• 제목/요약/키워드: fixed-payment system

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진료수가제도의 헌법적 한계와 정액수가제의 위헌성 -헌법재판소 2020. 4. 23. 선고 2017헌마103 결정을 중심으로- (Constitutional Limits of the Medical Fee Payment System and the Unconstitutionality of Fixed Payment System)

  • 현두륜
    • 의료법학
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    • 제21권1호
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    • pp.69-105
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    • 2020
  • 의료보장제도에서 진료수가는 의료보장체계의 근간을 이루는 매우 중요한 요소이다. 국민건강보험법은 진료수가의 결정방식에 관하여 계약제를 채택하였고, 그 계약의 내용은 상대가치점수에 대한 점수당 단가를 정하는 것이다. 그에 따라 건강보험 요양급여비용은 매년마다 물가상승이나 경제 상황의 변화에 따라 조정된다. 반면, 의료급여의 경우, 의료급여법에서는 진료수가의 결정방식에 관한 내용을 규정하지 않고, 모든 사항을 보건복지부 장관에게 위임하고 있다. 그에 따라 보건복지부 장관은 2001년부터 혈액투석 치료에 관하여 정액수가제를 채택하고 있다. 이러한 혈액투석 정액수가제에 대해서 2017년 헌법소원이 제기되었고, 헌법재판소는 2020년 헌법소원 심판 청구를 모두 기각하였다. 이 글에서는, 위 헌법소원 사건을 중심으로 진료수가제도의 의미와 내용을 살펴보고, 이에 대한 헌법적 한계로 3가지 원칙을 제시한다. 그 원칙의 첫째는 법률유보의 원칙, 둘째는 포괄위임금지의 원칙, 셋째는 비례의 원칙이다. 그러한 관점에서 검토해 보면, 혈액투석 정액수가제는 상당히 위헌적인 제도로 판단된다.

비용기반 전력시장에서의 용량요금 산정방안에 관한 연구 (A Study on the Capacity Payment in Cost Based Pool)

  • 한석만;김발호
    • 전기학회논문지
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    • 제57권9호
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    • pp.1531-1535
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    • 2008
  • In the past vertically integrated power system, the power utility forecasted power demand and invested new power plants to keep a system adequacy. However, in the competitive electricity markets, a principle part of the capacity investment is market participants who decided the investment to maximize their profit. Especially, one of the main factors in their long-term decision making is the retrieval of fixed costs (construction costs). This paper presents the capacity payment in electricity power markets. The capacity payment (CP) in Cost Based Pool (CBP) is needed to recover fixed costs. However, CP in CBP was applied not only recovering fixed costs but also ensuring supply reliability. In order to operate harmonious power markets, pool needs reasonable CP mechanism. This paper analysis CP using capacity proportion and Reliability Pricing Model (RPM).

의료기관 인공신장실의 원가계산에 의한 적정수가에 관한 연구 (Study on optimal treatment payment by cost accounting in the artificiality kidney center in medical institutions)

  • 문승권;이윤석
    • 한국병원경영학회지
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    • 제18권2호
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    • pp.81-103
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    • 2013
  • This study is to research cost accounting practice and to analyze propriety of patients' medical payment in artificiality kidney center. The researched cost datum of the year 2012 are as follows. - Hemodialysis medical treatment was reimbursed as much as 158,001 won in case of health insured patients, but payed-off as much as 135,810 won. - The average figure of the total hospitals and clinic center is 1,603,303 won, and one time cost of hemodialysis treatment is 154,487 won. Optimal treatment pay are suggested as follows. First, Regardless of the notified classification from MOHW(Ministry of Health and Welfare), 136,000 won of fixed price payment classification needs to be reclassified by patients, severity and tobe rearranged by fixed price payment system of hospitals. Second, Fixed payment code notified by the Ministry of Health and Welfare is recommended to be simplifies and to reflect according to contents of the medical treatment rendered to patients. Third, Establishment of artificial kidney center has to be risk managed because of its huge investment. Fourth, Cost analysis model has to be maintained as basis together with appropriate application of conversion index model mixed with SGR model.

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한방의료의 건강보험 적정 본인부담률 추계 (Reexamination of Patient's Cost-sharing System for Oriental Medical Services in the Korean National Health Insurance)

  • 김진현;유왕근;서동민
    • 보건행정학회지
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    • 제17권1호
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    • pp.1-27
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    • 2007
  • This study is designed to estimate an appropriate level of patient's cost-sharing for oriental medical services in the Korean National Health Insurance. The findings of this study can be summarized as follows: 1) The current co-payment system for oriental medical services does not reflect its cost structure in clinical practice due to inconsistency of cost-sharing plan in the NHI. 2) Both oriental medical institutions and their patients, as a result, are at a relative disadvantage in financial burden, compared with other services. 3) The substantial proportion of patients' cost-sharing depends on the amount of co-payment and the range of medical cost that a flat rate is applied to. 4) The extension of the range doesn't make any substantial decrease in patient's cost-sharing. 5) The fixed amount of co-payment is more sensitive than a range to total variations of patient's cost-sharing. Based on the above, the budget impacts of a new co-payment system were estimated for each co-insurance rate, according to given scenarios. The results range from -59 billion Won (-8.5%) to 16 billion Won(2.3%).

