醫療保險(의료보험) 財政共同事業(재정공동사업)의 效果分析(효과분석) = An Analysis on the Effect of Financial Stabilization Program in the Korean Health Insurance

다국어 초록 (Multilingual Abstract)

This study was carried out by using questionnaires with 126 insurance societies from Sept. 30, 1995 to Oct. 18, 1995. The primary data collected by the survey have been sig-nificantly supplemented by secondary data obtained from sources such as health insurance statistical year books and internal data in the Ministry of Health and Wolfare. Major fin-dings were summarized as follows: Two financial coordinating programs have significantly improved financial status of regional health insurance societies: the catastrophic program for high cost medical care that was initiated in 1991 and the program for hospitalization cost of the aged in 1995. Another finding is that there existed ambiguity and inconsist-ency of equity index that had been used by stabilization programs and its side effects coul-d not be ignored. Regression analyses were made to identify factors that affect financial transfers. Inde-pendent variables in the regression include utilization frequency, dependancy ration, in-surance contribution per insured and medical expense per insured. All these variables were statistically significant in the equations of applying distribution rate (distribution/contribution) and transfer rate (transfer/contribution) as dependent vari-ables. Policy suggestions for the catastrophic program for high cost medical care are modify-ing the definition of catastrophic case and setting the maximum amount of subsidies for each society based on distribution rates. To solve the problems of the financial coordinate-ing program for the aged, we could consider reimbursing more than 50% of the copayment incurred by the aged 65 or more and determining the maximum amount of outpatient cop-ayment at 10,000 Won per day or per visit for the elderly. More fundamental improvement could be made by amending the Welfare Benefit Act to establish and expand medical and welfare facilities for the elderly.