<BFCF2DBFACB1B85F323031302D303828BDC5BFB5BCAE292DC3D6C1BEC0CEBCE2BFEB2831323239292E687770> ··· ··



2010 12 268(: 122-705) : 02) 380-8000 http://www.kihasa.re.kr 1994 7 1 (8-142) 7,000
2010
ISBN 978-89-8187-677-7 93330

1977 . 12

2008 62.2% .

. 5.33%
62% 13%
80% , ,
.

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6 8
2011 5.9%
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. 5 2008( )
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.

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2010 12
3. ······································································· 18
2 ································· 27
1. ······································ 27
2. ········································································· 28
4. ···································· 32
5. ······················· 33
6. ······················································································ 34
2. ····································································· 45
3. Built-in Stabilizer ············· 55
4 ············································· 59
1. ····························································· 59
2. ····················································· 65
5 ········································· 71
1. ··············································································· 71
3. ············································································ 77
6 ···························· 95
1. ··············································································· 95
3. ························································ 98
4. ··································································· 103
7 ······················································ 107
1. ············································································· 107
3. ····················· 122
4. ···························· 127
8 ······················································ 141
1. ············································································· 141
4. ····································· 148
5. ······································································· 164
1. ············································································· 183
3. ························································· 187
4. , ································· 191
5. ························································· 199
················································································· 203
1. ····································································· 213
2. ································································· 219

2-1 ·······························34 3-1 ······························································40 3-2 ·······························41 3-3 ································42 3-4 ·····················································44 3-5 ··················································44 3-6 ···············································46 3-7 , ·······················51 3-8 ·······································52 3-9 ························53 3-10 ···········································54 3-112010 ············································55 4-1 ··················································60 4-2 ··········································62 4-3 OECD ··························62 5-1 1 ······················································74 5-2 1 ················································74 5-3 , , ···81 5-4 CT ··········································82 5-5 ·····················································83 6-1 2010 ········································99 6-2 ····································101 8-1 ·················································142 8-2 ············································144
Contents 8-3 ·········································147 8-4 , 2008····························147 8-5 ···················································149 8-6 ···················································150 8-7 - ················154 8-8 ···········································155 8-9 ···········································156 8-10 ··················164 9-1 ·························186 9-2 OECD ·······················189 9-3 ······················································192 9-4 ···································192 9-5 (2007)·····················196 9-6 (2006)···196 9-7 (, 2006)···197 9-8 (, 2006)···197 9-9 ···········································200

2-1OECD (65 ) ···29 2-2 ·······29 2-3 ································30 2-4(25∼49) ···31 2-5u-Health ·························32 2-6 ·········································33
3-1 ·····································40 3-2 ··················42 3-3 ··········································43 4-1 ·················································60 4-2 ························61 4-3 ·········································62 4-4 OECD ························63 4-5OECD ················63 4-6 ············································64 4-7 ····························65 4-8 ·····················································65 5-1 ·······································89 6-1 (2007, )···97 8-1 ····················145 8-2 ···························163 8-3 ···································163 8-4 ···················167 8-5 ···168 8-6 ······················169 8-7 (SHI) , 1999-2006()········································172 8-82003 2006
·······························173 9-1OECD ······················189 9-2 ·························································200
1
Abstract
Korea's public health insurance was found to have covered only
62.2% of total health expenditure in 2008, a figure way below the
OECD average of around 80%. Estimated to have spent KW35
trillion in 2010 alone, the National Health Insurance (NHI) is
financially at grave risk with its reserves of as little as KW880
billion as of the end of 2010. To make matters worse, many experts
are taking issue with the NHI’s reimbursement method. Ever since it
was implemented, the NHI has reimbursed based on a cost-incurring
fee-for-service method. The annual rate of increase in fee-for-service
has been kept under 3%, but many finger the costly fee-for-service
reimbursement approach as one of the factors responsible for
increasing health insurance benefits by 15% every year. Whether the
level of fee is appropriate also remains an issue of constant
contention. Providers claim that the fee level is set far too low for
the world-class quality of services they provide. Consumers on the
other hand feel that the services they get are overly priced. The
current fee reimbursement contract, which since 2008 has been made
based on provider type, is also a matter of unending dispute.
Problems also abound when it comes to the question of how
insurance premiums should be collected. A few rounds of reform
took place over the recent years, whereby in 2000 the National
Health Insurance Corporation was made the only insurer and in 2002
2

