<BFACB1B85F323031322D31345FBDC5BFB5BCAE5FC3D6C1BE5F32303133303132395FBCF6C1A42E687770>··
2012-14

: 02) 380-8000
1977 (1977-1989)

. 2010
62.7% ( ).
2009 4.3% OECD
( 3.2%) ( OECD , 2011).
1960 (life expectancy) OECD 16
2009 80.3 OECD 79.5 1
( OECD , 2011).

. 41)

.
1) 1977() :

1977∼2000() : ,
,

2000∼2020( ) : ,

2020 , ,
2020∼() :
, .
, (,
) .
(, , )
.
,
. . 2011
37 2020 80
(, , ). 2020
3%
(, ).
.
2020 Consumerism, Technology, Integration,
Openness . (Safety),
(Consumerism) . IT, BT
(Technology). ,
, (Integration).
,
(Openness) .

21
.
.
.

, .
KDI ,
, , .

. ,
.
2 ······························································ 29
2 ········································ 35
1 ··································································· 35
3 ··································································· 43
5 ····················································· 47
3 ······································ 53
1 ··································································· 53
2 ····································································· 79
2 CCO ······················································· 167
3 CCO ·························································· 175
4 CCO MCO ············································ 183
5 CCO ACO ············································ 184
6 : Health Share of Oregon ·························· 190
5 New Paradigm ································· 205
1 OECD · 205
2 ··············································· 209
3 New Paradigm ··················· 212
················································································· 221
························································································ 229
Contents
1- 1 ····························································26 2- 1 ····················································37 2- 2 1 ·········································38 2- 3 GDP (20112060)···································42 2- 4 (20022010)····················44 2- 5 ···········································46 2- 6 2013 ··········································47 3- 1 ·····················································61 3- 2 ···········································63 3- 3 2 ······70 3- 4 ·······································71 3- 5 ····················································71 3- 6 ································································74 3- 7 5 ········································76 3- 82011 ··················77 3- 9 ··················84 3-10 , , ·85 3-11 ···················85 3-12 ······························87 3-13 ······························88 3-142011 ··················89 3-15 ······························90 3-16OECD
(2003)·········································································91
3-17 ()·················································99 3-18 1 ·······················································99 3-19 1 ··············································100 3-20 ·············································102 3-21 ·················································123 3-22 ····························································127 3-23 ·······························129 3-24 ··································131 3-25 ··················································132 3-26 GDP···················································133 3-27 ····················································134 3-28 ·················································135 3-29 ···············································137 3-30 (2010)················································139 3-31 ························142 3-32 ············································145 4- 1 ········································170 4- 2 CCO ············173 4- 3 MCO CCO ··184 4- 4HSO ···················································200 5- 12009 ························207 5- 22009 ······························208
Contents
1 ······················································229 2 ····················································237 3 ······································245 4 ( 99 )···································247

