Research Report
Ⅰ. Background and Purpose
□ Background and purpose of this study
○ The cost of National Health Insurance Service has increased rapidly by more than 11 percent annual average for 10 years recently and the average rate of increase in the proportion of national fee for medical treatment per GDP is two times higher than that of average OECD countries.
○ The national demand for high-quality medical care services is growing, but there is a limit to raise up the insurance bill or the support of public finance.
○ Because the sustainability of the National Health Insurance Service (NHIS) system cannot be obtained without the stabilization and soundness of the NHIS finance, it is necessary to seek the improvement scheme of NHIS institution based on the trust of general people.
□ Methodology
○ In this study, I analyzed the current situation and problems of the Legal Institution of the National Health Insurance Service with reviewing the birth and historical development of NHIS system on the premise that it is one of the important institutions of social insurance based on the ideal of welfare state (“Sozialstaat” or “Wohlfhartsstaat” in german) and the principle of social solidarity (“Solidaritatsprinzip” in german)
○ In order to secure and fulfill the right to access the medical treatment or the right to health of the people, the premium goals of the NHIS legal institution is that the sustainable security level of NHIS should be enhanced continuously and its means is to unify the system of imposing the insurance bill centered on the income and profit.
○ To balance the revenue(by securing the financial resources with the insurance bill) and the expenditure (with providing medical fee), the structure of decision-making should be autonomous and independent mechanism by minimizing the political influence and channelizing the will and goods of people who are enrolled in the NHIS system.
Ⅱ. Main Contents
□ The Significance and Function of the NHIS Institution
○ The modern social(welfare) states are required to carry out a wide range of public tasks to provide benefits to the socio-economic disadvantaged groups for their survival care and to remove the social inequality, so that especially the realization of public health care service system is very important as the basis of survival.
○ The right to health, as a kind of social rights, is a public claim for payment or allowance to state that require the active coordination and intervention of the country and its contents and effect is embodied by law(statute).
○ The function of National Health Insurance Service system
: Strengthening the social cohesion (Social Integration)
- Adjust the individual equivalence principle between the insurance fees(bills) and medical fees. (Justification of public financial support)
- Basis to justify the redistribution of income in the social insurance system. (Principle of burden equality)
- Justification of the obligation to pay the insurance fee of third party(employer) who is not a direct beneficiary of the insurance and medical service.
- Financial adjustment between the insurers who have sound financial structure and the insurer who have vulnerable one.
○ The features of National Health Insurance Service system
- Compulsory joining and enrollment (the payment obligation of the insurance fee)
- Differentiate the burden of insurance fee depending on the earning and bearing capacity, however, the equal benefits of medical service and fee
- Short-term insurance
□ Management Structure of NHIS system
○ Configuration of desirable relationship among the Ministry of Health and Welfare, National Health Insurance Service and the Health Insurance Review and Assesment Service
○ The role of the NHIS as the insurer and the function of government to adjust the conflict of interests between the provider (medical doctor, hospital or pharmaceutical industry) and the general public as a subscriber.
○ The analysis of Health Insurance Review & Assessment Service to examine and evaluate the new medical treatment technology - its function should be accomplished independently.
□ The birth and historical development of NHIS
○ The situation before the year 2,000 - the integration of organization and finance
: Multiple associations(unions) are composed of regional subscribers and subscribers in workplace distinctively.
○ The debate over fiscal and organizational consolidation - analysis on its results and significance
○ The structural changes in the NHIS finance and the enactment of special act on the fiscal consolidation of NHIS in 2002
- Impose the “Fee for Health Promotion” on the tobacco to set up and manage the fund for the public health promotion
- Analyse the significance and function of the public financial support for the NHIS system
- Health Insurance Policy Deliberative Committee : the unification of the government-led centralized decision-making structure
□ The sustainable enhancement of securing the National Health Insurance Service
○ Analysis of the rule-making process and policy supports to streng- then the secure guarantee of NHIS
○ The major policy issues on the enhancement of securing the guaran- tee of NHIS
- Almost the same guarantee level of low-income (lower income family) as the medical care of welfariat
- Relief of the Catastrophic Health Expenditure
- Security enhancement centered on the necessary(indispensable) medical care
○ Considerations of security enhancement of NHIS : the need for the ongoing verification and validation
○ improvement plan of the legal system
- The subject of medical care expenses shall be prescribed by the regulations on the standards for National Health Insurance medical care expenses(the ordinance of the Ministry of Health and Welfare), authorized in the Article 41 of the National Health Insurance Act
- The subject of the user-paid expenditure of patient is embodied in the Article 19 of the enforcement ordinance of the National Health Insurance Act, with its asterisk 2 and 3 etc, which is overall entrusted by the basis of Article 44 of the National Health Insurance Act
- Improve the related legislation according to the legitimate scope and limitation of the delegated legislation that complies with the principle of statutory reservation (“Vorbehalt des Gesetzes” in german)
□ The unification of the levy system of imposing the insurance fee on the basis of income
○ The significance and formation principle of social insurance fee
: the principles of insurance, the principle of social solidarity
○ The historical development and legal system of imposing the NHIS fee
○ The problem of the system to impose the NHIS fee : Inequality of burden
○ The improvement of the levy system to impose the NHIS fee based on the income according to the principle of burden equality
- Unify the insurance levy system separated into the workplace subscribers and the regional subscribers
- Impose the NHIS fee on the other kinds of income, for example the financial income etc. rather than the earned income
: Establish the legal basis to share the data associated with various revenues (incomes) with National Tax Service
- Raise up the consumption tax to impose and collect the social insurance fee
: The Regressivity of consumption-tax (indirect tax) should be complemented by utilizing the tax-exemption for the protection of low-income class
○ Rationalize and Re-adjust the functions of the “Health Insurance Policy Deliberative Committee (under the Ministry of Health and Welfare)” and the “Fiscal Management Committee (under the NHIS)”
Ⅲ. Expected Effect
□ Academic effect
○ The legal and financial problems of NHIS in the course of a sustainable operation of national health insurance system are to be reviewed from the point of view of public financial democracy, taking into account the interests and will of the general public, so that the legal improvement of the guidelines or direction of the legal discipline of monitoring and supervision can be embodied on the general public trust and the democratic legitimacy.
□ Effect in Policy
○ This analysis re-examine the constitutional issues raised in the course of NHIS integration in the past, and seek to find out the measures of smoothly securing the revenue (insurance fee) and the efficiency of spending(expenditure, medical care expenses) in tandem as a remedy.