its financing underwent unification. Yet, the rate of premium applied
is vastly different for employees and the self-employed, which has
become the subject of increasing public complaints. Against this
backdrop, this study looks into many aspects of the NHI, identifies
areas for mid- and long-term improvement, not least in its coverage,
financing method, reimbursement plan, and premium collection
approach.
3
30 OECD
.
: 2008 62.2%(
) OECD 80%
.
: 2010 9 (2010 1
: 34 )
( : )
.
(Fee for Service)
(2008 5
18% ).
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18% .
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2002 (
4

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K I H A S A01

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8,800 (2010 1 : 35 )
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Focus Group Interview .
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K I H A S A02

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2
2-1OECD (65 )
(%)
2005 2010 2015 2020 2025 2030 2035 2040 2045 2050









: UN,World Population Prospects, 2006( '06

. ’09 , 9.9%
30.53% , 1
(249.4) (81.1) 3.1 .
2-2
( : , %)
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9.9(’00)→7.0(’08)→6.6(’10)→5.7(’15)
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116,423 138,903 168,231 185,722 203,325 223,876 252,697 289,079 311,817 227,350 90,173 108,764 133,993 150,892 166,377 185,514 215,979 248,300 263,717 190,644 26,250 25,747 27,792 28,567 27,695 28,698 27,042 30,540 37,838 29,689 - 4,392 6,446 6,263 9,253 9,664 9,676 10,239 10,262 7,017


140,511 146,510 157,437 170,043 191,537 224,623 255,544 275,412 311,849 230,315 132,447 138,993 149,522 161,311 182,622 214,893 245,614 264,948 301,461 222,338
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13.38 8.66 11.12 15.51 14.93 4.78 11.40








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2) 2006 2007
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. 2010
4 3,195 , 3 7,987
( ) 1 631 .
100 14,
100 6 .
.

,
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     2003 2004 2005 2006 2007 2008 2009 2010
13,741 15,579 16,928 18,811 21,729 24,973 26,166 -

2,779 2,857 2,770 2,870 2,704 3,002 3,657 3,788 % 20.22 18.34 16.36 15.26 12.44 12.02 13.98 -

645 626 925 966 968 1,024 1,026 1,631 % 4.69 4.02 5.46 5.14 4.45 4.10 3.92 -
: , , 2009
43
3
3-3
.
, 10%
.
OECD ,

.
(2010) “ ” 2001~2009 9
, 2010
~2020 ( 3-4 ). 2020
65 15% ,
(2010 65% ),
8% ,
2020 2009 2.68 80.40
( 9.38% ).
, ( )
20% 2020 9%
2.46
44


2011 36.89 6.35 31.76 5.83 5.77
2012 40.36 6.95 34.75 6.19 6.13
2013 44.31 7.63 38.14 6.60 6.54
2014 48.85 8.41 42.05 7.07 7.00
2015 51.76 8.91 44.56 7.27 7.20
2016 57.35 9.87 49.37 7.82 7.74
. 8%
2011
,
.
3-4

2010 77 7.10 33.57 34.68
2011 83 7.38 36.89 38.11
2012 89 7.66 40.36 41.69
2013 96 7.91 44.31 45.77
2014 103 8.07 48.85 50.46
2015 110 8.30 51.76 53.47
2016 118 8.49 57.35 59.24
2017 127 8.84 62.37 64.42
2018 136 9.11 68.00 70.24
2019 146 9.38 74.78 77.25
2020 156 9.60 80.40 83.05
: . 2020 65 : 15% .
.
45
3

3% 4%
2017 62.37 10.73 53.69 8.26 8.18
2018 68.00 11.70 58.54 8.74 8.65
2019 74.78 12.87 64.38 9.33 9.24
2020 80.40 13.84 69.22 9.74 9.65 : i. 2020 65 : 15% ii.
iii. ( ) 2011 16.6%

: (2010).

