노인장기요양보험제도의 개념과 의료계의 활용방안

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목차

Ⅰ. 변화하는 의료환경­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
1. 의료시장 개방­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
2. 민간의료보험 도입­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
3. 건강보험 기금화­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
4. 노인장기요양보험제도의 도입­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

Ⅱ. 노인장기요양보험제도­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
1. 노인장기요양보험제도의 개념­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
1) 제도 도입의 경과­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
2) 건강보험제도와의 차이점­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
2. 장기요양보험 적용 대상자­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
3. 장기요양인정 절차­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
* 인정조사 52개 항목­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
* 장기요양 등급별 심신의 기능 상태 수준­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
4. 장기요양급여의 종류 ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
5. 보험재원 ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
1) 장기요양보험료­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
2) 국가부담­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
3) 본인일부부담금­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
6. 급여 이용시 본인 일부 부담금­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
1) 법정 본인일부부담금­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
2) 월 한도액 초과 비용­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
3) 재가 및 시설 급여비용 수가­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
4) 장기요양급여비용청구­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
5) 비급여 항목 비용­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
* 관리운영 및 급여이용 체계­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
7. 서비스 제공기관­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
1) 장기요양기관­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
2) 장기요양요원­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
3) 요양보호사(장기요양요원 중 하나)의 개념­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
8. 서비스제공의 기본원칙­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
1) 서비스제공 기본원칙­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
2) 노인장기요양보험법 규정­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

Ⅲ. 노인장기요양보험제도의 영향 및 활용방안­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
1. 노인장기요양보험제도의 영향­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
1) 부정적인 측면­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
2) 긍정적인 측면­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
2. 노인장기요양제도의 활용방안­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
1) 재가급여를 제공하는 장기요양기관으로의 활용­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
2) 요양보호사교육기관으로의 활용­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­
3) 의사소견서 및 방문간호지시서 발급기관으로의 홍보 및 활동­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

본문내용

의료 산업에 있어서 의료서비스를 직접적으로 제공하는 의료 공급자(Health care Provider)와 의료서비스를 필요로 하는 사람(Beneficiary)인 환자가 있다. 이 두 이해 관계자는 과거에는 직접적으로 연결되었지만 현대에는 국가나 이익회사가 운영하는 보험회사가 개입하게 되고 의료 시스템이 발달한 나라일수록 보험회사가 관여하는 부분이 많아지게 된다. 그리고 의료서비스 전체의 제도에 대한 통제를 하는 정부가 있고, 의사들의 협력자이자 경쟁자인 제약회사가 있다. 또 기타 물품공급자와 기타 지원 노동력을 제공하는 집단이 있다.

위의 이해관계자들은 유기적으로 얽혀있어서 의료산업에서 살아남아야 하는 병원은 항상 그 변화의 과정을 주시해야 한다.

현재 한국의 의료산업에 있어서 여러 변화주체들이 있겠으나 의료서비스제도를 통제하는 정부의 입장과 관련되어 변화의 모습을 서술하고, 특히 2008년 7월부터 시행될 노인장기요양보험제도의 도입과 관련된 개념설명, 이의 시행에 따른 의료계에 미칠 영향과 활용방안에 대해 모색해 보도록 하겠다.

1. 의료시장 개방

외국인 투자촉진을 위한 경제자유구역의 지정 및 운영에 관한 법률이 개정·시행됨에 따라 경제특구 내 거주외국인의 의료이용 편의 제공 및 국내 의료제도 문제 해결을 위한 대안으로 경제특구 내 외국병원 설립 허용과 경제특구 내 설립되는 외국병원은 내국인 진료허용, 각종 자금 및 세제지원 규제완화를 하도록 한다는 것이 골자이다.

이는 해외원정 진료수요 국내 수용, 국내 의료산업 발전 및 의료인력 교류활성화라는 긍정적인 측면이 있으나, 부정적인 영향도 미친다. 예를 들어 내국인 진료허용으로 사치성 의료서비스 창출, 고급의료에 대한 왜곡된 수요조장하고 건강보험 수가인상, 영리법인 허용 등 국내병원의 각종 규제완화 요구하게 될 것이고, 건강보험 요양기관 당연지정 적용제외로 건강보험 수가와 관계없이 자신들이 책정한 일반수

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