일차의료에서 혼합수가 중심의 지불제도의 변화: 해외사례와 시사점 = Changes in the Mixed Fee-Based Payment System in Primary Care: Cases and Implications

다국어 초록 (Multilingual Abstract)

Payment systems have a significant impact on the behavior of both healthcare providers and users. There are various payment methods such as fee-forservice, payment per case or diagnosis-related group, capitation, global budget, and pay-for-performance. This study investigated the paymentsystems used in primary care overseas in order to identify potential payment systems that can be introduced in primary care in Korea. With an agingpopulation, the primary care system in Korea is in constant need of change. In this context, effective coordination between medical care, social care,and medical institutions is essential, and many countries have already improved their payment systems to address this challenge. For example, theprimary healthcare payment system in the United Kingdom combines fee-for-service and pay-for-performance, with a focus on capitation. Similarly,the United States is gradually transitioning from a fee-for-service to a blended payment system through pilot projects. In Korea, blended paymentwas introduced through primary care pilot projects, but it is not yet universally applied to primary care. To provide value-based primary care inKorea, it is crucial to implement payment system reforms and designate a primary care physician.

국문 초록 (Abstract)

지불 시스템은 의료 제공자와 사용자 모두의 행동에 상당한 영향을 미친다. 보건의료 영역에서는 행위별 수가, 건별 또는 진단 그룹별 묶음수가 지급, 인두제, 총액계약제, 성과기반 보상 등 다양한 지불 방식이 있다. 본 연구는 국내 일차의료에 도입할 수 있는 잠재적인 지불제도를 파악하기 위해 해외 일차의료의 지불제도를 조사하였다. 인구 고령화로 한국의 일차의료체계는 끊임없는 변화가 필요하다. 이러한 맥락에서 의료와 사회복지 사이의 효과적인 조정과 주치의를 통한 지속적인 의료제공이 필수적이며 많은 국가에서 이미 이러한 문제를 해결하기 위해 지불 시스템을 개선하였다. 예를 들어, 영국의 일차의료 지불 시스템은 인두제에 중점을 두고 행위별 수가제와 성과기반 보상을 결합한다. 유사하게 미국은 시범사업를 통해 행위별 수가제에서 혼합지불 시스템으로 점진적으로 전환하고 있다. 국내에서는 일차의료 시범사업을 통해 혼합지불제가 도입되었으나 아직 일차의료에 보편적으로 적용되지는 않고 있다. 향후 한국에서 가치기반 일차의료를 제공하기 위해서는 혼합형 수가로의 지불 시스템 개편과 주치의 지정이 필요하다.

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