의료보험 진료비의 결정요인에 대한 연구

Abstract

Since the inauguration of the medical insurance system in 1977, the increasing medical expenses which can be menace to the finance of the medical insurance system, have become major concern in the medical insurance field in Korea. This study focuses on the determinants of the medical expenses in the helth insurance in Korea and analyzes the impact of these factors on the increase in the medical expenses. The empirical work is dong using the pooled cross-section and time-series data of the medical insurance for the self-employeds and the industrial workers from the year 1995 to 1997. The result of this study shows that the main determinants of the medical expenses in the health insurance are the ratio of the population of the aged to the total population, the frequency of the utilization, number of doctors per capita and the regime changes. Although the increasing trend in the medical expenses seems to be unavoidable, we probably need to add some efficiency to the medical expenses by suppressing the supply and the utilization of the unnecessary medical services. The fee-for-service reimbursement system of today can`t supperss the supply of the unnecessary medical services effectively. So we need to convert the present fee-for-service system into DRG`s which is known to reduce the medical costs. The increase in the medical expenses comes from a lot of factors. Therefore, we should develop more systematic and comprehensive measures to control the soaring medical expenses in consideration of the various factors such as demand, supply, and the organiza-tional side of the medical system.