2012. 4

오 윤 섭 (감사원 감사연구원)

차례

제1장 서론
제1절 연구배경 ·································································· 1 1
제2절 연구목적 및 내용 ··················································· 13

제2장 국민건강보험재정의 특성 및 핵심관리 분야 ··········· 17
제1절 국민건강보험제도 개요 ··········································· 17
제2절 국민건강보험재정의 특성 ····································· 21
1. 부과방식(Pay-As-You-Go) ·················································· 21
2. 제3자 지불제도와 정보 비대칭성 ········································ 22
3. 명성재로서 의료 서비스와 Roemer의 법칙 ······················ 24
4. 재정 불안정 요인으로서 외부환경 ······································· 25
5. 정부실패와 건강보험재정 위험 ············································ 27
제3절 국민건강보험재정 핵심관리 분야 ·························· 28

제3장 핵심관리 분야별 위험분석 ······································· 37
제1절 재정총량관리 ·························································· 37
1. 건강보험재정 수입관리 ························································· 37
2. 지출관리와 보험급여 심사제도 ············································ 5 1
제2절 의료 서비스 공급체계관리 ··································· 61
1. 의료자원관리 ·········································································61
2. 의료 서비스 전달체계 ························································ 70
제3절 의료 서비스 생산 및 소비행태관리 ······················ 75
1. 가격 및 사용량 관리제도 ····················································· 76
2. 가격 및 사용량 관리현황 ····················································· 79
3. 가격 및 사용량 관리상의 위험요인 ··································· 83

제4장 결론: 건강보험재정의 감사접근법 ··························· 89
제1절 감사사항 및 감사중점의 선정 ································ 91
제2절 감사유형 및 감사결과의 활용 ······························· 96
제3절 감사와 모니터링과의 연계 ···································· 97

참고문헌 ·············································································99