• 의료법학
• /
• 제13권1호
• /
• pp.11-40
• /
• 2012

National Health Insurance Act has been enforced all over the People as part of the effort to assure the minimum constitutional human worth and dignity in the aspect of the right to pursue health for preventing misfortune that comes to death without even a chance to be received treatment for illness or injury. Meanwhile auto insurance is compulsory in certain parts in order to promote benefits of everyday life and the rapid recovery of the damage caused by traffic accident when one have negligently driven a car which has become the necessities in daily life. Any injured driver in a traffic accident can be treated by National Health Insurance without getting an auto insurance in various circumstances, but Article 3 paragraph 2 of Traffic Accident Act don't allow exception of criminal punishment when he has driven a car without license, drunken, or tresspassing the centerline, etc. When the injury occured by his own certain negligence is judged to 'when he has intentionally or through gross negligence caused a criminal conduct or intentionally contributed to the occurrence of an accident' of National Health Insurance Act, insurance benefits can be restricted. Such a restriction could harm the right to pursue happiness and health of People by depriving the poor, who cannot afford to pay, of chances to get treatment. Here we will see benefit restriction by 'gross negligence' of National Health Insurance Act Article 48 paragraph 1, which has largest portion of such restriction. It is desirable to delete 'gross negligence' clause from above paragraph and to interpret 'when' clause restrictively for diminishing confusion of interpreting and guaranteeing the right of health.

• 의료법학
• /
• 제14권2호
• /
• pp.11-41
• /
• 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.

• 한국콘텐츠학회논문지
• /
• 제18권8호
• /
• pp.483-493
• /
• 2018

예술인의 직업적 지위와 권리보호를 위한 법 제도인 노동관계법, 사회보험법, 예술인복지법의 개선을 통하여 근로자성 인정, 고용보험법 가입특례, 국민건강보험법과 국민연금법 적용특례 등이 인정되어야 한다. 이를 위해 노동관계법에 대한 법원의 해석이나 입법에 의해 근로자 범위를 확대해야 하고, 현재 제외되어 있는 예술인의 고용보험법 가입 특례와 국민건강보험법 적용 특례 등 사회보험의 지원범위도 넓혀나가야 한다. 보험료 전액 본인부담에 임의가입 방식인 예술인 산재보험제도도 보험료 지원을 통해 제도의 실효성을 가져가야 한다. 예술인복지법 역시 예술인에 대한 법적 보호를 강화하는 등의 내용으로 개정이 필요하다. 또한 예술인복지사업에 대한 재원의 확보도 중요하다. 그리고 표준계약서를 의무화하고 예술인의 경력증명시스템을 구축하여 예술 활동기준을 적용해 복지수혜가 필요한 예술인이 누락되지 않도록 해야 한다.

• Journal of Preventive Medicine and Public Health
• /
• 제43권6호
• /
• pp.455-458
• /
• 2010

The Affordable Care Act (ACA) was signed into law on March 23, 2010 and will fundamentally alter health care in the United States for years to come. The US is currently one of the only industrialized countries without universal health insurance. The new law expands existing public insurance for the poor. It also provides financial credits to low income individuals and some small businesses to purchase health insurance. By government estimates, the law will bring insurance to 30 million people. The law also provides for a significant new investment in prevention and wellness. It appropriates an unprecedented $15 billion in a prevention and public health fund, to be disbursed over 10 years, as well as creates a national prevention council to oversee the government's prevention efforts. This paper discusses 3 major prevention provisions in the legislation: 1) the waiving of cost-sharing for clinical preventive services, 2) new funding for community preventive services, and 3) new funding for workplace wellness programs. The paper examines the scientific evidence behind these provisions as well as provides examples of some model programs. Taken together, these provisions represent a significant advancement for prevention in the US health care system, including a shift towards healthier environments. However, in this turbulent economic and political environment, there is a real threat that much of the law, including the prevention provisions, will not receive adequate funding.

