Journal of Society of Preventive Korean Medicine (대한예방한의학회지)

Society of Preventive Korean Medicine (대한예방한의학회)
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Designing a Global Budget Payment System for Oriental Medical Services in the National Health Insurance

건강보험 한방의료의 총액계약제 도입방안

  • Kim, Jin-Hyun (College of Nursing/The Research Institute of Nursing Science, Seoul National University) ;
  • Kim, Eun-Hye (College of Nursing/The Research Institute of Nursing Science, Seoul National University) ;
  • Kim, Yoon-Hee (National Evidence-based Healthcare Collaborating Agency)
  • 김진현 (서울대학교 간호대학, 간호과학연구소) ;
  • 김은혜 (서울대학교 간호대학, 간호과학연구소) ;
  • 김윤희 (한국보건의료연구원)
  • Received : 2010.03.25
  • Accepted : 2010.04.06
  • Published : 2010.04.30
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Abstract

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.

Keywords

References

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