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AN OVERVIEW OF THE HEALTH INSURANCE DEMONSTRATION PROGRAMS IN KOREA

대한보건협회지 1977년 3권 1호 p.35 ~ 42
문옥륜,
소속 상세정보
문옥륜 ( Moon Ok-Ryun ) - Seoul National University School of Public Health

Abstract


The Korean government enacted its health insurance law in 1963.´ It was the Honanr Manure Company which organized the first health insurance plan to serve its employees on a voluntary basis in 1965. The law was amended in 1970- to cover civil servants, soldiers? and industrial employees on a compulsory basis. The second amendment of the law was made in 1976 after recognition of the failure in the compulsory application of the program.. The new health insurance law will be effective from July 1, 1977.
The Korean health insurance system is in its infancy in the development´, process. It has merely experienced 12 years of demonstrative practice, So far there are eleven government authorized health insurance programs and seventeen non-authorized programs. The former served 68,417 members and the latter 160,105 members by the end of December 1975. Table 3 shows the fact that population care and from 8.9% to 53.5% in outpatient care. The coinsurance rate of employees plan is generally lower than that of self-employed plan. The average size of coinsurance rate is around 30% of total medical expenses. The co-payment is certainly able to discourage over-utilization, but the barrier is as high as above 50% in some plans. It should be remembered that such high coinsurance rate keeps members from utilizing indispensable medical care.
The 1977 will be an epoch-making year for health insurance program in Korea. According to the revised Law, all the companies employing more than 500 workers are forced to organize their own independent health insurance plans by the end of this year, and self-employed people are encouraged to join area-wide community health plans on a voluntary basis. Should everything go as planned the employees programs will cover additional 1,200,-00.0 .employees and their dependents by December 1977, which are equivalent to 10% -of Korean population. However, the prospect of self-employed program is not so bright as that of employees. It is well acknowledged that the government´s strategy of health insurance
expansion has its weaknesses in risk spreading by a strict division of self-employed programs from employees. An alternative approach would be to encompass both employees and self-employed into a bigger health plan. Obviously, those twelve years of experiences in demonstration health insurance programs will help planners and administrators reorganize the program so as to maximize the level of health of Korean people.

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