• 대한치과의사협회지
• /
• 제53권10호
• /
• pp.696-704
• /
• 2015

The coverage of the National Health Insurance for the elderly is expanding to denture and implants. Although the National Long-Term Care Insurance was just being settled, Oral health service was not provided to the Elderly in Long-Term Care Facilities. The long-term care facilities had part-time facility doctors. However, there is no dentist in the long-term care facility because of lack of long-term care insurance-related legislations. The amendments of long-term care insurance-related legislations for the introduction of part-time facility dentists are needed because the elderly in long-term care facility are vulnerable to oral health. For the substantial management of the National Long-Term Care Insurance, the development of oral health service model for the elderly and education materials for the dental team will be needed. Also, adequate dental service fee of the National longterm care insurance will be needed.

• 의료법학
• /
• 제16권2호
• /
• pp.87-130
• /
• 2015

국민건강보험공단이 인신사고의 피해자에게 요양급여를 시행한 후 가해자에게 요양급여비용 중 공단부담금을 구상하는 사건에서 판례는 국민건강보험법이 정하는 청구권대위와 산업재해보상보험법이 정하는 청구권대위를 동일하게 취급하면서, 상계 후 공제설에 따른 공제 범위로부터 국민건강보험공단의 구상 범위를 도출하여 피해자의 손해배상채권액 내에서 공단이 부담한 요양급여비용 전부의 구상을 인정하고 있다. 그러나 국민건강보험법과 산업재해보상보험법은 모두 사회보험을 규율하는 법이지만, 국민건강보험법 요양급여는 '보장비율을 정한 일부 보험'의 성격을 띠고 있는데 비하여 산업재해보상보험법상 보험급여는 전부 보험의 성격을 보이거나 사회보험적 성격에 따라 손해액과 무관하게 산재를 당한 피보험자가 기존 생활에 가까운 생활을 영위하도록 보조하는 데 중점이 있다. 따라서 건보법상 청구권대위와 산재법상 청구권대위를 동일하게 취급할 이유는 없다. 피보험자는 보험금을 수령하는 대신 보험자가 대위에 의하여 취득하는 청구권을 상실하게 되므로 그 범위에서 보험금의 수령으로 인한 이익이 없다. 따라서 피보험자가 가해자를 상대로 손해배상을 구하는 소송에서 손익상계의 법리는 적용될 여지가 없고, 청구권대위의 범위나 손해배상에서 공제할 공제액은 당사자 사이의 약정이나 관계 법령에 따라 정하여야 한다. 따라서 판례가 상계 후 공제설로부터 국민건강보험공단의 구상 범위를 도출하는 것은 타당하지 않다. 국민건강보험공단의 구상 범위를 정한 국민건강보험법 제58조 제1항을, 손해배상이 먼저 이루어진 경우 국민건강보험공단의 면책 범위를 정한 같은 조 제2항과 결합하여 통일적, 체계적으로 해석하면, 국민건강보험공단의 구상 범위는 지급한 요양급여비용에 가해자의 책임 비율을 곱하여 정하는 것이 타당하다. 이는 산업재해보상보험법 제87조 제1항과 제2항의 해석상 근로복지공단의 구상 범위가 지급한 보험급여 내에서 피보험자의 청구권 전액에 미치는 것과 대비된다. 한편, 판례가 국민건강보험공단의 구상 범위를 판단하면서 그 전제로 삼은 상계 후 공제설은 피해자에게 손해액 이상의 이익을 귀속시키지 않는다는 목적을 이루기 위해서 피해자가 얻은 이익을 손해액에서 공제하면 족한데도 왜 그 이익을 손해배상채권액에서 공제하여야 하는지, 피해자가 입은 손해는 공평하게 분배하면서도 피해자가 얻은 이익은 모두 가해자에게 귀속시키는 것이 타당한지, 실제 사례에서 구체적 타당성이 있는지에 관하여 의문이 있다. 따라서 국민건강보험공단의 구상범위에 관한 판례 법리와 상계 후 공제설을 따르는 판례 법리는 재검토되어야 한다.

