국민건강보험 관리(영문)
분야
docx1. What is NHI?
2. History
3. Payment model
4. NHI of Korea
5. Conclusion
Fee-for-service arrangements pay general practitioners based on the service which is decided by particular pay standards. Most of capitalistic country adopted fee-for-service and this is because the market economy is relatively well reflected. They are even more widely used for specialists working in ambulatory care.
There are two ways to set fee levels:
• By individual practitioners.
• Central negotiations (as in Japan, Germany, Canada and in France) or hybrid model (such as in Australia, France's sector 2, and New Zealand) where general practitioners can charge extra fees on top of standardized patient reimbursement rates.
2) Capitation
In capitation payment systems, general practitioners are paid for each patient on their "list", usually with adjustments for factors such as age and gender. According to OECD, "these systems are used in Italy (with some fees), in all four countries of the United Kingdom (with some fees and allowances for specific services), Austria (with fees for specific services), Denmark (one third of income with remainder fee for service), Ireland (since 1989), the Netherlands (fee-for-service for privately insured patients and public employees) and Sweden (from 1994). Capitation payments have become more frequent in “managed care” environments in the United States.”
According to OECD, "Capitation systems allow funders to control the overall level of primary health expenditures, and the allocation of funding among general practitioners is determined by patient registrations. However, under this approach, general practitioners may register too many patients and under-serve them, select the better risks and refer on patients who could have been treated by the general practitioners directly. Freedom of consumer choice over doctors, coupled with the principle of "money following the patient" may moderate some of these risks. Aside from selection, these problems are likely to be less marked than under salary-type arrangements."
3) salary
In several OECD countries, general practitioners are employed on salaries for the government. According to OECD, "Salary arrangements allow funders to control primary care costs directly; however, they may lead to under-provision of services (to ease workloads), excessive referrals to secondary providers and lack of attention to the preferences of patients." There has been movement away from this system.
4) Case Payment
2006 ,Munyoung, Association for research on Insurance Business
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