요약/1 

Ⅰ. 서 론 / 22 

1. 연구의 필요성 및 목적 ········································································ 22

2. 연구의 범위 ·························································································· 24

3. 연구내용 및 방법 ················································································· 24 

Ⅱ. 건강보험 진료비 지불제도 운영 현황  / 26

1. 진료비 지불제도의 주요 특성 ······························································ 26

2. 건강보험 진료비 지불제도 변천 과정 ················································· 48

3. 건강보험 진료비 지불제도 현행체계 및 특성 ····································· 58 

Ⅲ. 건강보험 진료비 지불제도 주요 쟁점  / 66

1. 현행 지불제도의 재정적 영향 ······························································ 66

2. 건강보험 재정 및 현행 지불제도 관리의 지속가능성 ························ 75

3. 보험자의 역할 및 개입의 실효성 측면 ··············································· 81 

Ⅳ. 보험자 관점의 건강보험 진료비 지불제도 개편 방향  / 87

1. 진료비 지불제도 개편의 주요 원칙 ····················································· 87

2. 진료비 지불제도 개편 및 정책 대안 ··················································· 91

3. 정책대안 이행에 따른 고려사항 ························································ 104

참고문헌 ································································································· 107표차례

[표 1] 진료비 지불 제도 유형 및 특성 ·························································· 33

[표 2] 보건의료체계에서 진료비 지불제도의 전통적 유형 개관  ················· 36

[표 3] 에피소드 기반 묶음지불제도 개관(OECD 회원국 일부) ····················· 43

[표 4] 미국 에피소드 기반 지불제도 프로그램의 주요 특성 ························ 44

[표 5] 건강보험 재정 현황(2016~2021) ·························································· 67

[표 6] 건강보험 재정 관련 주요 항목 변동 추이 ·········································· 68

[표 7] 건강보험 급여비 증가요인(가격 및 수량) ··········································· 70

[표 8] 최근 5년간(2016~2020년)심평원 심사 물량 및 인력 현황 ················· 78

[표 9] 건강보험 급여여부 및 가격결정 관련