• Journal of Teachers' Pension
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• v.3
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• pp.207-252
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• 2018

현행 사학연금법은 공무원연금법 제46조 제1항 제4호 "정원 감소로 퇴직한 때부터 연금 지급" 조항을 준용함에 따라 정원감축 및 폐교에 따른 퇴직을 할 경우 법에 명시된 연금지급 개시연령이 아닌 퇴직 후 5년 이후에 조기연금을 지급하도록 하고 있다. 본 연구의 목적은 현행 지급개시연령 규정의 타당성을 검토하고 개선방안을 제시하는데 있다. 이를 위해 사학연금 지급개시연령 현황 및 사립학교 폐교 현황과 사학연금이 공무원연금법을 준용함으로써 발생하는 문제점 및 현행 규정에 따른 연금지급 시 사학연금재정에 미치는 영향을 분석하고 법 개정의 타당성을 검토하여 개선방안을 모색하였다. 주요 연구결과는 다음과 같다. 65세 정년이 되어 은퇴하지 않고 중도에 퇴직하거나 고용이 취소되어 지급개시연령 보다 훨씬 일찍 조기연금을 지급하게 될 경우에는 퇴직연금 자체가 노후소득보장제도이기 보다는 실업급여의 성격으로 전락하게 되는 측면이 있다. 또한, 폐교에 재직 중인 교직원은 근로가 가능한 연령과 건강상태임에도 불구하고 즉시 연금을 수급하게 됨으로써 재취업을 하지 않을 경우 연금에 대한 의존성이 높아지고 근로유인을 저해할 수 있다. 그리고 최근 잦은 폐교로 인한 연금수급자 과다 발생 및 재정적 지속가능성의 문제가 있다. 또한 사학연금 가입자와 공무원연금 가입자의 특성을 비교하면 중요한 차이점이 발견된다. 국공립학교의 경우에는 해당 학교가 폐교 또는 정원이 감소될 경우 다른 지역 학교로 해당 재직 교직원을 이동 배치하는 등의 대처 방안을 시행하기 때문에 사실상 퇴직하는 사례가 거의 없는 반면, 사학연금 가입자의 경우 공무원연금 가입자에 비해 상대적으로 고용불안에 노출되어 있고, 학령인구 감소 등으로 인해 사립학교 폐교 가능성이 상존하므로 이들에 대한 생활안정대책이 필요하다. 또한 공무원 조직의 개폐 및 정원 감소는 법령으로 정하고 있지만, 사립학교 교직원의 개폐 및 정원의 감소는 사학기관의 특성에 따라 차이가 있다. 그리고 공무원의 경우 공무원연금의 대상이면서도 고용형태의 상대적 취약점을 감안하여 임기제 공무원의 경우 고용보험의 가입이 일부 허용되나, 사학연금 가입자의 경우에는 전면적으로 가입이 제한되어 직역연금 간 형평성 문제가 발생하고 있다. 그리고 국민연금과 비교할 때 다음과 같은 차이점이 있다. 국민연금법의 경우 사업장가입자로 적용받고 있다 하더라도 준용법과 같은 사립학교 폐교 시 조기연금 수급 규정이 없으며, 고용보험법의 적용으로 실직 시 실업급여 등의 대응책이 있긴 하나 연금 수급을 통한 소득보장 수준에는 못 미치는 제도적 보완책을 갖추고 있다. 또한, 국민연금 가입자는 고용보험에 적용되나, 사학연금 가입자는 실업상태에 놓였을 경우 고용보험의 적용을 받지 못한다는 점에서 차이가 존재한다. 이에 다음과 같은 개선방안을 제시하였다. 폐교 시 사학연금 가입자의 생활안정을 위해 고용보험 가입을 검토할 필요가 있고, 재정안정화를 위해 연금을 전액지급하기 보다는 퇴직일부터 지급개시연령까지의 잔여기간에 따라 차등지급하는 방안을 모색해 볼 수 있으며, 고용보험법상의 실업급여 제도를 원용하고 소정의 연금지급기간을 설정하여 연금을 지급하는 방안을 고려할 필요가 있다. 이에 더하여 사학연금제도 내에서 별도의 고용보험기금을 마련하는 방안도 모색해볼 필요가 있다.

