실손의료보험 청구절차 개선을 위한 법적 과제

An amendment to the Insurance Business Act, which simplifies private health insurance, is being discussed proactively in the National Assembly. However, there are many challenges to be solved in the future, such as the selection of a specialized agency to transmit medical information and the protection and management of sensitive medical information. There are various candidates such as Health Insurance Review and Assessment Service, Korea Insurance Development Institute, and Insurance Association in relation to where to appoint a specialized intermediary agency to transmit medical information, and there is an opinion that there is no need for the agency at all. It is desirable to decide on the selection of a intermediary agency, which is a tool for simplifying claims for medical insurance claims and realizing them, in consideration of the convenience and benefits of the people. The Health Insurance Review and Assessment Service is an institution that has already performed similar tasks in the public domain for a long time, and the related system has already been established, so it is most suitable as a professional intermediary agency because it can control the excessive medical activities of medical institutions. When the simplified private health insurance service is introduced, special care is required for sensitive medical information. Medical information collected by the intermediary agency should be sent to the insurance company and then discarded. After the medical information provided by the insurance company is used for the purpose, it is desirable to discard it unless there is a special reason. Sanctions should be tightened to severely punish information leakage or misuse.