중국의 신형 농촌합작의료보험제도 : 문제점 및 개선방안 (New Rural Medical Cooperative in China: Problems and Improvements)

서지정보

· 발행기관 : 한국무역통상학회
· 수록지 정보 : 무역통상학회지 / 9권 / 2호 / 27 ~ 57페이지
· 저자명 : Bang Kgang, 이광봉

초록

New Rural Medical Cooperative(NRMC) first implemented in 2003 is now considered to be very successful in terms of improvements in participating rates, plan coverage, and claims payment. For example, the number of participating farmers has increased more than ten folds in just four years since the inception. The system as of 2006 covers approximately 410 million farmers, almost half of entire farmers in China. In addition, various administrative operations including Third-Party-Administration(TPA)
are aggressively being experimented to find out the most suitable one. NRMC seems to take root stably in the rural areas in China.
While the system has so far greatly enhanced the access to medical services for the farmers, it still faces formidable problems such as ever rising medical costs, relatively low level of insurance payments, and geographical imbalances in medical resources.
This paper recognizes that those problems mainly stem from moral hazard and
improper incentives of the interested parties in the system, and thus suggests the following measures to contain them. First of all, the system may apply the concept of managed care for medical costs containment. Specifically the system may establish a providers network, and improve the current reimbursement method of fee-for-service by adopting Diagnosis-Related-Group(DRG) or Per Diem methods. Considering government funds usually initiate medical service providers in China and there exists a serious shortage of medical staffs in rural area providers, a type of Health Maintenance Organization(HMO) is more appealing. Second, NRMC needs to recognize and utilize the relatively superior business know-hows and efficiencies of TPAs and private risk carriers. As demonstrated in other national health insurance markets, private health insurers are capable of complementing
the limits of a public risk carrier like NRMC, especially in the areas of risk assumption, financing, and reimbursements. Therefore, it is essential for NRMC to seek their voluntary cooperation by providing proper incentives to private insurers. Finally, this paper notes that health funds of NRMC are segregated into thousands pieces by the number of participating Hyuns, a lower administrative division and just sit in bank accounts with nominal returns. As the size of health funds grows by time, those funds could be aggregated and invested in the financial markets, at least with the risk level of
the most conservative private insurer in China.

영어초록

New Rural Medical Cooperative(NRMC) first implemented in 2003 is now considered to be very successful in terms of improvements in participating rates, plan coverage, and claims payment. For example, the number of participating farmers has increased more than ten folds in just four years since the inception. The system as of 2006 covers approximately 410 million farmers, almost half of entire farmers in China. In addition, various administrative operations including Third-Party-Administration(TPA)
are aggressively being experimented to find out the most suitable one. NRMC seems to take root stably in the rural areas in China.
While the system has so far greatly enhanced the access to medical services for the farmers, it still faces formidable problems such as ever rising medical costs, relatively low level of insurance payments, and geographical imbalances in medical resources.
This paper recognizes that those problems mainly stem from moral hazard and
improper incentives of the interested parties in the system, and thus suggests the following measures to contain them. First of all, the system may apply the concept of managed care for medical costs containment. Specifically the system may establish a providers network, and improve the current reimbursement method of fee-for-service by adopting Diagnosis-Related-Group(DRG) or Per Diem methods. Considering government funds usually initiate medical service providers in China and there exists a serious shortage of medical staffs in rural area providers, a type of Health Maintenance Organization(HMO) is more appealing. Second, NRMC needs to recognize and utilize the relatively superior business know-hows and efficiencies of TPAs and private risk carriers. As demonstrated in other national health insurance markets, private health insurers are capable of complementing
the limits of a public risk carrier like NRMC, especially in the areas of risk assumption, financing, and reimbursements. Therefore, it is essential for NRMC to seek their voluntary cooperation by providing proper incentives to private insurers. Finally, this paper notes that health funds of NRMC are segregated into thousands pieces by the number of participating Hyuns, a lower administrative division and just sit in bank accounts with nominal returns. As the size of health funds grows by time, those funds could be aggregated and invested in the financial markets, at least with the risk level of
the most conservative private insurer in China.

참고자료

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