실손의료보험의 문제점과 개선방안에 대한 법⋅정책적 연구

Indemnity health insurance is a representative private insurance that supplements medical expenses that are not covered by the National Health Insurance and has played a positive role in expanding access to medical care and reducing the economic burden on individuals. However, with the increase in the number of indemnity health insurance subscribers, problems such as over-treatment of non-benefit items, moral hazard, insurance premium increase and an increase in the loss ratio of insurance companies have been continuously raised. There is a need for legal and institutional measures to refine the problems and improvement of indemnity health insurance. In this study, the concept and legal nature of indemnity health insurance and problems raised in the insurance market along with the growth of indemnity health insurance were reviewed. The Supreme Court ruling gives an important meaning. From the perspective of a lawyer, a legal review was conducted along with the Supreme Court's position and analysis. After dealing with legal issues of indemnity health insurance such as cataract surgery, mammotome excision and out-of-pocket maximum policy, an improvement plan that can be derived from the Supreme Court decision was suggested. In order to secure the sustainability of the indemnity health insurance system, improvement is necessary from two perspectives-’reorganization of the structure of indemnity health insurance products’ and ‘non covered service’-, and then specific and detailed contents were analyzed and reviewed. Although indemnity health insurance is an important means of guaranteeing national medical expenses, sustainable operation of indemnity health insurance may not be possible unless the legal and institutional limitations of the current system are improved. Continuous development should be made based on the rational improvement of the indemnity health insurance system and measures for legal and institutional improvement.