• Title/Summary/Keyword: 의료보험법

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진료수가기준중개정

  • The Korean Dental Association
    • The Journal of the Korean dental association
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    • v.29 no.10 s.269
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    • pp.795-796
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    • 1991
  • 의료보험법 제35조의 규정에 의한 진료수가기준중 별표 2. 약가기준액표(보건사회부고시 제91-22호, '91.5.2)를 별첨과 같이 개정하였기에 고시합니다.

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A Legal Study on the Legal Regulations and the Attitudes of Cases in the Hospital Owned by Non-medical Personnel (사무장병원에 대한 법적 규제와 판례의 태도에 관한 고찰)

  • Baek, Kyounghee;Chang, Yeonhwa
    • 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.

The Medical Information Protection and major Issues (의료정보 유출의 문제점과 의료정보보호)

  • Jeun, Young-Ju
    • Journal of the Korea Society of Computer and Information
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    • v.17 no.12
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    • pp.251-258
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    • 2012
  • The protection of medical information by major Issues on medical information to protect the individuals' privacy on medical information. Especially, Issues of medical service information, medical record, insurance, employment, Genetic technology including genetic test and screening, gene therapy and genetic enhancement is developing rapidly. Defensibility of medical information documentation is tested in the courts. medical information can be illicitly accessed from anywhere and transmitted across the quickly and with risk of detection. Once data is distributed on the internet, it may become available to anyone who wishes to purchase it, and it cannot be expunge. Patient privacy protection of medical information is controlled mostly by patient consent laws that define how and when a patient must consent before a physician may disclose the patient's medical information to anyone else. enterprise that offers consumers commodities or services is checking problem about customer information of management system is checking problem about customer information of management system essentially. Therefore, in this paper will find a way out to Protection of medical information by major Issues on medical information.

Probleme nach geltendem Recht „Richtlinien für die Verwendung von Gesundheitsdaten" ('보건의료 데이터 활용 가이드라인'의 현행법상 문제점)

  • Lee, Seok-Bae
    • The Korean Society of Law and Medicine
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    • v.22 no.4
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    • pp.3-35
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    • 2021
  • Inmitten der Flut der privaten und öffentlichen Information gilt die riesige Informationsmenge als Schlüsselressource im Zeitalter der 4. industriellen Revolution, repräsentiert durch Big-Data. Das Interesse an diesen wächst weltweit. Es gibt eine aktive Diskussion darüber, wie man Daten sichert und akkumuliert und wie man die gesammelten Daten sicher und effektiv nutzt. Gesundheitsdaten werden vor allem als die wertvollste Ressource bewertet, für die Big-DataTechnologie eingesetzt wird. Um Gesundheitsdaten sinnvoll zu nutzen, müssen verteilte Gesundheitsdaten integriert und den Benutzern in einer Form zur Verfügung gestellt werden, die für Forschung oder Inspektion verwendet werden kann. In einer Situation, in der große Länder um den Aufbau bzw. die Führung der Datenwirtschaft konkurrieren, wurden im August 2020 auch in Südkorea die sog. „3-Daten-Gesetze" geändert, die das Datenschutzgesetz(DSG) enthälten. Das DSG führte das Konzept der pseudonymen Informationen ein und baute eine Rechtsgrundlage für deren Verwendung auf. Als Folgemaßnahme kündigte die, Kommission für den Schutz personenbezogener Daten(Personal Information Protection Commission: PIPC)' die „Richtlinien für die Bahandlung mit pseudonymen Informationen" und, Ministerium für Gesundheit und Wohlfahrt' die „Richtlinien für die Verwendung von Gesundheitsdaten" an. Gesundheitsdaten stehen direkt in Zusammenhang mit Leben und Körper des Menschen und damit enthalten viele sensible Daten. Es handelt sich also um ein System, das aus einer vorsichtigeren und konservativeren Sicht unter der Voraussetzung verwendet werden kann, personenbezogene Daten sicherer zu schützen. Um die Hauptinhalte der „Richtlinien für Verwendung von Gesundheitsdaten" zu analysieren, überprüften wir zunächst die Hauptinhalte des überarbeiteten DSG. Danach durch die Analyse der wesentlichen Inhalte der „Richtlinien für Verwendung von Gesundheitsdaten" wurden Probleme wie Konflikte mit anderen Gesetzen und Verbesserungsmaßnahmen überprüft.