2- 1 (19902050)····················36 2- 2 (2010, 2050)···36 2- 3 ······························37 2- 4 1 ······························38 2- 5 (19902030)39 2- 6 (20102050)····················40 2- 7 (1985~2040)·······················41 2- 8 ··········································44 2- 9 ········································45 2-10 ·····················································48 3- 1 1,000 ····································62 3- 2OECD 100 ······················62 3- 3OECD 1,000 (2009) ·······64 3- 4 1,000 ······················64 3- 5 1,000 ···········································66
3- 6 1,000 ··············································66 3- 7 10 ·······································67 3- 8 5 ······································68 3- 9 ····················································69 3-10 10 (2011)·····················69 3-112011 OECD 100 CT, MRI, PET
····································································75 3-12 UR(Utilization Rate)·············86 3-13 ·························92 3-14 ··································128 3-15 ···············129 3-16 ·····················131 3-17 ·····································132 3-18 ·····································138 3-19 (2010)············································139 3-20OECD GDP (2010)·············140 3-21 ··········································141 3-22 ·····································142 3-23 (2010)·························143 3-24 (2010)·························144 3-25 ·········································146 3-26 (2011 )··················150 3-27 5 (2011)······151 3-28 (19952009)·········151 3-29OECD 1 (2005~2009)··152
Contents 3-30 (1995
2009)·····································································153 4- 1 CCO ···········································172 4- 2CCO ······························································182 4- 3HSO ··························································192 5- 12009 OECD GDP 1
········································································206
The Korean National Health Insurance (NHI), Korea's public
health insurance, has made a great stride since its introduction in
1977. Despite its remarkable growth in both quantitative and
qualitative terms, the coverage and financial structure of NHI have
been criticized.
Korea's public health insurance was found to have covered only
62.2% of total health expenditure in 2008, a figure way below the
OECD average of around 80%. Estimated to have spent KW35
trillion in 2010 alone, the National Health Insurance (NHI) is
financially at grave risk with its reserves of as little as KW880
billion as of the end of 2010. To make matters worse, many
experts are taking issue with the NHI’s reimbursement method.
Ever since it was implemented, the NHI has reimbursed based on
a cost-incurring fee-for-service method. The annual rate of increase
in fee-for-service has been kept under 3%, but many finger the
costly fee-for-service reimbursement approach as one of the factors
responsible for increasing health insurance benefits by 15% every
year. Whether the level of fee is appropriate also remains an issue
2 New Paradigm
of constant contention. Providers claim that the fee level is set far
too low for the world-class quality of services they provide.
Consumers on the other hand feel that the services they get are
overly priced. The current fee reimbursement contract, which since
2008 has been made based on provider type, is also a matter of
unending dispute. Problems also abound when it comes to the
question of how insurance premiums should be collected. A few
rounds of reform took place over the recent years, whereby in
2000 the National Health Insurance Corporation was made the
only insurer and in 2002 its financing underwent unification. Yet,
the rate of premium applied is vastly different for employees and
the self-employed, which has become the subject of increasing
public complaints. Against this backdrop, this study suggests new
paradigm of health care system integrating health care delivery,
reimbursement, financing, system and resource allocation all
together through Coordinated Care Organization adopting at Oregon
Health Plan in U.S.


.
1989
, 2008 62.2%
(
, 2009).

.
2011 2012



.



.
.

.


.
2.
.
2010 60 765
15.5% , 2050 2,120
44.1%


2011
10.5% 65 15 38
5
16.8% (
10.5%)
2030 38.6%



.
2030 1.7% (KDI ‘
2040’)
1% OECD( ) 42

,


’10 15 2382
35% , ’02 46788
15.7% 8
1) ‘ (Looking to 2060:Long-term global growth prospects)’ OECD, 2012.
6 New Paradigm
’10

20 54.3% 50
68.7%, 60 83.7%, 70 91.3%




’05 ,
,

.
OECD 72.2% ,
’04 61.3% ’10 62.7% 6
1.4% .


,




7



.
10 31.1%
74.1%


,





8 New Paradigm

.


,






,


(2011 CT
MRI OECD 3 ).
2011 , CT 100 35.9 OECD
(23.5) 1.5 MRI PET
. (Mammographs) ,
100 52.1 OECD OECD
(22.4) 2.3 .
9
10 5.5% ,
13.8% ,

Big5

Big 5 100%
,
48.4%

( )
.


71.6% OECD 75.5%
, 10.6 OECD
7.1 1.5 ,

.
2012 7 ,
, , , , ,
7
(DRG)

18%

: DRG



.
(Performance based payment):
DRG,

.


.
,





:

: IC


.

2.32 , 2.35
GDP 1.63

2010
58.2% OECD 72.2%
( )
5% 11%

,
10%

.
, ,
.

.

,

2010 62.7%
21.3% 16.0%
37.3%
GDP 7.1%
OECD 9.5% 2.4%p
2010
32.1% OECD 20.1% 1.6



,
.

.

U-health, , ,




.


OECD
·
14 New Paradigm
,

,

CCO(Coordinated Care Organization)
(Oregon) (Medicaid)
(Oregon Health Plan)

Coordinated Care Organization ( CCO)
(2012 8 1)
, ,

Accountable Care Organization(ACO) vs. CCO
CCO
,



CCO ,
(Global Payment Methods) CCO

15


, , ,

CCO ,
CCO

CCO (CCO Payment Methods)
CCO
,
CCO
CCO
CCO CCO


Care Home, PCPCH)

(Governance)
CCO (board of directors)
,
(community advisory
council)
16 New Paradigm

CCO
,

CCO
.
,


List of Health Services) ,
.
CCO MCO( )
MCO CCO
MCO CCO

X
X
X
X
X
,
, ,
, (, )
.
3%

,

, OECD
,
.



