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치료재료 관리체계 개선방안 마련을 위한 연구

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Type
Research report
Author(s)
정형선권용진민하주백세종최정아김정훈김무진
Issued Date
2023-07
Keyword
치료재료분류체계등재제도가격보상체계개선방안
Publisher
건강보험심사평가원
URI
https://repository.hira.or.kr/handle/2019.oak/3234
Table Of Contents
제1장 서론 ··································································· 1
1. 연구 배경과 목적 ··················································································· 3
가. 연구 배경 ·································································································· 3
나. 연구 목적 ·································································································· 6
2. 연구 내용과 방법 ··················································································· 7
가. 연구 내용 ·································································································· 7
나. 연구 방법 ·································································································· 8
다. 연구 수행체계 ···························································································· 9

제2장 치료재료 제도 현황 ··································································· 10
1. 치료재료의 개념 및 정의 ······································································· 12
2. 치료재료의 등재 및 관리 ······································································· 18
가. 등재의 신청/직권 발동 ·············································································· 18
나. 등재의 결정 ····························································································· 19
다. 사후관리 ·································································································· 21
라. 기타 관리제도 ·························································································· 24
마. 치료재료 등재 및 지출현황 ········································································ 25
3. 치료재료의 보상체계 ············································································· 52
4. 치료재료의 분류체계 ············································································· 57
가. 식약처의 의료기기 분류체계 ······································································· 57
나. 건강보험의 치료재료 분류체계 ···································································· 66
다. 치료재료 건강보험 청구코드 ······································································· 67
라. 치료재료 분류체계 현황 진단 ····································································· 69
5. 치료재료 제도 전반에 대한 고찰 ···························································· 72
가. 치료재료의 등재 및 관리 ··········································································· 72
나. 치료재료의 보상체계 ················································································· 73
다. 치료재료의 분류체계 ················································································· 76

제3장 해외 사례 ··································································· 77
1. 대만 ···································································································· 79
가. 건강보험제도 개요 ···················································································· 79
나. 치료재료 개요 ·························································································· 85
다. 치료재료 급여 등재제도 ············································································· 88
라. 치료재료 가격 보상체계 ············································································· 91
마. 치료재료 분류체계 ···················································································· 96
바. 사후관리 및 재평가 ·················································································· 98
사. 치료재료 관련 최근 동향 ········································································· 102
2. 일본 ·································································································· 104
가. 건강보험제도 개요 ·················································································· 104
나. 치료재료 개요 ························································································ 105
다. 치료재료 급여 등재제도 ··········································································· 107
라. 치료재료 가격 보상체계 ··········································································· 109
마. 치료재료 분류체계 ·················································································· 114
바. 치료재료 사후관리 및 재평가 ··································································· 120
3. 호주 ·································································································· 122
가. 건강보험제도 개요 ·················································································· 122
나. 치료재료 개요 ························································································ 125
다. 치료재료 급여 등재제도 ··········································································· 128
라. 치료재료 가격 보상체계 ··········································································· 134
마. 치료재료 분류체계 ·················································································· 136
바. 치료재료 사후관리 및 재평가 ··································································· 139
사. 치료재료 관련 최근 동향 ········································································· 139
4. 프랑스 ······························································································· 141
가. 건강보험제도 개요 ·················································································· 141
나. 치료재료 개요 ························································································ 143
다. 치료재료 급여 등재제도 ··········································································· 146
라. 치료재료 가격 보상체계 ··········································································· 147
마. 치료재료 분류체계 ·················································································· 151
바. 치료재료 사후관리 및 재평가 ··································································· 155

제4장 치료재료 등재 및 가격보상체계 개선방안 ··································································· 156
1. 이해관계자 및 전문가 의견 조사(FGI)에서의 시사점 ······························· 158
가. 등재방식의 적정성 ·················································································· 158
나. 가격결정 방식의 적정성 ··········································································· 161
다. 가치평가 방식의 적정성 ··········································································· 163
라. 기타 ······································································································ 164
2. 개선방안 ···························································································· 165
가. 치료재료의 등재 ····················································································· 165
나. 가격산정 및 가치평가 ·············································································· 171
다. 치료재료 유통체계 ·················································································· 176

제5장 치료재료 분류체계 개선방안 ··································································· 179
1. 이해관계자 및 전문가 의견 조사(FGI)에서의 시사점 ······························· 181
가. 치료재료 품목군별 분류체계(기준 및 원칙) 검토 ········································· 181
나. 치료재료 품목군 고시 적용 코드화 필요성 검토 ········································· 182
다. 식약처 치료재료 허가정보 연계 검토 ························································ 183
2. 개선방안 ···························································································· 184
가. 중분류 신설·통합·변경·삭제 기준 ······························································ 184
나. 건강보험 표준코드 전환방안 ····································································· 187
다. 식약처 허가정보 연계방안 ········································································ 190

◾ 참고문헌 ······················································································· 193
◾ 부록 ····························································································· 198
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건강보험심사평가원
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Citation
정형선. (2023-07). 치료재료 관리체계 개선방안 마련을 위한 연구.
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