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홍차넷
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티타임
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- 다양한 주제에 대해 자유롭게 글을 작성하는 게시판입니다.
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전체기타일상/생각꿀팁/강좌방송/연예도서/문학영화의료/건강문화/예술경제생활체육과학/기술철학/종교정치요리/음식역사여행육아/가정IT/컴퓨터음악창작게임스포츠사회오프모임
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| Date |
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| Name | 모모스 |
| Subject | 각국의 의료보험 |
|
옆 동네에서 아래와 같은 댓글이 있길래 언급된 나라들 의료보험제도에 대해서 좀 알아봤습니다. 급히 쓰다보니 반말투입니다. "블룸버그의 의료제도 효율성 순위입니다. http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-2014-countries 1위 싱가포르 / 5위 한국 10위 영국 / 15위 스위스 34위 덴마크 / 44위 미국" 1위 싱가포르 의료계정 - 싱가포르의 의료보장제도는 사회적연대가 아닌 개인책임원칙을 바탕으로 정부가 개인별 의료저축 (소득의 6~8.5%) 을 강제하고 이 의료저축계정에 적립된 돈은 의료비용에만 사용하게 한다. 의료계정에 저축된 금액을 각 개인이 의료비용에 사용함에 있어서도 적용범위가 법으로 철저히 규제된다. 다만 남은 저축액은 가입자가 사망 후 지정한 사람에게 상속될 수는 있다. 우리나라의 의료급여격인 저소득층을 위한 정부에서 운영하는 Medifund제도도 있다. 의료보험을 추가로 가입하여 보장성을 더 받을 수 있으며 공공개념의 Medishield/MedishieldPlus, 민간의료보험의 Eldershield 등이 있다. 외래진료 보장성이 약하고 자영업자들의 의료계정 저축이 잘 안되고 있어서 문제가 있다고 한다. 싱가포르는 정말 가장 성공한 사회주의독재국가 같다. GDP의 4.5%를 의료비로 사용한다. 5위 한국 국민건강보험 - 전국민의료보험으로 강력한 국민건강보험이 시행 중이다. 모든 국민이 강제적으로 국민건강보험 가입해서 보험비를 납부해야하고 모든 의료기관은 강제적으로 국민건강보험 환자를 받아야 하며 국가가 정해준 수가대로 진료를 해야 하는 시스템이다. 다만 의료보험비가 소득수준에 비례해 부과되므로 소득재분배효과가 있다. (소득에 따라 월보험금이 최소2만원~ 최대 500만원선, 연봉10억이상이면 매월 500만원정도의 의료보험비를 납부하는데 이는 미국의 최고수준의 사의료보험비보다도 비싸다. 우리나라 고소득자들이 매달 어마어마한 보험료를 내는데 국민건강보험을 무력화하고 사의료보험을 도입하고 영리병원을 도입해 최고수준의 의료서비스를 받고자하는 심정은 충분히 이해된다.) 또 우수한 의료인력을 낮은 수가로 효율적으로 이용해서 GDP 대비 낮은 의료비 지출에도 불구하고 높은 의료서비스를 받을 수 있다. (우리나라 평균 내원회수는 14.3회로 완전무료의료국가인 영국의 5.0회보다 높다.) 우리나라 의사들의 수익이 결코 낮은 수준은 아니나 다른 나라 의사에 비해 훨씬 격무에 시달리고 그에 돈으로 보상 받는 수준이다. 행위수가제이므로 낮은 수가로 많은 환자를 봐서 수익으로 보전 받는 박리다매형이라고 할 수 있다. (한의사, 치과의사, 성형이나 비만, 피부 등 비급여진료는 하는 경우는 제외 ) 또 국공립의료기관의 수도 적고 의사양성에 국가가 부담하는 부분이 적어서 이도 문제가 많다. 아무튼 덕분에 국민들의 의료기관 접근도가 어느 나라보다도 높고 의료기관과 의사들의 수준도 높다. 보험 진료인 경우 비용전체에서 국민건강보험이 70% 부담하고, 환자 본인이 30% (본인부담금) 정도 부담한다. 이 비율은 암치료 같은 중증질환치료나 비급여포함한 진료, 의료급여환자, 의료기관 등에 따라 달라진다. GDP의 7.0 %를 의료비로 사용한다. 10위 영국 NHS - NHS (National Health Service) 는 영국민이 가장 사랑하는 국가제도라고 하며 의료보험비를 따로 납부하는게 아니라 전액 국세에서 충당되는 시스템이다. 모든 의료비용이 무료다. ( 높은 세율로 확보된 세금을 사용하므로 소득재분배 효과가 매우 크다. ) 주치의제도와 공공의료중심이다. 