• Health Policy and Management
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• v.32 no.2
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• pp.154-163
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• 2022

Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• Journal of the Korean Society of Radiology
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• v.81 no.5
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• pp.1038-1052
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• 2020

Advancements of medical care with the use of new medical technologies have been promoting public health, but they can also place a financial burden on individuals and the country. Since the introduction of the health insurance system in 1977, the South Korean government has been attempting to control medical expenses. Radiological examinations have been a major target for cost reduction. Meanwhile, the radiological report fee has been combined with the technical fee for a long time; hence, its value has not been independently evaluated, and was also decreased proportionally with examination cost reduction. However, in the revised medical fee estimation system for MRI, the report fee has begun to be calculated separately from the technical fee, significantly contributing to the evaluation of the radiologists' work value. In conclusion, radiologists need to know and actively participate in the process of determining the insurance cost of radiological examinations and reports to get a proper value of their professionalism.

• The Journal of the Korea Contents Association
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• v.18 no.1
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• pp.504-516
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• 2018

Many countries have tried to reform financing systems toward UHC and paid attention to the function of strategic purchasing. This study was performed to examine theoretical foundations and the function of strategic purchasing. And we examined the functions of strategic purchasing in Korea based on the framework proposed by Preker(2005). For this purpose, we reviewed literature related to purchasing. we defined the strategic purchasing as strategic activities to provide health care services people need within a given budget, which is carried out by certain organizations, purchasing organizations. These activities include selecting appropriate providers, designing and operating the payment system, setting the price, and determining the target populations and their needs etc. The relationships among government, purchasers and healthcare providers can be explained by the principal-agent theory. In addition to Preker's framework, we emphasized the importance of the infrastructure such as decision making support systems, information systems, health care resource management systems, or expenditure monitoring systems. The National Health Insurance Service and the Health Insurance Review & Assessment Service play major roles in performing strategic purchasing.

• Health Policy and Management
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• v.34 no.1
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• pp.48-58
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• 2024

Background: The purpose of this study was to investigate the association between external medical service use and the characteristics of Chungcheongnam-do patients. We aimed to provide evidence of external medical service use enhance the healthcare delivery system in Chungcheongnam-do. Methods: We used the Health Insurance Cohort DB 2.0 of 2016-2019, and 2,570,439 patients were included in the study. Multivariate logistic regression and multinomial logistic regression were used to identify the association between external medical service use and each patient characteristic. Generalized linear model was used to identify the association between medical costs and external medical service use area. Results: During the study period, 32.2% of inpatients and 12.5% of outpatients had external medical service use in Chungcheongnam-do. In comparison to patients living in Cheonan and Asan, the odds ratio (OR) for external medical services use was higher across all regions. Specifically, hospitalized patients from Gyeryong, Nonsan, and Geumsan (OR, 116.817) and Gongju, Buyeo, and Cheongyang (OR, 72.931) demonstrated extremely high likelihood of external medical service use in the Daejeon area. Furthermore, compared to medical expenses incurred within Chungcheongnam-do, patients with external medical service use in the capitol area (outpatient=17.01%, inpatients=22.11%) and Daejeon area (outpatient=16.63%, inpatients=15.41%) spent more on healthcare services. Conclusion: This study found the evidence of external medical service use among Chungcheongnam-do patients. Further study should be conducted taking into account variables including satisfaction of local medical services, different types of patient diseases, and others. The study's findings may serve as a foundation for policy proposals aimed at ensuring the financial stability of our health insurance system, ensuring the efficient delivery of medical care, and localization of medical care.

• The Journal of the Korea Contents Association
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• v.20 no.2
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• pp.435-450
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• 2020

How do Korean people recognize major welfare policies of the Moon Jae-in government? Using a survey of 1,000 adults conducted in December 2018, this study examines what the public thinks about major issues related to welfare policies and what factors are related to variations in their opinions regarding the welfare policies. Results show that the public recognized the roles of government in providing welfare in a positive way. The positive opinion on expanding the coverage of National Health Insurance was the highest. Regarding the resolutions of fiscal problems of the National Pension Plan, there were substantial oppositions to reforms such as insurance premium increase, benefits cut, and increase in the age of receipt of pension benefits. Both efficiency and equality were perceived as important when government makes decision for allocating budgets. Only one-third of respondents agreed Korean government contributed to promoting the happiness of Korean people. Based on these findings, implications for developing welfare policies were discussed.