.
,
18 New Paradigm
Consumerism, Technology, Integration, Openness


·






, ,
( : Time Driven Activity Based Cost)




,
,
,

-Multi Network :
Network
CCO(Coordinated Care
Organization)
CCO
CCO
.
CCO ( :
70%) Band(10% )

CCO
, CCO
.
1 CCO
CCO CCO
1 CCO
20 New Paradigm

CCO CCO




Quality Control


2) -Multi


CCO
, ,
.



CCO
.
21
CCO
.
.
CCO

CCO CCO Peer Review

.
CCO

.
Organization), , , ,
K I H A S A1

1.


.
1977 500 1989
·
. 74%(1980)2) 31.4%(2010
) .

.
. 2011 2012

3) .
2) , “2010 ”, , 2012 3) 1997 IMF
2008
.
1-1
(: , %)
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

116,423 138,903 168,231 185,722 203,325 223,876 252,697 289,079 311,817 335,606 379,774 12.55 88,516 106,466 131,807 148,745 163,864 182,567 212,530 244,384 259,352 281,629 323,995 13.85 26,250 30,139 34,238 34,830 36,948 38,362 36,718 40,779 48,100 49,753 51,697 7.01 1,657 2,298 2,186 2,147 2,513 2,947 3,449 3,916 4,365 4,224 4,082 9.43 140,511 146,510 157,437 170,043 191,537 224,623 255,544 275,412 311,849 348,599 373,766 10.28 132,447 138,993 149,522 161,311 182,622 214,893 245,614 264,948 301,461 336,835 361,890 10.57 7,101 6,568 7,085 7,901 8,535 8,966 9,734 9,841 9,724 11,764 11,876 5.28 963 949 830 831 380 764 196 623 664 - - -24,088 -7,607 10,794 15,679 11,788 -747 -2,847 13,667 -32 -12,994 6,008 -18,109 -25,716 -14,922 757 12,545 11,798 8,951 22,628 22,586 9,592 15,600
: , 2011.
2010 1 3 2011
6
. 10 10.57%

.
.
.

.
. ,
.



.
.

1 27
2.

.

.

, ,
1, 2, 3
.
.


.
3.
, ,
.
.
(2010)
.
.
28 New Paradigm
( )
. , ,
,

.
(2010)

, DRG
,
. , DRG,

.
(2010)

. ,
.
,
.


. .
, ,
.
.

.
1 29
.
.
.
, ,
.

. .
(, , , ) .
OECD
.
. .
, 1 2
.
. CCO(Coordinated
Care Organization) .


.
,
.
.

30 New Paradigm
.
( Value :
Targeted Quality )
New Paradigm .
2.
OECD Data ,
, .
, ,

.
, .
,
· .
, New Paradigm CCO
.
.
, Paradigm
.
. 1 ,
, . 2
. ,
. 3
.
, ,
.
.

.
.
.

.
4 CCO(Coordinated Care Organization)
.
. 5
New Paradigm .
4. ,
, ,

.
32 New Paradigm

.

.



.

, . 2010
60 765 15.5%
, 2050 2,120 44.1%
( , 2011).
OECD
, 2050
. 2010 11.0%
(5.9%), (6.3%) (OECD 14.8%),
2050 , 38.2%
(39.6%) 65 (OECD
25.8%).
: (2011),
2-2 (2010, 2050)
: OECD, OECD 2010 Factbook.


. 2011 518
10.5% 65
15 38 33.3% . ’02
’11 10.5% 65
2 37
16.8%
.
(: , , , %)
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

4,666 4,710 4,737 4,739 4,741 4,782 4,816 4,861 4,891 4,930 0.61
335 354 375 392 407 439 460 483 498 518 4.99
7.2 7.5 7.9 8.3 8.6 9.2 9.6 9.9 10.2 10.5 4.28
18.8 20.7 22.5 24.9 28.4 32.4 34.9 39.3 43.6 46.2 10.5
3.79 4.40 5.13 6.07 7.35 9.12 10.74 12.42 14.13 15.38 16.8
20.1 21.2 22.8 24.4 25.9 28.2 30.8 31.6 32.4 33.3 5.77
94.4 103.6 114.2 129.1 150.4 173.2 194.5 214.5 236.6 247.1 11.3
: , 2011,
2-3
20.1 21.2
22.8 24.4
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
() (%)

. ’02 ’11 65 1
38 New Paradigm
2.6 .
65~69 9.0%, 70~74 9.9%, 75~79 11.8%, 80~84
15.1% 85 20.3%
. 85 ’02
’11
.
2-2 1
(: , %)
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

