지역의료보험의 재정안정 및 관리운영효율화방안에 관한 연구

목차

제 1 장 서 논
제 1 절 연구의 배경 및 목적
제 2 절 연구의 범위 및 방법

제 2 장 지역의료보험재정의 안정화 방안
제 1 절 그간의 재정안정시책 경과
제 2 절 지역보험 재정현황
1. 지역보험 급여재정 일반현황
2. 재정적자요인 분석
제 3 절 기본방향의 설정
제 4 절 수입측면의 안정화 방안
1. 보험료부과 및 징수체계의 개선
2. 재정조정사업의 개선
3. 국고보조금의 적정확보 및 분배개선
제 5 절 지출측면의 안정화 방안
1. 보험급여비용의 급상승 억제
2. 보험급여비용의 누수방지
3. 관리운영비의 절감

제 3 장 관리운영의 효율화 방안
제 1 절 관리운영체계의 방향설정
1. 현행 관리체계
2. 조직의 적정규모에 대한 접근
3. 향후의 방향설정
제 2 절 부문별 관리운영의 효율화 방안
1. 기본방향
2. 조직의 자율능력 향상
3. 행정기능의 합리적 분산
4. 조합의 기능활성화
5. 업무의 신속한 연계처리 확보
6. 지원 및 감독기능의 전문화

제 4 장 요 약

본문내용

esent situation and problems on self-employed medical insurance, first, the financial instability has risen as an urgent question. The amount of deficit has increased from 24.1billion won in 1995 to 150.3billion won in 1996. In spite of maximizing the effect of financial support through grading government subsidies and strengthening financial adjustment etc, self-employed medical insurance is confronted with financial limit by rapid growth of benefit cost. Especially, the lack of efforts on increasing contribution to adequate level and insufficient administrative efforts on collection etc have become major cause of financial deficit.
Second, in terms of administrative aspects, scale of economy is needed to correct the weakness of cost-effectiveness in case of utterly small medical insurance societies. Efforts are also required to resolve the lack of efficiency like over-spending on administrative cost etc
2. Countermeasures for financial stability of self-employed medical insurance, being similar in the character of short-term medical insurance, have focused on ,in the short run, maintaining actuarial equilibrium both at the incomings level through improving contribution assessment and collection, extending financial adjustment program and expanding government subsidies and the outgoings level through controlling rapid growth of benefits cost, preventing leakage of benefits cost and reducing administrative cost. In the longer run, contribution and benefit system(adequate and reasonable contribution, appropriate benefit)must be reviewed to meet increasing medical need of people within a certain extent.
3. In relation to improving efficiency of administration, first, current society-managed system having its own history over the past twenty years achieves nation-wide medical insurance and enter the phase of fixing in korea. Accordingly, korea makes the most of the experience of trial and error accumulated for a long time and grafts the merit of uniform medical insurance system on existing society-managed system to make medical insurance more convenient and useful to people. However, this study presents the plan of wide area societies based on the adjacent zone of life and the plan of separately established society for farmers and fishers as one of the plan of appropriate scale of societies to reduce administrative cost.
Second, korea makes the most of original idea and merit of society-managed system taking the adventage of competition principle pursued by developed countries to make medical insurance one step higher, because korean medical insurance program has been operated by society-managed system on the basis of autonomy and self-government.
Finally, this study have suggested that korea is now under the necessity of improving the autonomy of decision-making organization, strengthening authority and responsibility through miminizing regulation, activating the function of societies, computerizing works, specializing function of direction.

키워드

지역의료보험,   재정안정,   행정기능,   현행 관리체계,   관리운영의 효율화 방안,   향후의 방향설정