요양기관 법적 지위보장을 위한 법정책적 개선방안 (Legal and Political Ways to Guarantee Legal Status of Medical Institutions)

서지정보

· 발행기관 : 고려대학교 법학연구원
· 수록지 정보 : 고려법학 / 50호 / 123 ~ 167페이지
· 저자명 : 이인영

초록

The health insurance system has developed remarkably over the
past three decades. It began as the medical insurance system in 1977.
For 12 years since its inception, the old system had focused on
expanding the number of its beneficiaries. In 1989, the old system
decided to cover self-employed people in urban areas. The same year,
it was replaced by a new one, the current health insurance system, to
cover all people across social strata. Under Article 40 of the National
Health Insurance Act, hospitals and clinics are forcibly designated by
the government as institutions of medical treatment and recuperation.
The health insurance system is designed to meet the needs of all
people for medical services and benefits by raising sufficient funds for
insurance coverage.
The system of forcibly designating institutions of medical
treatment and recuperation, however, ironically paved the way for an
excessive distortion of the medical system, considering that it allowed
medical authorities to manage and operate the medical system with
unilateral control and instruction, instead of rational means.
As an example, an “arbitrary exclusion of patients from health
insurance coverage benefits in some medicines and treatment” became
a big issue between St. Mary’s Hospital in Yeouido, Seoul and a group of leukemia patients in December 2006. The issue still remains a hot
potato. Under the current National Health Insurance Act, medical
institutions' arbitrary exclusion of patients from health insurance
coverage benefits in some medicines and treatment, which are deemed
absolutely necessary for certain groups of patients from a medical
point of view, constitutes “fraud and deceit,” most of the Supreme
Court case summaries have thus ruled. It is, therefore, noteworthy that
Justice Cho Dae-hyun of the Constitutional Court directly recently
commented on this issue when he presented his view on the
constitutionality of an “atopic patient case.”
There currently exists a judicial relationship between doctors and
their patients under medical contract. Their relationship in this context
never changes, although their relationship is affected by administrative
authorities' intervention in the payment of medical expenses within the
social security framework called health insurance. But national
insurance coverage standards are nothing but regulatory rules aimed at
attaining the goals of the health insurance system, not binding laws
that could deny the effects of medical contracts between doctors and
their patients. Now, it is high time to make a well-balanced
constitutional interpretation of the trilateral relationship between
doctors, patients and the National Health Insurance Corporation.
The current doctors' fees are unrealistically low, which has caused
discontent within medical circles and institutions. Under these
circumstances, it is urgently necessary to increase the doctors' fees to
a realistic level. Given the insufficient health insurance coverage funds,
I hereby would like to suggest a way to expand tax revenues most
realistically: to levy “health tax” as a national tax on the consumers of
tobaccos, liquors and oil, substances deemed harmful to the people's
health. I would also like to suggest a way to guarantee the legal status of institutions of medical treatment and recuperation legally and
systematically : to establish an autonomous health insurance system
based on market principles, so that medical staff and institutions can
take a more proactive attitude toward their patients.

영어초록

The health insurance system has developed remarkably over the
past three decades. It began as the medical insurance system in 1977.
For 12 years since its inception, the old system had focused on
expanding the number of its beneficiaries. In 1989, the old system
decided to cover self-employed people in urban areas. The same year,
it was replaced by a new one, the current health insurance system, to
cover all people across social strata. Under Article 40 of the National
Health Insurance Act, hospitals and clinics are forcibly designated by
the government as institutions of medical treatment and recuperation.
The health insurance system is designed to meet the needs of all
people for medical services and benefits by raising sufficient funds for
insurance coverage.
The system of forcibly designating institutions of medical
treatment and recuperation, however, ironically paved the way for an
excessive distortion of the medical system, considering that it allowed
medical authorities to manage and operate the medical system with
unilateral control and instruction, instead of rational means.
As an example, an “arbitrary exclusion of patients from health
insurance coverage benefits in some medicines and treatment” became
a big issue between St. Mary’s Hospital in Yeouido, Seoul and a group of leukemia patients in December 2006. The issue still remains a hot
potato. Under the current National Health Insurance Act, medical
institutions' arbitrary exclusion of patients from health insurance
coverage benefits in some medicines and treatment, which are deemed
absolutely necessary for certain groups of patients from a medical
point of view, constitutes “fraud and deceit,” most of the Supreme
Court case summaries have thus ruled. It is, therefore, noteworthy that
Justice Cho Dae-hyun of the Constitutional Court directly recently
commented on this issue when he presented his view on the
constitutionality of an “atopic patient case.”
There currently exists a judicial relationship between doctors and
their patients under medical contract. Their relationship in this context
never changes, although their relationship is affected by administrative
authorities' intervention in the payment of medical expenses within the
social security framework called health insurance. But national
insurance coverage standards are nothing but regulatory rules aimed at
attaining the goals of the health insurance system, not binding laws
that could deny the effects of medical contracts between doctors and
their patients. Now, it is high time to make a well-balanced
constitutional interpretation of the trilateral relationship between
doctors, patients and the National Health Insurance Corporation.
The current doctors' fees are unrealistically low, which has caused
discontent within medical circles and institutions. Under these
circumstances, it is urgently necessary to increase the doctors' fees to
a realistic level. Given the insufficient health insurance coverage funds,
I hereby would like to suggest a way to expand tax revenues most
realistically: to levy “health tax” as a national tax on the consumers of
tobaccos, liquors and oil, substances deemed harmful to the people's
health. I would also like to suggest a way to guarantee the legal status of institutions of medical treatment and recuperation legally and
systematically : to establish an autonomous health insurance system
based on market principles, so that medical staff and institutions can
take a more proactive attitude toward their patients.

참고자료

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