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보험료 등급에 따른 임플란트 건강보험 급여 적용의 차이

대한임상보험의학회지 2020년 15권 1호 p.1 ~ 14
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Abstract


Since the health insurance coverage for dental implants were implemented in July 2014 and the age of eligibility was lowered for patients aged 65 or older in July 2016, the coverage has been expanded. Despite the expansion of the health insurance coverage, the benefit for dental implants only covers up to 2 implants during a whole lifetime of one person and the coinsurance rate is 50% per each implant which is equivalent to about KRW 620,000 (for clinics). In this regard, we cannot say that there is no financial burden to the patients. Low-income elderly people have the lower rate in retaining 20 or more natural teeth and their total tooth mortality rate is higher than that of high-income elderly people. However, the coverage is currently up to 2 implants and most of the elderly people need more implants than that. It means that this system would hinder fairness, the goal of the national health insurance system in that those who can afford more than 3 implants receive benefits while those who cannot afford are excluded from the coverage. This study aimed to investigate the influence of the dental health insurance policy for implants on the use in implant coverage by ratings.
The investigation was conducted with selected people aged 65 or older for whom the implant procedure codes had been prescribed with the customized data for the year 2017 and 2018 from National Health Insurance Service. Frequency analysis was done to identify the general characteristics of who received benefits from implant coverage.
The result was that the grade 20 of the insurance premium rates used implants most frequently in 7.41% (p<.0001). With the implant usage rates by insurance premium rates shown in graphs, it was verified that there was an increase in the usage of implant as the rate gets higher. This shows a result that goes against the national health insurance which is the social security system where all citizens can use healthcare services in the principle of fairness regardless of their income. From such results, I think that it is necessary to consider changing the dental insurance policies based on the importance of primary care which is dental checkups and preventive dentistry, rather than treatment such as prosthetic treatment at a high cost.

키워드

implant; health insurance; coverage; insurance premium rate

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