의사들은 거의 공무원 수준으로 급여가 연 3억 정도 되나 우수한 의사들은 영국을 떠나 급여 수준이 더 높은 미국으로 많이 유출된다고 한다. 의사 양성에 드는 비용도 국가에서 많이 부담하고 있다. GDP의 9.4%를 의료비로 사용한다. 15위 스위스 의료보험 - 스위스의 건강보험료는 가입자의 소득, 건강 상태와 무관하게 면책금액 ( 본인부담금 ) 과 연령대에 따라 보험료가 다르다. ( 우리나라의 자동차보험이나 미국의 사의료보험과 유사한 면이 많다.) 다만 저소득층의 경우 국가에서 보험료를 보조해준다. 일단은 저소득층도 값비싼 의료보험에 무조건 강제 가입해야한다. 본인부담금이 존재하는 시스템이라 완전 무상의료를 하는 나라에 비해 도덕적 해이가 적고 보험 본연의 목적인 사용자부담원칙에 의거해서 병원을 자주 가는 사람이 비용을 더 부담하는 방식이다. 또 이런 제도의 특성상 의료기관의 수준이 매우 높다. 그럼에도 불구하고 많은 유럽의 복지국가들이 추구하는 의료에서의 소득재분배효과가 상대적으로 미비하고 저소득층에 부담이 가는게 사실이며 국가 재정도 부담이 많이 가는 편이다. 국민적 합의에 의해서 유지되는 제도라서 옳고 그름을 간섭하기엔 무리가 따른다. GDP의 11.4%를 의료비로 사용한다. 34위 덴마크 의료보장제도 - 북유럽의 복지국가답게 높은 세율로 많은 세금을 걷어 영국과 유사한 전국민 무상의료를 시행하고 있다. 주치의제도를 통해 모든 환자는 주치의를 먼저 만나야하고 경미한 질환인 경우 거의 치료를 안하는 경우가 많다. 치과는 의료보장에서 제외되고 가격도 비싸다. 중질환 외에 다른 경질환의 경우 치료를 받고 싶어도 받지 못하게 하여 의료비용을 절감하는 등 나름 효율적으로 운용하려 하나 의료비용이 증가하고 있다. 선진국 중에 평균수명도 낮은 편으로 특이한 나라다. 그럼에도 덴마크의 의료보장제도는 국민들의 지지를 받는 제도이다. 의료보장예산을 국세로 조달하지만 그 시행은 중앙정부가 아닌 지방자치단체에서 한다. GDP의 11.2%를 의료비로 사용한다. 44위 미국 - 전국민 3억명 중 6400만명이 의료보험이 없던 사의료보험의 천국이다. 오바마케어를 통해 제도를 보완하려고 노력 중이다. 세계에서 가장 높은 수준의 의료서비스를 제공하고 가장 비싼 의료비를 내는 나라다. GDP 대비 엄청난 의료비를 사용한다. 전세계를 휘어잡는 미국군사력의 밑천인 미국의 국방비보다도 더 많은 돈이 미국내에서 의료비를 사용됨에도 불구하고 의료혜택을 못받는 사람이 너무 많은 나라이다. 의료서비스에 대한 사회연대책임의식이 약하기 때문이다. 기본적으로 사의료보험제도는 보험가입의 의무가 없고 소득과 관계없이 회원의 건강과 나이 등에 의해서 보험료 ( 보장성 수준에 따라 가격이 다양하며 적당한 보험인 경우 의료보험료가 4인가족 연 2만불수준으로 매우 높다. 그나마 직장에 다니는 경우 많은 보조를 받으나 기업입장에서는 상당한 부담으로 좋은 회사들만 의료보험비를 보조해준다.) 가 결정되므로 부자나 가난한 사람이나 같은 가격의 보험료가 부과되고 이는 부자들만 의료보험에 드는 부작용을 낳게 만들었다. 의료서비스가 최고라고 하나 사의료보험회사, 영리병원, 거대제약회사들의 이익을 반영해서 약값과 의료수가가 또한 세계 최고 수준이고 보험료도 세계 최고 수준이다. 가난한 사람이나 보험이 없는 중산층은 아프면 엄청나게 높은 의료비에 의해 파산한다. 가난한 사람에게는 자비가 없는 승자독식의 나라이다. 또 회원들이 납부하는 보험금을 의료기관에 전액 진료비로 지급하는 복지국가의 국가의료보험에 비해 미국의 사의료보험회사들은 이윤추구를 하므로 회원들이 어마어마한 보험료를 납부함에도 불구하고 총보험료의 약 70%정도만 진료비로 쓰고 나머지 30%는 매년 본인들의 이익금으로 가져간다. 이렇게 축척된 엄청난 자본을 바탕으로 미국의료보험회사들이 강력한 이익단체가 되었다. GDP의 17.2%를 의료비로 사용한다. GDP의 3.8% 정도 국방비로 사용한다. 오줌병 이야기 https://new.redtea.kr/?b=3&n=1519 지헬슈니트 (낫질) 작전 - 1940년 독일-프랑스 전투 https://new.redtea.kr/?b=3&n=1461 지구의 온난화와 빙하기 https://new.redtea.kr/?b=3&n=1354 설사병 이야기 https://new.redtea.kr/?b=3&n=1322 토마토는 과일인가? 