Legal and Regulatory Issues in Genetic Information Discrimination - Focusing on Overseas Regulatory Trends and Domestic Implications - (유전정보 차별금지의 법적문제 - 외국의 규율 동향과 그 시사점을 중심으로 -)

  • Yang, Ji Hyun;Kim, So Yoon
    • The Korean Society of Law and Medicine
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    • v.18 no.1
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    • pp.237-264
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    • 2017
  • With the onset of the Human Genome Project, social concerns about 'genetic information discrimination' have been raised, but the problem has not yet been highlighted in Korea. However, non-medical institutions' genetic testing which is related to disease prevention could be partially allowed under the revised "Bioethics and Safety Act" from June 30, 2016. In the case of one domestic insurance company, DTC genetic testing was provided for the new customer of cancer insurance as a complimentary service, which made the social changes related to the recognition of the genetic testing. At a time when precision medicine is becoming a new standard for medical care, discipline on genetic information discrimination has become a problem that can not be delayed anymore. Article 46 and 67 of the Bioethics Act stipulate the prohibition of discrimination on grounds of genetic information and penalties for its violation. However, these broad principles alone can not solve the problems in specific genetic information utilization areas such as insurance and employment. The United States, Canada, the United Kingdom, and Germany have different regulations that prohibit genetic information based discrimination. In the United States, Genetic Information Non-Discrimination Act takes a form that adds to the existing law about the prohibition of genetic information discrimination. In addition, the range of genetic information includes the results of genetic tests of individuals and their families, including "family history". Canada has recently enacted legislation in 2017, expanding coverage to general transactions of goods or services in addition to insurance and employment. The United Kingdom deals only with 'predictive genetic testing results of individuals'. In the case of insurance, the UK government and Association of British Insurers (ABI) agree to abide by a policy framework ('Concordat') for cooperation that provides that insurers' use of genetic information is transparent, fair and subject to regular reviews; and remain committed to the voluntary Moratorium on insurers' use of predictive genetic test results until 1 November 2019, and a review of the Concordat in 2016. In the case of employment, The ICO's 'Employment Practices Code (2011)' is used as a guideline. In Germany, Human Genetic Examination Act(Gesetz ${\ddot{u}}ber$ genetische Untersuchungen bei Menschen) stipulates a principle ban on the demand for genetic testing and the submission of results in employment and insurance. The evaluation of the effectiveness of regulatory framework, as well as the form and scope of the discipline is different from country to country. In light of this, it would be desirable for the issue of genetic information discrimination in Korea to be addressed based on the review of related regulations, the participation of experts, and the cooperation of stakeholders.

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Review of 2022 Major Medicla Decisions (2022년 주요 의료판결 분석)

  • Lee Jeongmin;Yoo Hyunjung;Park Taeshin;Jeong Heyseung;Cho Woosun;Park Nohmin
    • The Korean Society of Law and Medicine
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    • v.24 no.2
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    • pp.79-117
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    • 2023
  • Among the healthcare-related judgments handed down in 2002, there was a significant ruling on the timing of the duty of explanation, stating that, in order to ensure the exercise of the patient's right to self-determination, the patient must be given time to consider and decide on the risks and side effects of a medical procedure in specific circumstances. In addition, in a case where an insurance company claimed unjust enrichment against a medical institution on behalf of its insureds, the court provided a clear standard by distinguishing between active and passive requirements regarding the need to preserve the right of subrogation of creditors. In the area of medical administration, there was a ruling that clarified that a medical institution's business suspension under the National Health Insurance Act is directed against the medical institution, a ruling that broadly recognized causation in a case of compensation for side effects of corona vaccination, and a ruling on the scope of a medical practitioner's license, such as the use of ultrasound devices by an oriental medicine practitioner. In a case involving a patient's claim for eviction from a medical institution, the court reviewed a ruling on just cause for termination of a hospitalization contract in relation to Article 15(1) of the Medical law.

