디지털 기술의 건강보험 보장방법에 대한 고찰: 5개 국가 중심

Abstract

With the development of various digital technologies such as artificial intelligence, internet of things, mobile health programs, wearable devices, and medical three-dimensional printing technology, healthcare paradigms are changing toward increasing the quality of care and user demand. The value of specificity, individuality, and individual choice of digital technology affects all organizations, management, payment and approach for health maintenance. We reviewed the regulatory guidelines and current status of the United States, Japan, United Kingdom, Germany, and Republic of Korea in order to understand the current status of health insurance coverage of digital technology and to respond to various medical needs. Each of the five countries has applied various reimbursement approaches for digital technology according to the healthcare insurance system. For example, when digital technology applied with artificial intelligence-based software used is judged to improve the clinical outcome of a stroke patient, an additional fee is given to the diagnosis-related group costs in the United States, and costs on therapeutic mobile applications were compensated in Germany. Although the current state of introducing digital technology into health insurance varies by country, they were considering applying it as health insurance for medical services to improve medical quality and patient satisfaction. In conclusion, the suggestions about the digital technology into our national health insurance system in the future are as follows. First, it is necessary to present an appropriate protocol as a guideline for use in actual medical fields. Second, a reasonable compensation method should be considered by creating a new fee schedule that considers the cost of digital technology. Third, the scope, function, purpose, as well as type of technology, is considered. In addition, compensation methods should be reviewed based on a rational evaluation basis, but decisions should be made in consideration of both the positive and negative effects of digital technology.