우리나라 산재보험의 보상제도의 현황과 발전방향 (State-of-the-Art and Perspectives of the Industrial Accident Compensation Insurance System in Korea)

  • 이윤혁;이상도
    • 한국안전학회지
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    • 제13권3호
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    • pp.143-162
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    • 1998
  • There are two ways to prevent labor from Industrial accident One is pre-prevention, another is compensation. Onless It happens the compensation problem from The pre-prevention, It will be best way to solve. To prevent lobar widely first, the application range should be wide which is base of repayment second, assoradiy to reconsideration of apportionment properly The Max-Min limitative cost of compensative should be paid, one the other hands, The lay-off payment of limitative and The fixed payment of Funeral should be introduce Third, The specialization of examination.

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국제대금결제에서의 신용위험 대처방안에 관한 연구 - 국제팩토링.포페이팅을 중심으로 - (A Study on the Exporter's Measures against Credit Risks in International Payment System - focus on international factoring.forfaiting -)

  • 오원석;박세훈
    • 무역상무연구
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    • 제39권
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    • pp.143-175
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    • 2008
  • The documentary letter of credit is the most preferred and frequently used method in International Payment System in Korea, as it has less possibility of occurring credit risks in export than any other payment system. That's because the exporter can get payment from the issuing bank(confirming bank) by delivering the goods and presenting documents following the required procedure under the letter of credit, as the payment is affirmed by the issuing bank(including the confirming bank in case of the confirmed letter of credit) regardless of the buyer's payment. However, the pattern of payment methods used in international trade of Korea is changing dramatically like the importance of the credit is decreasing continuously among the payment methods while the remittance is increasing. The increase of remittance has a positive aspect that International Payment System are changing into those of advanced countries, but the decrease of the credit also has a negative aspect that the exporter might have a greater credit risks. Therefore, we need a systematic device to deal with this. Exporters in Korea usually have used the export credit insurance to deal with the credit risks However, the export credit insurance also have a limitation as the policy finance due to the limitation based on the credit status of the business and the limitation of acceptance from the lack of financial resources of the government, etc. Korea, which is the 11th export power in the world, has a basic limitation to deal with the credit risks by depending on the export credit insurance only. So, in this thesis, I have studied on the international factoring, forfaiting, which are advanced export finances and widely used in advanced countries, as substitutes to deal with the credit risks. the international factoring is an trade financing in which a factor offers full services such as credit cover, offering prepayment, collection, account receivables, management, etc, instead of the exporter on the account receivables occurred by the exporter's delivering goods to the importer. This international factoring has a high possibility of using as a means to deal with the credit risks, because it offers prepayment without recourse. the forfaiting is another export financing in which a forfaiter purchases the draft, the promissory note and other negotiable instruments issued from the international trade, with fixed interest rate without recourse from the exporter or previous holder. By using this method, they can avoid foreign exchange risks, contingency risks as well as credit risks, as the conveyances like the promissory note, etc are issued with the note warranty so-called 'per aval' in business practice. These trade financing are good substitutes to deal with the credit risks in export, but they are not widely used in Korea. Though it can be explained with various reasons, the common reasons are the lack of understanding on the use of advanced export finance, the lack of experts to manage the advanced trade finance, the conservative way of thinking of domestic organizations related to trade financing, the lack of organizations supporting the trade financing, etc.

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종합병원 간호사의 밤번고정근무제도와 이직의도에 관한 인식 (Perceptions on Fixed Night Shift System and Turnover Intention of General Hospital Nurses)

  • 이미애;조혜진;안성희;김효주
    • 간호행정학회지
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    • 제21권5호
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    • pp.519-529
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    • 2015
  • Purpose: This study was performed to identify perceptions on fixed night shift system and turnover intention of general hospital nurses and to explore a desirable application plan for a fixed night shift system. Methods: This study was a cross-sectional survey. Participants were 300 nurses working at one general hospital in GyeongGi-Do, Korea. Data were collected from November 3 to 7, 2014, with a structured questionnaires and analyzed using SPSS/PC ver 20.0 programs. Results: Of the participants 73.5% had thought about turnover because of night shifts and the preconditions for desirable fixed night shift system were a payment plan differentiated according to work conditions and an adequate number of nursing staff. Economic and administrative supports like 'raising extra-pay for night shift' and 'increasing the number of paid holidays' were very important for a desirable fixed night shift system. Conclusion: The results indicate that the most important factor for a desirable fixed night shift system to decrease nurses' turnover intention is economic and administrative support according to the needs of the nurses. So nursing managers need to find a desirable fixed night shift system considering nurses' demographic characteristics and organizational characteristics.

