ABSTRACT
The current national health-insurance system of the Republic of Korea uses the negative-list method to determine benefit coverage, which includes most medical services. However, financial limitations have led to frequent conflicts between medical-service providers and the Health Insurance Review and Assessment Service (HIRA) about the inclusion of specific service-providers' practices within benefit coverage. The role of HIRA is to determine whether payments claimed by service providers are clinically valid and formulated in a cost-efficient manner. This article describes the present state and structure of the benefit system in the Korean national health-insurance system. We focus on issues of arbitrary uninsured benefits that may arise when service providers request patients to pay in full (with their approval) for a service that is not included in the benefits, according to the National Health Insurance Act. We also consider the legal treatment of arbitrary uninsured benefits in Korea and other countries. We suggest measures to improve the payment system for arbitrary uninsured benefits in Korea. Laws and regulations should be revised to cover these arbitrary uninsured benefits in a manner that can be agreed upon by HIRA, service providers, and patients.
Subject(s)
Humans , Consensus , Insurance, Health , Jurisprudence , Korea , Medically Uninsured , National Health Programs , Republic of Korea , Social Control, Formal , Social SecurityABSTRACT
The medical system is turning into a general health care system recently. The change in the system increases the cooperation between the physicians and the non-physicians in reality. So it is inappropriate to punish every cooperative work between the two for unlicensed medical practice control program anymore. In order to readjust the control over the unlicensed medical practice, critically dismantling and reconstructing the concept of medical treatment must be done. The three elements of the concept of medical treatment can be constructed socially in relation to disease. When this is done under social subsystems, the ideological functions of disease and medical treatment concepts can be explained. There are three aspects to the current unlicensed medical practice control program. There is a large gap between the legal judgment and the medical rationality. Moreover, the government unnecessarily has a full control over all dimensions of the medical treatment concept, and the license system only emphasizes the status, not the essence of the medical treatment itself. The dermatologists and cosmeticians' work must be divided but done cooperatively. A way to legislate this is to draw the cosmeticians into the area of medical skin treatment. Rather than solving the problem by giving cosmeticians another status, it is important for them to cooperate functionally with the dermatologists. The government should control the `cooperative division of work' between the two indirectly, so that the civil society can function on its own disciplinary mechanism.
Subject(s)
Delivery of Health Care , Judgment , Licensure , SkinABSTRACT
The intercourse for mutual understanding between the doctor and the patient is an essential factor of successful medical treatment. The law should confine its duties to forming conditions where the remedial discourse can be held freely and peacefully. Under the Art. 16 of the medical law, however, the structure of free remedial discourse is distorted by asymmetrically distributing the rights and obligations between the doctor and the patient.; The doctor's responsibility to treat the patient ends as soon as the recipient decides to terminate it on his or her own volition. In the case of patients requiring immediate attention the doctor and the patient should discuss the matters of the medical, ethical and political aspects of the termination of treatment with religious men or women etc. If the above mentioned is properly carried out, any decision is fully legitimated regardless of the its content.
Subject(s)
Female , Humans , Male , Human Rights , Jurisprudence , VolitionABSTRACT
Long, severe, and fixed congenital tracheal stenosis is a life-threatening anornaly and not relieved by endotracheal or tracheostomy intubation. The rarity of congenital tracheal stenosis has not allowed sufficient experience for the development of standard treatment methods, therefore, congenital tracheal stenosis still carries significant morbidity, with a mortality rate as high as 70%. We have followed up two patients managed by different methods, but O(2)-isoflurane-Fentanyl-vecuronium was used for induction and maintenace. We experienced one case of tracheoplasty with pericardial patch for extensive tracheal stenosis under extracorporeal circulation, and one case of slide tracheoplasty for funnel-shaped tracheal stenosis. The first case was noticed incidentally during anesthetic induction and the vocal cord was visible but 2.5 mm sized tube could not be advanced,so we used the guide wire which is used for central line, then we could intubate with some resistance. Tracheostomy was not allowed due to diffuse tracheal stenosis reaching from cricoid cartilage to carina. During the extra corporial circulation, the guide wire was inserted from operation field, and 3.5 mm sized tube was introduced via guide wire by anesthesiologist. After operation the grannulation tissue that obstructing airway, was noticed by bronchoscopy, and was removed, then he was weaned from ventilator successfully. The second case was discovered due to diffcult weaning from ventilator after open heart surgery. the bronchogrm showed right tracheal bronchus and diffuse tracheal stenosis from T2 to carina. He was ventilated initially with 4.0 mm sized endotracheal tube, and ventilated intermittently with other 2.5 mm sized endotracheal tube from operation field during tracheal anastomosis. After operation, he died with increased airway pressure and airway bleeding.