건강보험 한방의료의 총액계약제 도입방안

• Published in: 대한예방한의학회지 Vol. 14; no. 1; pp. 77 - 96
• Main Authors: 김진현, 김은혜, 김윤희, Kim, Jin-Hyun, Kim, Eun-Hye, Kim, Yoon-Hee
• Format: Journal Article
• Language: Korean
• Published: 대한예방한의학회 01.04.2010
• Subjects: 한의학; Health insurance; Global budget; Oriental medicine; Prospective payment
• ISSN: 1226-7066; 2713-9360

Objectives : This paper recommends a global budget based payment system for reimbursing oriental medical services in the national health insurance. Methods : We analyzed previous research outcomes related to oriental medical services and payment system We reviewed the experiences of other countries' global budget system in terms of their strength and weakness. In addition, we developed a reimbursement method for oriental medical services based on global budget. Results : Our reviews focused on global budget system of Germany, the Netherlands, the United Kingdom, Canada, France, and Taiwan. The estimation of global budget in the national health insurance was described in two scenarios. First scenario was to allocate oriental medical services in scale after signing a contract for global budget. In this case, 4.16% of the national health insurance expenditure was allocated for the oriental medical services. Second scenario was to estimate the global budget in a historical context. As a result, the first scenario in total budget was higher than the second, and we proposed a retrospective adjustment method for the gap between the budget and the actual expenditure Conclusions : The payment system for oriental medical services is recommended to shift from fee-for-service to global budget.