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국민건강보험제도목차
Ⅰ. 국민건강보험 ······························································································ 11. 건강보험이란 ······································································································1
1) 건강보험제도의 개념 ······················································································· 1
2) 건강보험제도의 특성 ······················································································· 1
2. 건강보험의 발달사 ····························································································· 2
3. 적용대상 ············································································································2
1) 건강보험 가입자 ····························································································· 3
2) 건강보험 보험자 ····························································································· 3
3) 건강보험 적용인구·····························································································3
4. 건강보험급여 ······································································································4
1) 건강보험급여의 구분··························································································4
2) 법정급여 ·········································································································4
5. 관리운영체계 ······································································································5
1) 보건복지부 ······································································································5
2) 국민건강보험공단 ·····························································································6
3) 건강보험심사평가원 ··························································································7
6. 재원조달 ············································································································7
1) 보험료율 ·········································································································7
2) 보험료의 산정과 부담······················································································· 8
3) 본인부담액······································································································ 8
7. 요양기관············································································································ 9
1) 요양기관········································································································· 9
2) 요양급여비용···································································································10
Ⅱ. 건강보험의 한계 및 발전방안 ···································································11
Ⅲ. 기출문제·······································································································14
참고문헌 ············································································································19
본문내용
Ⅰ. 국민건강보험1. 건강보험이란
1) 건강보험제도의 개념
국민건강보험은 일생생활의 우연한 질병이나 부상이라는 불확실한 사회적 위험의 발생과 분만, 사망 등으로 인해 개별가계가 일시에 고액의 의료비를 지출함에 따라 겪게 되는 어려움을 덜어주고 가계가 파탄되는 것을 방지하기 위해 국가가 법으로 정하여 실시하는 사회보장제도로서 보험가입자 전원에게 소득에 재산에 따라 보험료를 내어 기금화 하였다가 보험사고가 발생했을 때 보험급여를 하여줌으로써 국민의 경제적 부담을 덜어주고 보건을 유지, 향상시켜주며 국민 상호간에 위험을 부담하고 의료서비스를 제공하는 제도이다.
사회계층간 의료수혜의 불평등이 심화되고, 의료이용도의 소득계층별, 지역별, 성별, 직업별, 연령별 차이가 사회적 불만의 한 원인으로 대두되고 보건의료서비스가 의식주 다음 제4의 기본적 수요로 인식됨에 따라 의료보장제도의 필요성이 나날이 높아지고 있으며, 의료수혜 불평등을 해소하기 위해서는 사회적·국가적 노력에 대한 필요성이 높아지기 시작하였다. 따라서 국민건강보험은 예측할 수 없는 질병의 발생 등에 대한 개인의 부담능력의 한계를 극복하고 개인의 위험을 사회적·국가적 위험으로 인식하여 위험의 분산 및 상호부조인식을 제고하기 위한 제도로써 등장하게 되었다. 즉 의료서비스에 대한 범국민적인 욕구 증진과 의료수혜의 불평등을 해소하고 개인의 부담능력을 줄이기 위하여 전 국민에게 적용되는 사회보험의 형태로써 의료보장제도가 시행이 되었다.