• 보건행정학회지
• /
• 제10권1호
• /
• pp.57-94
• /
• 2000

Korea's social health insurance system was introduced in 1977, which has made a universal coverage possibly by July 1989. Korean government had pursued a single objective for the last decade to put the whole population under the coverage of medical security, and the objective was achieved within 12 years. The rapid accomplishment is primarily due to such factors as limited benefits, high copayment rate, low contributions as well as rapid economic growth. There are several sources of pressure for the implementation of social health insurance such as health professional group, labor unions, politicians, international organizations etc.. However it is important to look at the feasibility of social health insurance. Among other things, it is necessary to identify the administrative infrastructure of insurance system and to assess income for source of fund. As many developed countries, Korea began to apply health insurance to the employees of the large firms, and the expansion based on employment status. Thus the several funds system was inevitable according to the gradual expansion strategy. However many persons had criticized several funds system in respect with equity and efficiency aspects. In the short history of the Korean health insurance, whether one fund or sever or funds had been the most controversial issue. In Febrary 1999, the National Assembly passed the act of one fund system. From July 2000 separate funds will be unifed under new health insurance scheme. In this study we will analyze the policy making process on implementation, expansion and integration of health insurance system of Korea. And also analyse problems related to policy making.

• The Journal of Korean Physical Therapy
• /
• 제34권2호
• /
• pp.80-89
• /
• 2022

Purpose: In Japan, the long-term care insurance and health insurance acts have stipulated the visiting rehabilitation system to provide support at the national level. The prior case of Japan would provide guidelines for seeking a suitable policy direction in South Korea. This study aims to examine the historical transition process of the visiting rehabilitation system in Japan, and the issues that emerged in the process of the institutionalization of this system. Methods: To examine the historical transition process of the system, the regulations announced by the government and their reports were reviewed. The relevant issues were qualitatively analyzed based on the opinions of scholars, therapists, and interested organizations that were reported in published papers on the topic. Result: The visiting rehabilitation system has been implemented in the following chronological order: The Health and Medical Service Act for the aged (1982-2006), the Health Insurance Act (1988-), and the Long-term Care Insurance Act (2000-). Currently, visiting rehabilitation is provided through hospitals, clinics, visiting nursing stations, etc. The following issues came to the fore in the process of the institutionalization of the system: (1) the complexity of the system, (2) the necessity of changing perceptions into a life model approach, (3) insufficient service provision by therapists, (4) the lack of human resources and an education system, (5) the lack of awareness of care managers and doctors about visiting rehabilitation, and (6) the necessity of quality enhancement through a team approach. Conclusion: It is deemed worthwhile to refer to the visiting rehabilitation system in Japan and the issues that emerged in the process of institutionalizing the system while seeking a policy direction for a similar system in South Korea.

• 의료법학
• /
• 제13권2호
• /
• pp.45-72
• /
• 2012

The National Health Insurance Corporation has been retrieving from health care providers the payments made to them by insured patients as a result of the health care providers' arbitrary denial of coverage under the National Health Insurance, and has been disbursing such retrieved monies back to the patients, pursuant to Article 57, Sections 1 and 4 of the National Health Insurance Act. However, such practice is an application of the law that lacks legal exactitude. Another problem with such practice is that there is no legal provision under any laws or notices that expressly prohibits arbitrary denial of coverage. A legislative solution, therefore, is called for to address these issues.

• 의료법학
• /
• 제10권2호
• /
• pp.287-307
• /
• 2009

A person is injured in car accident caused by his/her slight negligence except he / she causes accident by his / her willfulness or gross negligence. Because the National Health Insurance Corporation (hereinafter called "Corporation") shall not provide any insurance benefit "when he has intentionally or through gross negligence caused a criminal conduct or intentionally contributed to the occurrence of an accident" referred to in Article 48 (1) 1 of the National Health Insurance Act. So, if he / she is insured by his / her own bodily injury coverage, he / she can be compensated for his / her medical expenses. The injured have the rights to file either National Health Insurance claim and Automobile Insurance claim but there is no clear and definite adjustment clause. The claim disputes between National Health Insurance (hereinafter called "NHI") and Automobile Insurance (hereinafter called "AI") in the own bodily injury coverage makes some problems. Firstly, there are some differences in co-payments which he / she chooses between NHI and AI. Profit per a patient is higher in the NHI than in the AI. Secondly, it can provoke criticism that people shall unnecessarily pay double contributions. Lastly, it can raise moral hazards. For example, if he / she can cover the compensations when the insured receives the compensations from his / her insurer, the Corporation can be claimed by medical care institution payment of the health care benefit costs. In conclusion, first of all, to improve the national health and preserve the insured's rights the Corporation shall keep notice these facts.