저소득층 의료보장성 비교연구

Comparative Study on Public Health Care Coverage for Low Income Bracket-Comparison between Medical Benefits and Medicaid-

This study intended to make a comparative analysis of our country’s medical benefits plan; a representative policy of the residual medical security system and the US Medicaid. Through this, this study aimed to inquire into policy alternatives for reinforcing the public health care coverage of medical benefits. The analysis results are as follows: First, the medical benefits plan puts emphasis on the centralized unity whereas in case of Medicaid, a far-reaching scope of autonomy is given to the state government in the area of recipient selection, service contents, and medical fees, etc. Second, the medical benefits plan invests the right to medical benefits with focus on households while Medicaid applies individualized selection criteria differently. Third, the medical benefits plan offers medical services through the three-stage medical delivery system; on the contrary, in Medicaid, dominated is the managed-care-centered medical delivery system through the contract with a medical institution. Fourth, the medical benefits plan in relation to medical fees adopts a ‘Fees for Service’ system as a central policy whereas the managed medical care forms a nucleus in Medicaid. Lastly, both the medical benefits plan and Medicaid control the demand for medical services through a user fee for the medical care system, but this study could confirm that the latter applies this system more strictly than the former. Consequently, it’s necessary to reflect individualized characteristics more aggressively in the selection of recipients, and to get the local government to take account of regional characteristics by vesting local governments with the extensive authority.