중국의 신형 농촌합작의료보험제도 : 문제점 및 개선방안 = New Rural Medical Cooperative in China: Problems and Improvements
저자
Bang Kgang (인제대학교 동북아경제연구센터) ; 이광봉 (인제대학교)
발행기관
학술지명
무역통상학회지(Journal of Korea Research Association of International Commerce)
권호사항
발행연도
2009
작성언어
Korean
주제어
자료형태
학술저널
수록면
27-57(31쪽)
KCI 피인용횟수
0
제공처
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.
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.
분석정보
연월일 | 이력구분 | 이력상세 | 등재구분 |
---|---|---|---|
2027 | 평가예정 | 재인증평가 신청대상 (재인증) | |
2021-01-01 | 평가 | 등재학술지 유지 (재인증) | KCI등재 |
2018-01-01 | 평가 | 등재학술지 유지 (등재유지) | KCI등재 |
2015-01-01 | 평가 | 등재학술지 선정 (계속평가) | KCI등재 |
2013-01-01 | 평가 | 등재후보학술지 유지 (기타) | KCI후보 |
2011-01-01 | 평가 | 등재후보학술지 선정 (신규평가) | KCI후보 |
기준연도 | WOS-KCI 통합IF(2년) | KCIF(2년) | KCIF(3년) |
---|---|---|---|
2016 | 1.3 | 1.3 | 1.15 |
KCIF(4년) | KCIF(5년) | 중심성지수(3년) | 즉시성지수 |
1.04 | 0.98 | 0.553 | 0.52 |
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