디지털융복합연구 (Journal of Digital Convergence)

  • 제14권4호
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  • Pages.231-237
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  • 2016
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  • 2713-6434(pISSN)
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  • 2713-6442(eISSN)
한국디지털정책학회 (The Society of Digital Policy and Management)
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온라인 기반 원스톱 실손의료보험료 청구에 관한 연구

A Study on the Online-based one-stop private health insurance claims

  • 투고 : 2016.03.01
  • 심사 : 2016.04.20
  • 발행 : 2016.04.28
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초록

실손의료보험은 국민건강보험이 보장하지 않는 부분을 지원함으로써 보장성을 강화시키는 기능을 수행하고 있다. 그러나 까다로운 운영체계 및 절차로 보험가입자의 의료실손금액 청구가 어려운 실정이다. 이러한 현상을 해소하기 위하여 보험가입자가 진료비를 요양기관에 지급한 후 청구서류를 작성하여 보험금을 청구하는 체계로 운영(상환제)하고 있다. 그러나 상환제 운영도 여전히 보험가입자의 권익보호가 어렵고, 번거로운 청구 절차로 소액보험금의 청구를 포기하는 상황이다. 그래서 보험가입자의 편리와 운영의 간소화를 위하여 개인정보 은닉기술, 본인인증기술, e-page safer 기술 기반 증명서 발급에서 공인전자주소(#-mail)를 활용한 보험료 청구까지 한번에 처리할 수 있는 원스톱 보험 청구 시스템을 적용하였다. 이렇게 개발된 시스템은 번거로운 청구절차를 간소화함으로써 보험 청구율이 높아져 의료비의 부담을 줄일 수 있을 것이다.

The private health insurance covers areas that are not covered by the national health insurance to reinforce insurance guarantee. Realistically, however, many people renunciate small sum insurance claims because the inconvenient claim procedures require a certificate from the hospital for resubmission to the insurance company, which is very time consuming. Therefore, One-stop insurance payout claiming system that is capable of one stop processing of the issuance of e-page safer technology-based certification to claiming of insurance payout by utilizing authorized electronic address (#-mail) through the utilization of private information concealment technology and identification certification technology for the convenience of the subscribers and the simplification of operation was developed.

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