어린이 공공전문진료센터 원가기반 손실 보상 사례

[Purpose]This study aims to identify the design and operational mechanism of the activity－based costing (ABC)－based loss compensation system introduced in the pilot post－compensation program for Children’s Public Specialized Care Centers and to empirically examine the incentives of participating hospitals and their policy implications through a case study of Hospital A. [Methodology]The study analyzed the case of Hospital A, which participated in the pilot project implementing a cost－based loss compensation mechanism for Children’s Public Specialized Care Centers from 2023 to 2025. To strengthen the foundation for advanced pediatric specialty care, the government required the use of activity－based costing (ABC) to estimate operational losses arising from the operation of children’s hospitals. Hospital A calculated these losses through its ABC system but received compensation for only part of them. Given the characteristics of the program, the study analyzed various issues that may occur when directly compensating deficits of private institutions on a cost basis. [Findings]The analysis revealed that even with an elaborately designed ABC system, cost－based loss compensation can still give rise to moral hazard, cost shifting, equity, and information asymmetry problems. It also demonstrated that conflicts of interest may emerge between the government and participating institutions during the calculation of cost－based compensation amounts. [Implications]The paper suggests that, when compensating losses from socially significant public service like children's hospitals, it is essential to design rational incentive mechanisms to minimize side effects and enhance efficiency.