J Korean Med Assoc.  2007 Oct;50(10):856-858. 10.5124/jkma.2007.50.10.856.

Issues on the Eligibility Management System in Medical Aid

• Yoon YS

• KMID: 2064996
• DOI: http://doi.org/10.5124/jkma.2007.50.10.856

Abstract

The Ministry of Health and Welfare introduced a new reimbursement system called the Eligibility Management System in Medical Aid in July 2007. The operation of this system is interlocked with patient care programs of medical institutions. The new system was expected to realize effective management of the eligibility of beneficiaries by interactive communications between medical institutions and the National Health Insurance Corporation (NHIC) and thereby improve financial stabilization of the reimbursement system and optimize healthcare practices by preventing moral hazards in the relationship between beneficiaries and medical institutions. For the effective operation of this system, however, several drawbacks need to be resolved; firstly, one can currently use the system only through the internet, secondly, there is a legal issue that medical institutions are the subject of the management of eligibility, and lastly, healthcare information needs to be transferred to NHIC in a real-time manner. Particularly the last one needs a special attention because it can raise critical concerns of potential violation of human rights of patients and unnecessary regulations of medical practices.

Keyword

Eligibility Management System in Medical Aid; Real-time healthcare surveillance system; Violation of human rights of patients; Regulation of medical practice

MeSH Terms

Delivery of Health Care
Human Rights
Humans
Internet
National Health Programs
Patient Care
Social Control, Formal