This study aimed to: analyze the effect that four serious diseases guarantee assurance policy implemented in 2013 has on usage and profits of medical facilities; search for the assurance policy by distinguishing serious and rare incurable disease; and figure out problems resulting from health insurance reinforcement policy by the present government in order to identify plans for improvement.
The study identified the first, second, and third mid-term coverage reinforcement plan of health insurance that the government announced.
The study also focused on the changes in health insurance guarantee rate and the plans announced by the current government to determine what differenced made guarantee reinforcement.
For these purposes, the study compared the impact of enhanced guarantee, using the case of an A medical institution in Jeonbuk Province. Moreover, the study summarized the status of cancer diseases and rare incurable diseases and the direction of implementation by comparing before and after the policy and analyzed comparatively medical usage and profits on serious diseases. (presented support expansion plans.)
The results showed statistically significant effect of the reinforcement policy of health insurance guarantee coverage on increased use of medical service, whereas the increase in profitability of the medical institution had no significant effect.
The causal effect of the guarantee policy somewhat reduced medical expenses for individuals with the four serious diseases. However, it was deemed that these radical assurance reinforcement measures are insufficient to support adequate numbers and reasonable price criteria, and that there is a lack of funding for medical institutions to maintain and develop the quality of medical care in the absence of non-payment.
Also, it is inevitable to raise the health insurance premium rate in the long term in order to cover the costs of guarantee assurance policy, which may cause an economic inefficiency and reduce the uncertainty of disposable income after deducting medical expenses. This may lead to a problem that can act as a pressure to reduce domestic savings by reducing the inflow of household savings.
It is anticipated that there may be pressure due to an increase in staffing and facility investment following the introduction of differential compensation systems such as improving the quality of medical care in medical institutions and integration nursing care services. Besides, there is a concern that the number of patients in hospitals and weak competitiveness and public medical institutions may be reduced due to the tendencies in which a number of patients go to large hospitals and seek medical treatment in metropolitan areas, resulting from reduction of patient costs that patients should pay. In the process where medical institutions receive medical fees after the paid treatment, there has been a variable called an appropriate assessment of medical care by the Health Insurance Review and Evaluation Institute.
Therefore, the actual medical fee that the medical institutions receive is reduced because of various reasons during the examination process, which reduces the income of the medical institutions.
The increase in the amount of medical care due to the decrease in the costs felt by the visiting patients will control the amount of medical care for the sustainability of health insurance finance. Moreover, the polarization of the 'the rich and poor' in the medical institutions is expected to intensify due to the improvement of the quality of medical care, proper manpower, and strengthened safety for patients. Therefore, it is necessary to establish countermeasures in terms of hospital management.
In this paper, the following improvements were proposed.
It is believed that the implementation of 4 major disease assurance policies has improved the accessibility of medical services for severely ill patients. However, in order to actualize universal medical care with a high degree of completeness, increasing medical access without time and space limitations across the country can reduce the heavily biased use of large hospitals in the metropolitan areas. To do this, it is necessary to lessen the gap among local communities and medical institutions through policies to address the issue of medical bipolarization.
Furthermore, by establishing a network for each base station in each region, the government should respond to flooding in the metropolitan areas. That is, in the case of severe patients, after receiving acute care, a forwarding system can be established to enable the use of infrastructure that can be managed in the region after receiving acute care.