치과 건강보험 급여확대의 우선순위 설정에 관한 연구

Abstract

건강보험의 제한된 자원을 효과적으로 사용하기 위해 합리적인 기준을 마련함과 동시에 근거를 바탕으로 한 우선순위의 필요성이 요구되고 있으며, 특히 차별화된 치과질환 및 치료의 건강보험 급여 우선순위 설정 기준이 필요하게 되었다. 본 연구는 문헌고찰과 전문가 및 의료소비자의 의견조사를 통해 치과 건강보험 급여여부를 위한 평가기준과 급여확대의 우선순위 항목의 설정을 목적으로 조사, 분석하였으며, 궁극적으로 치과 건강보험 급여확대 방안에 기여하고자 한다.; The purpose of this study was to determine the order of priority in scaling up the coverage of dental health insurance in an attempt to ensure the security of that insurance, to provide more efficient dental services and ultimately to contribute to improving national satisfaction level with that insurance and promoting national oral health. Relevant literature was reviewed, and the opinions from experts and medical consumers were gathered to find out about what mattered in expanding the coverage of dental health insurance. The findings of the study were as follows: 1. Relevant literature was reviewed and the opinions from experts were gathered to find out about evaluation criteria in connection with priority setting for the dental health insurance coverage. They made a selection of 'equity of treatment', 'usefulness of treatment', 'utility of treatment', 'prevalence and incident', 'demands of the public', 'fatal of life', 'urgency of treatment', 'seriousness of disease', 'seriousness of disorder', 'cost effectiveness', 'economical charge', 'financial charge of insurance', 'prevention possibility', 'improvement in quality of life'. 2. As for evaluation criteria in connection with priority setting for the dental health insurance coverage, 5 grade, both of the experts and medical consumers laid stress on the importance of 'prevalence and incident' each 3.89, 3.94. However, they disagreed with each other on the other criteria. Experts made a selection of 'utility of treatment'(3.82) and 'prevention possibility'(3.73) as the priority, and medical consumers made a selection of 'economical charge'(3.87), 'fatal of life'(3.83) as the priority. 3. Concerning what item of dental service should newly be covered by the insurance first, 5 grade, both groups singled out 'pit and fissure sealing' each 3.71, 3.61 as the top priority. In addition both groups selected out 'preventive scaling' each 3.70, 3.61, and 'fluoride application'(3.64, 3.47), 'tooth brushing instruction'(3.63, 3.36), 'denture of the aged'(3.40, 3.47). Both groups singled out preventive treatment as the top priority. But medical consumers supported about prosthetic treatment rather than experts. 4. For priority-setting in expanding the dental insurance coverage, it is based on evaluation criteria and item of dental service that experts and medical consumers supported and compromise with finances of insurance. It's attempted in this study to adopt an officially reliable survey instrument to acquire synthetic information on the views of experts, who affected policy making, and of medical consumers, who influenced public opinion, and the effort is expected to lay the groundwork for selecting rational priority-setting criteria and dental service thereby for formulating better policies about the dental health insurance coverage.