" 한국보건경제정책학회 9 (9): 53-78, 2003

5 이선희, "건강보험 재정분석 및 진료비 지불체계 개선방안" 2008

6 신현웅, "건강보험 내실화를 위한 재정효율화 방안: 본인부담 구조조정방안 중심으로" 한국보건사회연구원 2009

7 국민건강보험공단, "2012년도 유형별 환산지수 연구" 국민건강보험공단 2011

8 한국보건산업진흥원, "2006년 요양급여비용 계약을 위한 환산지수 연구" 한국보건산업진흥원 2006