• KDI Journal of Economic Policy
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• v.11 no.3
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• pp.61-85
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• 1989

본고(本稿)에서는 최근 달성된 전국민의료보험(全國民醫療保險)(NHI)의 재원조달방식(財源調達方式)을 개관한 다음 소득재분배관점(所得再分配觀點)에서 이론적(理論的), 실증적(實證的) 분석(分析)을 행하고자 한다. 의료보험(醫療保險)은 주로 건강한 사람으로 부터 병든 사람으로 의료(醫療)의 수평적(水平的) 재분배기능(再分配機能)을 행하나 결과적으로 수직적(垂直的) 재분배(再分配)에도 영향을 주게 된다. 형평(衡平)과 관련하여 모든 국민(國民)들에게 필요한 최저수준(最低水準)의 의료이용(醫療利用)을 보장한다든가 의료이용(醫療利用)에 따른 경제적(經濟的) 부담(負擔)을 균등하게 한다든가 하는 제기준(諸基準)의 선택은 결국 우리 사회(社會)가 내려야 할 가치판단(價値判斷)의 문제일 것이나 우리의 여건에 비추어 전자(前者)를 기조(基調)로 하되 후자(後者)를 지향하는 접근방식이 바람직하고 평가된다. 실증분석(實證分析)의 결과는 비록 작은 크기이기는 하나 어느 정도 재분배효과(再分配效果)를 보여주었으나 프로그램간 급여(給與)와 보험료부담(保險料負擔)의 측면에서 격차가 벌어지고 있는 실정이어서 NHI 재정통합(財政統合)이라는 장기목표(長期目標) 아래 소득연계적(所得連繫的)인 보험료부담(保險料負擔) 및 급여체계(給與體系)를 단계적으로 확립해 나가되 우선은 의료보호(醫療保護)부터 이 방안(方案)을 실천에 옮기도록 권고한다.

• The Korean Society of Law and Medicine
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• v.21 no.1
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• pp.33-67
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• 2020

The hospitals that are owned by non-medical personnel result when non-medical personnel with resources conspire with newly graduated medical doctors who cannot afford the enormous amount of capital required at the beginning of the establishment of a medical institution. Such hospitals, though they may have met the external requirements as medical institutions, disrupt the medical market as it should be centered by medical personnels, In addition, such hospitals are causing a huge social problem as it is illegally receiving and reducing various benefits such as medical care benefits and subsidies from the government, resulting in a significant financial leak in the national health insurance. The illegality of the opening of a non-medical personnel hospital is so high that it nullifies the contractual arrangement for the establishment, imposes criminal penalties on all persons involved in the establishment under the Korean Medical Law, and imposes administrative sanctions on medical personnel. In case the hospital was aware of the illegality of its opening, but had applied to receive medical care benefits from the National Health Insurance Act and the Medical Care Act, such actions will result in the return of the benefits under the National Health Insurance Act and the Medical Care Assistance Act, subject to the penalty for the crime of fraud, and aggravated punishment for specific economic crimes based on the amount of gain, as well as civil liability for torts. In this study, we will examine the current status of the regulations on the non-medical personnel hospital and present the basis for future legislative directions by looking at the legal regulations and the attitude of the precedents.

• Journal of Hospice and Palliative Care
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• v.20 no.1
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• pp.8-17
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• 2017

Globally, efforts are being made to develop and strengthen a palliative care policy to support a comprehensive healthcare system. Korea has implemented a hospice and palliative care (HPC) policy as part of a cancer policy under the 10 year plan to conquer cancer and a comprehensive measure for national cancer management. A legal ground for the HPC policy was laid by the Cancer Control Act passed in 2003. Currently in the process is legislation of a law on the decision for life-sustaining treatment for HPC and terminally-ill patients. The relevant law has expanded the policy-affected disease group from terminal cancer to cancer, human immunodeficiency virus/acquired immune deficiency syndrome, chronic obstructive pulmonary disease and chronic liver disease/liver cirrhosis. Since 2015, the National Health Insurance (NHI) scheme reimburses for HPC with a combination of the daily fixed sum and the fee for service systems. By the provision type, the HPC is classified into hospitalization, consultation, and home-based treatment. Also in place is the system that designates, evaluates and supports facilities specializing in HPC, and such facilities are funded by the NHI fund and government subsidy. Also needed along with the legal system are consensus reached by people affected by the policy and more realistic fee levels for HPC. The public and private domains should also cooperate to set HPC standards, train professional caregivers, control quality and establish an evaluation system. A stable funding system should be prepared by utilizing the long-term care insurance fund and hospice care fund.

• Journal of the Korean Data and Information Science Society
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• v.26 no.1
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• pp.179-185
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• 2015

The cost of advanced medical technologies is commonly considered to be a major factor in the overall escalation of expenditures on health. The use of computed tomography (CT) scanning has increased dramatically over the past decade. CT has been rapidly adopted, despite their high cost. The aim of this study is to analysis the increasing factor of the frequency of the CT, using the decision tree model. Finally, we propose the effective policy option of diagnostic imaging technology in Korea.