Comparison of the Health Care Systems in Korea and Taiwan And Factors Associated with National Health Insurance Expenditure in Korea

韓國本來在歷史文化上一直受到中華社會影響，光復以後在冷戰體系下韓國跟台灣以反共友邦的連帶意識更加強烈，再加上，兩國經濟社會發展過程中在社會方面互相受對方影響。因此，醫療保障體系的發展過程看起來也相似，兩國都以員工為對象開始實施醫療保障，其範圍漸漸擴大為全民，最後具備政府運作的單一保險人制度，以減少行政費用、提升醫療服務品質及效率，結果，兩國對國民健康水平方面比較短的期間內得到一定的成就，世界上受到相當矚目。可是，近來兩國醫療保健支出成長趨勢比較來看，台灣每年成長3-5%左右，韓國則每年成長10%以上，其成長速度在OECD國家之中第一，健保醫療費用支出成長亦是10%以上，成為對未來韓國健保永續經營的威脅，因此，本論文希望透過文獻分析，了解兩國醫療保健體系與健康保險制度的相同點與不同點，探討韓國醫療保健費用及健保醫療費用支出成長的原因。 兩國醫療保健支出都陸續呈現逐年增加趨勢，與GDP成長及老人高齡化有關，惟韓國醫療保健制度比台灣快速成長的原因為：一、韓國對市場要求比較敏感，資源供給方面的規制比較放寬，公共醫療資源比例也比台灣很低，醫療資源分配功能較脆弱。；二、換算指數的支付費用計算方式不能有效管控健保醫療服務價格。；三、由於論量計酬為主的支付制度及有限制的給付範圍，缺乏價格及醫療服務量控制機制。 韓國醫療保健支出無論在私部門或公部門都快速增加，對此，跟台灣的健保制度及醫療照護體系來比較看看，韓國的健保雖然是以公共財源而保障民眾健康的社會保險，可是由於民間供給者為主的醫療環境下該公共性相對發揮不夠。提升公共性、控制資源供給以及輔導醫療合理使用，需要全面性策略。Korea has been under the influence of Chinese culture due to geographic reason and become to have similar politics, economy and social culture because of politic cooperation due to cold war and economic cooperation called the four Asian dragons. This led similar establishment of health care system: First, health insurance scheme for employees was implemented under the banner of economic development, then the coverage was extended to the universal population and reduced administrative cost and raised the quality of health care service with single payment. As a result, the both countries raised the average health status of the population effectively in a relatively short time. However, seeing the rising trend of national health expenditure in the both countries, the fastest increase in the world can be observed in Korea by 10% or more increase per year, while Taiwan shows 3-5% increase per year and this threatens the sustainable development of Korea health insurance. Therefore, this research was conducted to understand similarities and differences of health care system and health insurance policy of the Korea and Taiwan through literature review and to study the reason for the increase of national health insurance expenditure of Korea. National health expenditure of the both countries is showing uprising trend every year and this relates with GDP and rapid aging of population in the both countries. The reason for faster increase of health expenditure in Korea learned from the comparison of policies of the both countries is as follows: 1. Korea has weak health care resource distribution function due to loose regulations for resource supply since Korea is relatively sensitive to the demand of market and the portion of public health care resource lower than that of Taiwan. 2. Conversion factor cannot control medical fee due to diversified price determination system. 3. Korea has insufficient control mechanism for the quantity of health care service due to payment system mainly with ‘Fee for Service’ and limited range of benefits. National health expenditure of Korea is increasing rapidly without distinction of public and private sector. Comparison to Taiwan’s health care system and national health insurance, although Korea’s national health insurance is social insurance with public revenue, it has insufficient public sector health care system due to health care environment mainly with private supply. Therefore, it requires a comprehensive strategy such as strengthen public resource, control supply and proper use of health care resource