채소인가? https://new.redtea.kr/?b=3&n=1310 쓰레기 유전자 ( Noncoding DNA ) 와 유전자 감식 https://new.redtea.kr/?b=3&n=1297 생명체의 과밀화 https://new.redtea.kr/?b=3&n=1269 X 염색체 - 인간의 기본형은 여성? https://new.redtea.kr/?b=3&n=1259 각인 - 애들은 엄마, 아빠 누구 머리를 닮나? https://new.redtea.kr/?b=3&n=1252 정자왕 침팬지 https://new.redtea.kr/?b=3&n=1243 이스터섬 https://new.redtea.kr/?b=3&n=1234 불멸의 세포 https://new.redtea.kr/?b=3&n=1215 히스파니올라섬 https://new.redtea.kr/?b=3&n=1200 천연두 바이러스 https://new.redtea.kr/?b=3&n=1191 기생충 이야기 https://new.redtea.kr/?b=3&n=1183 기생충에 대한 또다른 인간의 방어법 IgE https://new.redtea.kr/?b=3&n=1175 가축화된 포유류는 어떤게 있나? https://new.redtea.kr/?b=3&n=1161 섹스의 진화 https://new.redtea.kr/?b=3&n=1147 외계로부터의 생명 전달 https://new.redtea.kr/?b=3&n=1097 항생제 이야기 https://new.redtea.kr/?b=3&n=1091 소주 이야기 https://new.redtea.kr/?b=3&n=1075 콜라 이야기 https://new.redtea.kr/?b=3&n=1057 커피 이야기 - Caffeine https://new.redtea.kr/?b=3&n=1051 보스턴차사건 (Boston Tea Party) - 보스턴홍차사건 https://new.redtea.kr/?b=3&n=1034 유전자조작식물 (GMO) https://new.redtea.kr/?b=3&n=1024 Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 133 Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 146 Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 161 4
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30045 class="iamcmt" style="display:none;"> Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 66
30045 class='vcm '>
Warning: Use of undefined constant x - assumed 'x' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 70
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30045'> Toby
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16/01/30 11:54
30045>삭제 주소복사
Warning: Use of undefined constant level - assumed 'level' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 150
우리나라의 의료보험 제도에 대해서도 이래저래 말이 많지만 일단 효율은 상당히 좋은편이네요.
부족한 부분이 있다면 개선해서 계속 지속되었으면 좋겠습니다.
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Warning: Use of undefined constant password - assumed 'password' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 166
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 171
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부족한 부분이 있다면 개선해서 계속 지속되었으면 좋겠습니다.
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Warning: Use of undefined constant password - assumed 'password' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 166
Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 171
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30045>
30045>
