일본 의료보험수가제도의 이해와 시사점
- Type
- Research report
- Issued Date
- 2024-12
- Publisher
- 건강보험심사평가원
- Table Of Contents
- 요약 ···························································································· ⅰ
제1장 서론 1
1. 연구 배경 및 필요성 ············································································· 3
가. 한국 행위별수가제도 현황 및 문제점 ·························································· 3
나. 한국 건강보험수가 구성 및 결정 체계 ························································· 6
다. 일본 의료보험수가제도 연구 필요성 ···························································· 8
2. 연구 목적 ·························································································· 10
3. 연구 내용 및 방법 ·············································································· 10
가. 한국 행위별수가제도와 수가 결정 체계 검토 ·············································· 10
나. 일본 의료보장제도 및 진료보수체계 검토 ·················································· 11
다. 수가 수준 비교를 위한 분석 틀 마련 및 차이점 검토 ································· 11
라. 수가 체계 개선 방안 제언 ······································································· 12
4. 연구 수행 체계 ··················································································· 13
제2장 일본의 의료보장제도와 진료보수체계 15
1. 일본 의료보장제도 ·············································································· 17
가. 건강보험제도 발전과 특징 ········································································ 17
나. 건강보험 관리운영 체계 ··········································································· 20
2. 일본 진료보수체계 ·············································································· 22
가. 진료보수 개요 ························································································ 22
나. 진료보수 주요 내용 ················································································· 24
다. 진료보수 개정 ························································································ 39
3. 의료보장과 진료보수 관리 ···································································· 47
가. 진료비 지불제도 ····················································································· 47
나. 진료보수 심사 ························································································ 49
4. 소결 및 시사점 ··················································································· 52
가. 일본 의료보장제도와 진료보수체계 고찰의 소결 ·········································· 52
나. 일본 의료보장제도와 진료보수체계 고찰의 시사점 ······································· 56
제3장 한국과 일본의 수가 수준 59
1. 수가 수준 비교를 위한 틀 마련 ···························································· 61
가. 수가 수준 비교 목적 ··············································································· 61
나. 수가 수준 비교 틀 ·················································································· 62
2. 한국과 일본 수가 비교 개요 ································································ 63
가. 한국과 일본 수술 행위 특징 ···································································· 63
나. 수가 비교를 위한 접근 방법 ···································································· 66
3. 한국과 일본 수술 행위 매칭 결과 ························································· 68
가. 1차 매칭 결과(포괄적 매칭) ····································································· 68
나. 2차 학회 검토 결과(정확성 검토) ····························································· 73
다. 3차 전문심사위원 검증 결과(타당성 확보) ················································· 79
4. 한국과 일본 수가 수준 비교 ································································ 81
가. 수가 수준 비교 방법 ··············································································· 81
나. 한국과 일본 수술 행위 기초 통계 ····························································· 82
다. 표준점수 활용 한국-일본 점수 비교 ························································· 89
라. 조정된 표준점수 활용 한국-일본 진료과목별 점수 비교 ······························ 96
마. 주요 수술 중심 한국-일본 수가 비교 ······················································ 122
5. 소결 및 시사점 ················································································· 127
가. 한국과 일본 수술 행위 매칭 관련 결론 및 시사점 ···································· 127
나. 한국과 일본 수가 수준 비교 결론 및 시사점 ············································· 128
제4장 결론 및 제언 133
1. 한국과 일본 수가 체계 비교 ······························································ 135
가. 수가 결정 구조 ····················································································· 135
나. 수가 조정 체계 ······················································································· 136
다. 수가 산정 방법 ······················································································· 138
2. 수가 체계 개선을 위한 제언 ································································ 139
가. 수가 결정 구조 개선(거버넌스 포함) ······················································· 139
나. 수가 산정 방법 개선 ··············································································· 142
3. 연구의 결론 및 제한점 ········································································ 144
◾ 참고 문헌 ··················································································· 147
◾ 부록 ··························································································· 151
◾ ABSTRACT ················································································ 209
- Publisher
- 건강보험심사평가원
- Location
- KOR
- Citation
- 임지혜. (2024-12). 일본 의료보험수가제도의 이해와 시사점.
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