,

.
2.
. OECD 9)
,
.
, , ,
.
NHI
.10) “
”.
2009 6 .11)
9) OECD/Korea Policy Center, "Health Care Reform in Korea", 2010. 10) . 11)
46

,

. OECD
(OECD, 2004). ,
. , NHI

NHI .
3-6
( )
1980 1990 2000 2001 2005 2007 2008
20.1 36.5 44.9 51.7 52.1 54.9 55.5 15.0 13.3 19.3 24.1 15.9 18.3 16.9
1) 5.1 23.2 25.6 27.7 36.1 36.6 38.6 79.9 63.5 55.1 48.3 47.9 45.1 44.5
72.1 47.8 31.4 25.4 25.1 22.0 21.0 3.4 10.4 14.5 14.4 13.9 13.7 13.7
0.7 2.0 4.7 3.8 3.9 4.1 4.4 100.0 100.0 100.0 100.0 100.0 100.0 100.0
: 1) NHI . “ ”
“ ” . : OECD Health Database(2009) 2008 Jeong(2010)

. 70%
( 3-6 ).
.
,
, . ,
, 3
.
. NHI
.
(3 ).
47
3
2 , ( ) .
OECD
. 2009 20~64
6 . 2050 1.3
, . OECD
8~10%
5~6% (Wagstaff, 2009a).12)
.13)
.
14)
(OECD, 2008).15)
“tax wedge”
. ,

OECD .
OECD
(2010 OECD ).
2000 2008
OECD .
.
12) 1967 1986 OECD 10
. 13) . 14) . i) (2006 16.8%,
OECD 19.3%), ii) (12.7%, OECD 11.6%), iii)(3.1%, OECD 0.6%). 20
, .
(2008 OECD
). 10% OECD 18%
2006 OECD 6.8% GDP 4.5% . 15) OECD OECD’s Job Strategy .
.
48

5 10%
3.5 (OECD 2007b).
2008
Earned Income Tax Credit
. 2011
.
.
, . ,
3 1
. , 2000
72% 2008 54% .


. ,
.
.
80% (2008
OECD ).16) ,
(Kwon, 2007)17)
NHI
.

. 2000 ,
NHI .
NHI,
16)
, . 17) ,
.
49
3
Health Insurance
Policy Review Committee . ,
. 2007 (
, ) , , ,
GDP 1.5
. ,
OECD GDP 6 .
.18)
. :


.
, ,

.
.
.
.
.
1)
.
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3.5% (Wagstaff, 2009a).
50

OECD

.
OECD
.

.
OECD


.
2011 .
14%,
6%( 65% )
.
.
.
. 65
50% ( )
. 21
-
. 50%
50% 2011
. 2009
( ) 15.18%( 16.66%
51
3
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.

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[ : 49.6%(’04) → 66.1%(’05) → 71.0%(’06) →
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2005 2006 2007 2008
31,671 100.0% 35,559 100.0% 39,990 100.0% 43,494 100.0%
19,670 62.1% 23,248 65.4% 26,544 66.4% 28,605 65.8%
12,001 37.9% 12,311 34.6% 13,447 33.6% 14,889 34.2%
6,278 19.8% 6,868 19.3% 7,774 19.4% 8,510 19.6%
5,723 18.1% 5,443 15.3% 5,673 14.2% 6,380 14.7%
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61
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.
.
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4-2
2002 2003 2004 2005 2006 2007
50.6 49.8 50.8 52.1 54.6 54.9
OECD 73.0 73.2 72.7 72.9 73.0 73.0
: OECD Health Data 2009.
4-3
: , 2008 , , 2010.
4-3 OECD
2007
Netherlands 5.5% Switzerland 30.6%
Source : OECD HEALTH DATA 2009, Nov. 09
63
4
4-4 OECD
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.
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2020 100
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2003 2005 2006 2007 2008 2009
106,559 116,475 125,131 131,519 129,795 133,741 3.86%
15,338 16,801 17,988 19,056 19,934 20,892 5.29%
5-2 1

2003 14.64 1.09 13.54 8.08 2004 14.86 1.13 13.74 8.21 2005 15.33 1.19 14.13 8.43 2006 16.01 1.32 14.69 8.78 2007 16.53 1.57 14.96 8.80 2008 16.78 1.74 15.03 8.82 2009 18.11 1.92 16.15 9.46
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( : %, 10 )


