국가의 국민건강보호의무와 건강보험제도에 대한 법적 연구

Abstract

The concepts of Constitutional right to Health is yet unfamiliar one. The Article 34(1) of the Constitution, 'All peoples shall be entitled to a life worthy of a human beings.', and Article 36(3) of the Constitution, 'The health of all peoples shall be protected by the State.' are provisions on which Constitutional right to Health is based. Since the Constitution has guaranteed right to Health, the State became responsible to the protection Health of peoples, and the peoples gained the right of security of Health toward State.

In this study, I analyzed the current situation and problems of the Legal Institution of the "National Health Insurance System (hereafter NHIS)" with reviewing the birth and historical development of NHIS on the premise that it is one of the important institutions of social insurance.

The purpose of the "National Health Insurance Act" is to improve the people's health and promote social security by providing the people with insurance benefits for, prevention of disease and injury, medical examination, medical treatment, rehabilitation and childbirth, death, and improvement of health. The first public medical insurance act enacted in 1963 and according to the Amendment in 1976 became the health care insurance compulsorily. The national health insurance act enacted in 1999 and amended recently in 2013. Though the NHIS has contributed to the marked improvement in health conditions, it has some problems to be solved. It faces difficulties with a low coverage rate, a rapid cost expansion, and a inequality of burden. Based on the analysis, I suggest several improvement points of NHIS.

First, the NHIS achieved universal coverage only 12 years after its introduction. Nevertheless, payments for non-covered services remain large compared to other countries, and the co-payment rate is high. According to the OECD, Out-of-pocket payments (co-payments and the cost of non-covered services) by patients is the third highest in the OECD countries. Especially, co-payment rates for out-patient care is the highest among the 20 OECD countries that require co-payments. Thus, I suggest that the security level of the NHIS should be enhanced continuously and security enhancement centered on the necessary medical care. Also, the NHIS ought to provide almost the same guarantee level of low-income as the medical care of welfariat. In addition, as a mid-and long-term policy issue, I suggest that the introduction of Sickness Benefit Program.

Second, perhaps the biggest challenge facing the NHIS is the rapid increase in its expenditure. During the decade to 2011, per capita health expenditure in Korea rose at an 9.3% annual average rate, the fastest in the OECD countries. Funding for rising health expenditure will have to come from some combination of higher NHIS fee, tax revenue, and out-of-pocket-payments by patients and private health insurance. However, expanding out-of-pocket payments, by raising co-payment rates or reducing the coverage of NHIS, would not be desirable as it would reduce access to health care. While private insurance can provide additional resources, relying mainly on private insurance to finance the increase in health expenditure would not be appropriate, given the already high level of private spending. Also, continuing to rely primarily on the NHIS fee for health expenditure would tend to hold back employment and growth. Thus, I recommend to raise up the support of public finance and introduce new consumption tax to impose. The expiration of the law on financing NHIS in 2016 could provide an opportunity to begin rebalancing the financing of health care toward tax revenue.

Third, because the insurance levy system separated into the workplace subscribers and the regional subscribers, the workplace subscribers claim that they burden much more than the regional subscribers. Also, the regional subscribers on the other hand feel that the present levy system is unfair. Thus, it is necessary that the reform of the levy system to impose the NHIS fee based on the income according to the principle of burden equality. Also, the NHIS fee ought to be imposed on the other kinds of income, for example the financial income etc, rather than the earned income.

Finally, to maximize the will and interests of subscribers (general peoples) from the point of view of financial democracy, the structure of decision-making should be autonomous and independent mechanism by minimizing the influence of provider (medical doctor, hospital or pharmaceutical industry). To do so, making it essential to rationalize and re-adjust the functions of the "Health Insurance Policy Deliberative Committee (under the Ministry of Health and Welfare)" and the "Fiscal Management Committee (under the National Health Insurance Service)". Also, the "National Health Insurance Service" and the "Health Insurance Review and Assessment Service" need organizational consolidation.