Workers' Compensation Insurance and Occupational Injuries

  • Shin, Il-Soon;Oh, Jun-Byoung;Yi, Kwan-Hyung
    • Safety and Health at Work
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    • 제2권2호
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    • pp.148-157
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    • 2011
  • Objectives: Although compensation for occupational injuries and diseases is guaranteed in almost all nations, countries vary greatly with respect to how they organize workers' compensation systems. In this paper, we focus on three aspects of workers' compensation insurance in Organization for Economic Cooperation and Development (OECD) countries - types of systems, employers' funding mechanisms, and coverage for injured workers - and their impacts on the actual frequencies of occupational injuries and diseases. Methods: We estimated a panel data fixed effect model with cross-country OECD and International Labor Organization data. We controlled for country fixed effects, relevant aggregate variables, and dummy variables representing the occupational accidents data source. Results: First, the use of a private insurance system is found to lower the occupational accidents. Second, the use of risk-based pricing for the payment of employer raises the occupational injuries and diseases. Finally, the wider the coverage of injured workers is, the less frequent the workplace accidents are. Conclusion: Private insurance system, fixed flat rate employers' funding mechanism, and higher coverage of compensation scheme are significantly and positively correlated with lower level of occupational accidents compared with the public insurance system, risk-based funding system, and lower coverage of compensation scheme.

비율(보합) 급제하에서 어업(자원)관리에 관한 연구 - 대형기선저인망어업을 중심으로 - (A Study on Fisheries Resource Management Under the Rate Payment System - In Case of Large Trawl Fisheries -)

  • 박성쾌
    • 수산경영론집
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    • 제36권3호
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    • pp.1-24
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    • 2005
  • Korean fishery wage system has been evolved with the different titles. However, Since the law of fishing crew was enacted in 1984, the fishery wage system has been established as a rate system, which is a legal term. The present rate system in practice shows various contents and modalities, depending on fisheries and regions, but the fisheries of large trawl cooperative employ a rate system of fixed plus rate wage. However, such change did not transform basically the properties of pure rate scheme. As well known, fishing vessel owners face an awful lot of difficulty in managing and controlling effectively the production process because fishing activities are carried out in the seas remote from the land. Thus, it tend to be inevitable for vessel owners to employ a rate system to induce fishermen's positive motivation for promoting productivity and saving operating costs. However, the rate system has worked out as a driving force, which induce an increase in production more strongly under the expansion of vessel numbers and power and the keener competition of fishing activities. Even though the control mechanism of fishing instruments are well established, fishermen become naturally to have an incentive to increase their fishing effort for maximizing production since they are able to raise their shares by maximizing the quantity harvested. Thus, as far as the rate system exists, fisheries administration may have much difficulty in realizing its fishery management goals only through vessel reduction and fishing gear regulations. Also, under the rate system fishery management authority may be in face of a serious dilemma between the spontaneous rate system and vessel reduction policy. If the realistic aspect of the rate system is recognized and resource restoration and profit promotion are main policy goals, it is necessary to develop effective ways to control vessel owners' and fishermen's production-maximizing motives at an appropriate level. From this point of view, it seems reasonable to introduce TAC system by species or by fisheries into the existing fishery system. The research results suggest that if the fisheries administration could understand clearly the spontaneous fisheries wage system, it would know the norm of TAC and the basic reasons for illegal fishing activities and thus it would be able to develop and implement more realistic resource management policies.

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농지 역모기지의 월지급금 추정 및 정책적 시사점 (Estimating the Payment of Farmland Reverse Mortgage and Its Policy Considerations)

  • 박원석;조덕호;김병규
    • 한국경제지리학회지
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    • 제13권4호
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    • pp.548-560
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    • 2010
  • 이 논문은 농지 역모기지의 월지급금을 추정하고, 농지 역모기지 도입 이후 농촌지역 원활한 구조조정을 위한 정책적 고려사항들을 검토하는 것을 목적으로 한다. 농지 역모기지는 농촌지역 고령자들에게 농지와 같은 고정자산을 담보로 안정적인 월소득 기반을 제공해 준다. 본 연구의 주요결과는 다음과 같다. 첫째로, Rodda et al.(2003)이 제안한 주택지분전환모형에 기초하여 농지 역모기지(FRM)모형을 개발하고, 농지가치 상승률, 이자율 등 모형에 들어가는 변수들을 예측하였으며, 이를 통해 생애 연지급금계획모형을 적용하여 적절한 월지급금을 추정했다. 이에 따라 농지가치가 1억 원일 때, 65세, 75세, 85세 고령자가 받는 월지급금은 각각 46,982원, 419,374원, 757,379원으로 추정되었다. 둘째로, 성공적인 농지 역모기지의 도입과 농촌지역 구조조정을 위한 정책적 고려사항으로 다음 3가지를 제안했다. 첫째는 농촌 고령자를 위한 통합자산관리시스템을 개발해야 하고, 둘째는 기업농체제의 합리적인 정착방안을 마련해야 하고 것, 셋째는 농촌 토지이용계획 수립을 위한 선제적 대응방안을 마련해야 할 것이다.

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