94.4 103.6 114.2 129.1 150.4 173.2 194.5 214.5 236.6 247.2 11.3
6569 91.4 101.0 110.0 123.8 139.6 153.4 165.9 179.4 194.7 198.7 9.0
7074 102.7 112.9 122.8 135.8 158.1 183.4 199.4 217.4 234.8 241.5 9.9
7579 102.9 111.9 124.7 143.4 169.7 198.5 224.6 246.7 267.1 280.7 11.8
8084 88.2 96.0 111.1 128.2 157.8 193.7 232.1 260.9 289.5 312.3 15.1
85 61.7 66.0 76.7 92.5 119.3 157.7 216.3 250.0 289.3 325.4 20.3
: , 2011,
2-4 1
0
50
100
150
200
250
300
350
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
65- 69 70-74 75- 79 80- 84 85
2 39


.

.
65 1990 7.4%
2010 15.2% 2 2030 38.6%
. 20% 68.4%
2030 193% .
2-5 (19902030)
1980 1990 1999 2000 2009 2010 2019 2020 2030
(%) 6.1 7.4 9.6 10.1 14.7 15.2 18.5 2.1 38.6
(%) 11.2 20 32.3 34.3 63.9 68.4 99.5 119.1 193
1() 16.3 13.5 10.4 9.9 6.8 6.6 5.4 4.5 2.6
0
2
4
6
8
10
12
14
16
18
0
50
100
150
200
250
: 1) = (65 /15~64 )*100 2) = (65 /0~14 )*100
: (2011),
(UN) (Population Growth Rate)4)
, 2050 256
4) (-) ( - )

40 New Paradigm
. 2030
2030
2050 –0.532%
(2050
0.435%).
,
.
2-6 (20102050)
, 0.364
, 0.153
, -0.196
, 0.233
, -0.341
, 0.484
, -0.532
%
2

,

.
2 41
.
KDI ‘ 2040’ 2010
4.1%, 2020 2.8%, 2030 1.7%
.
OECD 5)
2031 2060 30
1% OECD( ) 42
. 2011 2060
50 1.6% 42 8
. 2011 2030
2.7% 2031 2060 1%
. ·
(15~64)
5) ‘ (Looking to 2060:Long-term global growth prospects)’ OECD, 2012.
42 New Paradigm
(demographic dividend)

. 73%
. 2020 71.1%,
2030 63.1%, 2040, 56.5% .
2-3 GDP (20112060)
: “Looking to 2060:Long-term global growth prospects”, OECD, 2012.
2 43
3
,

. , , ,
,
. , ,
, ,
.
(WEF) 10
‘ ’
‘30 5 47
( GDP 4% ) .
. 11
6) ’10 15 2382
35%
. ’02 4 6788 15.7%
8 ’10 . ,
, , , 5
’10 6 ( 2-4,
2-8 ).
11 5
6) (I10-I15), (E10-E14), (F00-F99, G40-G41),
(A15-A16, A19), (I05-I09, I20-I27, I30-I52), (I60-I69),
(G00-G37, G43-G83), (C00-C97, D00-D09), (E00-E07), (B18-B19, K70-K77), (N18)
44 New Paradigm
, , , ,
,
(23.9%), (16.3%),
(12.3%) (10.5%) ( 2-9
).
(: , %)
2002 2003 2004 2005 2006 2007 2008 2009 2010

(A) 46.8 56.6 64.7 72.8 85.2 106.5 123 136.9 152.4 15.71

(B) 188.3 207.4 225.1 248.6 284.1 323.9 348.5 393.3 436.3 10.45

(A/B) 24.9 27.3 28.7 29.3 30.0 32.9 35.3 34.8 34.9 4.76
: DB(20012010)
(: )
23.0 24.9
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
:
2-9
-
20 54.3%
50 68.7%, 60 83.7%, 70
91.3% .
10 191
OECD 84 7).


.
4
’05 ,
’04 48.6% ’10 70.4% 500
’04 49.0% ’07 67.6%
.
,
7) OECD Health at a Glance 2009: key findings for Korea
46 New Paradigm

2004 , 62
2005 MRI, (, ) 10%
2006 (50%→20%), PET,
2007 (6 300→200)
2008 6 10%,
2009 ( 200, 300, 400
), (10%→5%)
2010
2011
,

. ’10
58.2% OECD 72.2%
, ’04 61.3% ’10 62.7%
6 1.4%
.

,

.
2 47
2013

,
,
1 5
.
(: )
110 4
6,000 7
15,040
.