2001 100.00 100.00 12,941 100.00 2002 2.90() 97.10 2.70 102.70 13,425 3.74 103.74 2003 2.97 99.98 3.60 106.40 14,755 9.91 114.02 2004 2.65 102.63 3.60 110.23 16,130 9.32 124.65 2005 2.99 105.70 2.80 113.31 17,989 11.52 139.01 2006 3.50 109.40 2.09 115.68 20,932 16.36 161.75 2007 2.30 111.92 1.95 117.94 23,956 14.45 185.12 2008 1.94 114.09 3.89 122.53 25,600 6.86 197.83 2009 2.22 116.62 3.70 127.06 28,916 12.96 223.46
26)
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.
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.
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. CT 2007 37.1
, , 2 .
.
5-4 CT
(: )
1990 1995 2000 2001 2002 2003 2004 2005 2006 2007
15.5 28.4 27.3 31 31.9 31.5 32.3 33.7 37.1
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27)
2020 253 100
.
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83
5

67 .
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10%
.
.
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( )
2010 77 7.10 33.57 34.68 2011 83 7.38 36.89 38.11 2012 89 7.66 40.36 41.69 2013 96 7.91 44.31 45.77 2014 103 8.07 48.85 50.46 2015 110 8.30 51.76 53.47 2016 118 8.49 57.35 59.24 2017 127 8.84 62.37 64.42 2018 136 9.11 68.00 70.24 2019 146 9.38 74.78 77.25 2020 156 9.60 80.40 83.05
: . 2020 65 : 15% . 8%

.
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Transition 1999
89
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, 2004
. 36) Gregory C. Pope et al, Risk Adjustment of Medicare Capitation Payments Using
the CMS-HCC Model, Health Care Financing Review 2004;25(4):119-141
91
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2006
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102

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1997
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( , 2002).

(71%),
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(52.1%)
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,

. NHS(National Health Service)
GP(General Practitioner)
,
.
112

.

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Care Model(CCM)

. NHS (long-term conditions)

(Nolte et al., 2008). 1)
, 2) ,
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, 5)
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(Nolte et al., 2008).
2006 1 “Our health, our care, our say: a new
direction for community services"
.

. ,
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(2009) , 2003
NHS (GP) .
Quality and Outcome
Framework(QOF) , ,
10
.
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7
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30% . GP , GP

.
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( , 2007).
NHS .

( , 2007). 1
7-80% .

. 2 , .

. 3
.
.
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. 2004 NHS
(Improvement Plan)
. 2004 'NHS Improvement
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.
(Nolte et al., 2008).
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, () ,
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114

( , 2005).
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( , 2005).
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( , 2005).

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.
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management programmes, DMPs)'
. 2002

(Nolte et al., 2008).
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, , , ,
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. DMP DMP

. DMP
(Nolte et al., 2008).
DMPs , .
2004 10 2005 12 , DMPs
, 200 . DMPs
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(Nolte et al., 2008).
DMPs ,
, ,
116

,
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( , 2007).
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.
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(, 2008).

.

(,
2008).


2005
(, 2006; , 2008).
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.

117
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(, 2008). 2005
,
.
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2005
.
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, 2008:69). 1
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.
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.
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, 2006). , ,

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( , 2007).
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119
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.
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, .
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120

. 20 (PCCM, primary
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. ,

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, ,
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(, 2010).
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122

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.

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,
(, 2008).
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6
.

( , 2007:137).

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( , 2010)( 1 ).
,

(sub-acute care
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. ,


( , 2010).
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.

, , ,
124

( , 2005).



( , 2010).
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( , 2010).

(, 2009).

( , 2010).

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(
, 2010). .
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(,
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(, 2008).
125
7

.

(, 2010).

(, 2008).

(, 2010).


( , 2010).
(, 2008).
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(, 2008). ,

126


.


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( , 2010).

. ,
(, 2010).
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.


(, 2010). 57%
.
(, 2010).
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.
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127
7
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(, 2010). ,

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.

130

(, 2008).
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(, 2008).
, (
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.

.

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.
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(Primary care
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.

(, 2010).

. .
(
, 2007).