In order to protect the people against economic risks due to high medical expenses and low coverage, the government enforced health Insurance coverage expansion policies in 2005. The purpose of health insurance coverage expansion policies is to improve the accessibility of medical uses restricted owing to the burden of medical expenses so as to enhance the health of the people.
In order to heighten the efficiency of medical uses in the people, our government has continued to make its efforts to advance health insurance coverage expansion policies, including the expansion of insurance benefit items and the reduction of out-of-pocket payment. As health insurance coverage expansion policies were expanded and economic standards grew so that more and more people received medical services, medical uses were increased as well as medical institutions continued to be increased.
However, even though medical uses were increased, the profits of medical institutions were not increased as much. The reason is that insured medical expenses claimed after medical treatment were reduced by medical care quality assessment in Health Insurance Review & Assessment Service, so that actual medical expenses were less than claimed medical expenses. As a result, as the profit of medical institutions is decreased, the quality of medical services is lowered and new uninsured medical services continue to be increased.
Therefore, the current government's radical coverage expansion policies should be supported by optimal medical treatment payment and reasonable insured medical expense criteria, and strategies for the financing of medical institutions should be prepared in order to maintain and advance the quality of medical care in the absence of uninsured medical expenses. In addition, it is necessary to try to derive measures for understanding and managing the responses to national health Insurance policies as a major factor influencing profitability in order to promote the efficient management of medical institutions.
However, in spite of this importance, there were few studies on the effect of the government's coverage expansion policies on the change in medical uses or medical profits.
So, the purpose of this study is to analyze the effect of health insurance coverage expansion policies on the people's medical uses and medical institutions through literature research methods. Also, the additional purpose of this study is to analyze how the change in medical uses affected the profit of medical institutions. In addition, the further purpose of this study is to understand the effects and limitations of health insurance coverage expansion policies, and so examine measures for complementing such policies.
According to the results of this study, national health insurance coverage expansion policies increased the rate of insured medical expenses and decreased the rate of out-of-pocket medical expenses among insured medical expenses, so that the people's medical uses were increased. Additionally, even though medical uses were increased, the medical profits of medical institutions were not increased as much. Rather, because the increase of medical uses reduced the finance of National Health Insurance Service, which should pay insured medical expenses, profits were decreased due to medical care quality assessment for reducing the payment of insured medical expenses. Therefore, national health insurance's coverage expansion policies should enhance genuine medical coverage levels through ensuring the quality of medical services, the optimum of insured medical expenses, and reasonable medical treatment payment.