. , , , ,

.
/
.

.
.

.

.

. , , '
' . ’30
2 49
42% , 20 600
. 2 ,
10 8 (WHO)
.
. , , 6
(, , , , , )
. ,
.
.
,
.
’00 GDP 4.5% ’10 7.1%
(OECD Health data).
u-Health .
’06 1,050 ’16 2,700 .
ICT ’06 32 ’16 470
32% .
.
WTO, FTA
. , ,
, .
.
’00 25%, 17%
, ’25 16 , ’20 1
.
.
50 New Paradigm

, ,
.
.
. HCA
, , 173
107 , Tenet 2
12 65 .

, . Bangkok
Hospital Group (14)
(3), (3), (2), (1) 23
.
K I H A S A3

1
.
, ,
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5 7
.10)
8) 2() 9) , , 2009. 10) 5( )
9
.< 2010.1.18., 2012.2.1.>

1

1 2
. < 2012.2.1>
9
, 3
,11)

.12)
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62 New Paradigm
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2006 2007 2008 2009 2010
13,871 14,473 15,472 16,313 17,020 4,079 4,252 4,418 4,562 4,930 2,871 3,080 3,255 3,412 3,524 2,180 2,272 2,437 2,578 2,673 1,834 1,914 1,960 1,985 2,136 1,877 1,969 2,032 2,106 2,202 949 998 1,040 1,087 1,119 9,646 10,143 10,899 11,463 11,977 1,445 1,470 1,533 1,593 1,681 1,313 1,359 1,425 1,488 1,548 1,676 1,738 1,849 1,907 1,976 1,975 2,001 2,098 2,195 2,271 1,720 1,816 1,935 2,029 2,116 2,240 2,307 2,447 2,520 2,601 2,726 2,862 3,117 3,291 3,431 557 552 588 613 641
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535 542 578 597 623 91 90 87 87 83
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76 New Paradigm
.
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100.0 12.5 13.1 6.6 67.8
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100.0 13.0 13.5 7.0 66.4
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100.0 13.3 14.1 7.2 65.4
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100.0 14.2 14.6 7.3 63.9
2007 11,079,412 1,672,793 1,665,908 873,770 6,866,941
100.0 15.1 15.0 7.9 62.0
2008 11,910,854 1,870,800 1,897,936 992,876 7,149,242
100.0 15.7 15.9 8.3 60.0
2009 13,405,463 2,306,674 2,091,330 1,197,329 7,810,130
100.0 17.2 15.6 8.9 58.3
2010 14,522,235 2,527,375 2,328,189 1,366,961 8,299,710
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88 New Paradigm
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3-15
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MRI
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) HIC . GP HIC ,

(
). Bulk-billing
,
Bulk-billing ,
.
3 113
Health care agreement) .
.
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.
.
.

.
medical benefits schedule fee
75% .
, .

.
.
63% .
managed care
.
.

. (global prospective
budgets) patient casemix
payments .
casemix payment( )
. 1985
diagnosis related group DRG
15 . 667 the
114 New Paradigm
Austrlian national diagnostic related groups
. new south
wales DRG
.
DRG . casemix
funding south Australia
.
.
.
.
salaried medical officer
. visiting medical officer

.
1958 .
40


.
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,

,
3 115
.
,

.

1)
(doctor fee ), 2)
(hospital fee ), 3) .
.

.

,
.
1 10 1 10
. 10
.
1945 .
,
,
.
8% .

,
,
116 New Paradigm
. 2003 4 82 ( ,
, ) (DPC:
Dignosis Procedure Combination) .
16 (MDC)
591, 1,727 1 DRG
.
.
. DPC
,

.


. 2002
20.4
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.
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budget) , (per diem) .
3 117
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.
, ARH
.
. , ,
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.
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.
.
.
.
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.
118 New Paradigm

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1995).
.
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/
. DRG , HMO
PPO .
(GP) (sickness fund)
, .
120 New Paradigm

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122 New Paradigm
, (GP) ,
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.

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,

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.
124 New Paradigm

DRG
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-
: ,
.
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.
.

.

.
.

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3 125
,
(
, 2007).
. , ,
,
, DRG . DRG
,
, DRG ,
DRG .
DPC(Diagnosis Procedure Combination)
DRG 3 372 (
12%) . DRG
.

.
DRG .
.
,
( ) . ,
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(service-based)
(activity-based)
. NHS HMO
. , , ,
126 New Parad