Substantial Fairness in the Administrative and Judicial Process of Medicine Price Cut in Korea (약가 인하 효력 발생 시점 차이에 따른 문제점과 그 해결방안)

  • Park, Sungmin;Lee, Taejin
    • The Korean Society of Law and Medicine
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    • v.20 no.1
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    • pp.25-43
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    • 2019
  • This study analyzed the problem of the time difference of medicine price cut in Korea according to the administrative and judicial process and sought to present the amendment in the related law to achieve substantial fairness. We considered unfairness of medicine price cut caused by the administrative and judicial process in three situations, the approval-patent linkage system, realistic differences in the practice of administration and suspension of price cut execution. Based on it, we reasoned out the solution to get substantial fairness in the administrative and judicial process of medicine price cut in Korea. Although each step of the administrative and judicial process is lawful and reasonable, the time difference of medicine price cut according to the administrative and judicial process can result in damages or windfall to both of pharmaceutical company and National Health Insurance Service. In the present legal system of Korea, it is unable to be correct. Thus, we present the amendment to correct the damages and windfall when it happens.

Legal Issues on Deception of Fraud and Abuse of Paid Medical Expenses (요양급여비용 허위청구와 사기죄의 법적 쟁점)

  • Hwang, Manseong
    • The Korean Society of Law and Medicine
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    • v.14 no.2
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    • pp.11-41
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    • 2013
  • Article 347 of criminal law provides the act of deceiving another, thereby taking property or obtaining pecuniary advantage from another. On the other hand, the concepts of fraud and abuse are confused upon interpretation since the definition in National Healthcare Insurance Law is unclear, and it affects closely to the administrative measures such as surcharge levy by the period of inspection, therefore, the disputes continue in the forms of formal objection, administrative ruling and administrative litigation. This study aims to look over the legal problems on application of criminal fraud toward the abuse of 'Paid Medical Expenses(Article 57, Sections 1 and 4 of the National Health Insurance Act)'. The main issues are concept of abuse(Article 57, Sections 1 and 4 of the National Health Insurance Act), the problems of Directions of Health-Welfare Ministry on aspect of 'Nullum crimen sine lege' Principles, the proper sentenc-ing guidelines of fraud.

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Review of 2014 Major Medical Decisions (2014년 주요 의료판결 분석)

  • Jeong, Hye Seung;Lee, Dong Pil;Yoo, Hyun Jung;Lee, Jung Sun
    • The Korean Society of Law and Medicine
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    • v.16 no.1
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    • pp.155-190
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    • 2015
  • The court sentenced meaningful decisions related to the medical service in 2014. The court assumed the negligence of medical staff in the accident if being broken while using the medical equipment for not an original purpose at the time of surgery and ruled that the compensation for damage can be recognized in recognition of the causal relationship between the explanation duty violation and side effect's happening when unproven surgery on safety is implemented regarding the duty of explanation, that in the case of cosmetic surgery, the subject on the duty of explanation needs to be expanded compared to the general medical practice and that the duty of explanation cannot be accepted for the range that cannot be expectable. Also, the court has provided the requirement and limitation of self-determination exercise in case of the crash between patient's self-determination and doctor's duty of care and has ruled that as automobile insurance contract is a contract with the insurance company to pay regarding liability for car accidents, treating patients and taking the insurance money is not illegal activity even for the unlicensed hospital violating the medical law while established. The judgment stating the opinion that medical practitioners cannot be punished according to the medical law prohibiting the receiving of rebate in case that medical practitioners did not receive benefit while the medical institution itself gained an unfair economic benefit also stands out. And the court has ruled that even if the medical institution who received a business suspension is closed, the suspension is still effective in case that the same operator opens a new medical institution in the same place, ruled on the requirement to conduct a medical service outside of the medical institution that the doctor opened and ruled that the administrative penalty cannot be conducted prior to the conviction on charge of violating the medical law.

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A Study on Recent Policy and Legislation Trend of the Stem Cell/Regenerative Medicine in Japan (최근 일본의 줄기세포·재생의료에 관한 정책 및 입법 동향)

  • Lee, Min-Kyu;Ryoo, Hwa-Shin
    • The Korean Society of Law and Medicine
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    • v.16 no.1
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    • pp.191-219
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    • 2015
  • The Japanese government has announced that it would invest 30 billion yen in iPS cell research for the next 10 year, and the Japan National Assembly has made an act that supports the iPS cell research. This study analyzes 1) the current trend and application field of stem cell research under Japan; 2) recent policy and regulation change in stem cell research and its application under Japan. This treatise reviews about "Act for Promoting Regenerative Medicine", "Act for Assuring Safety of Regenerative Medicine", and "the Revision of Pharmaceutical Act under Japan. This study may serve as the fundamental reference for the improvements of legal and institutional systems with regard to regulations on the stem cell research under Korea.

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