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Objectives: This study aimed to understand the level of unmet medical experience in terms of medical accessibility and to provide basic data necessary for medical accessibility and policy establishment. Methods: The research data were analyzed using the SPSS statistical program, using the original data from the National Health and Nutrition Survey. Results: It was confirmed that the unmet medical rate continued to decrease. The most common reasons for unmet medical care were "lack of time," with the second being "economic reasons" and the third being "light symptoms." And Gender, age, average monthly gross household income, and insurance benefit types were found to have a significant causal relationship with unmet medical care was not met. Conclusions: The cause of the unmet medical care is believed to be resolved if strengthening coverage, providing information, and diversity of policies are promoted at the same time.

Objectives: This study investigated how Korean daily newspapers frame the present government’s health insurance coverage expansion policy, Moon Jae-in Care. Methods: A contents analysis was conducted to construct news frames represented in the four Korean daily newspapers’ editorials and columns on Moon Jae-in Care during from April 2017 to April 2018. News text was classified into three different layers of frames: expressive element, narrative structure, and implied values. Results: The analysis revealed that the frequency of narrative frames was as follows: health system improvement (20.8%), public burden (14.6%), opposition by doctors (14.6%), and populism (12.5%). The financial sustainability accounted for 41.7% of the value frame, followed by procedural legitimation (18.8%), and coverage expansion (16.7%). The results also revealed that reported frames were different among newspapers: Chosun Ilbo tended to report in a negative tone, while Hankyoreh shinmun and Kyunghyang shinmun used a positive tone. Conclusions: This finding suggests that there are salient framings in reports on Moon Jae-in Care. Based on the results, the government needs to present a detailed financing plan on Moon Jae-in Care in detail. I discussed another implication of media frames results.

New health technologies are as the state-of-the-art in the modern medicine and health care that can be applied to various systemic diseases. Regardless of its importance, in many cases the patients are not being able to benefit from new health technologies for their systemic diseases. Hence, they are not covered under health insurance generally, and even covered, it is common that long time is taken to be covered. This study looks at different perspective to the number of previous studies on regenerative medicine as an exemplary case and health insurance coverage, which focused on the clinical results that was beneficial to the patients, researchers and society. In this study, the insured benefits and various non-insured benefits under the health insurance system were examined. Even some regenerative medical services are recognized as safety and efficacy to some degree, the problem of being treated as non-insured medical services due to the new health care technology as itself was discussed through the concept of shadow price. In addition, the study discussed that regenerative medicine proven effectiveness for disease treatments should be included in the insurance benefits, in principle. For this, Japanese cases were referred. The case of Japan may not be fully applicable to all other countries or some specific countries. However, it may be a reference for countries with low protection even though taking public medical insurance systems.

본 연구는 최근에 이루어진‘건강보험 보장성 확대’정책의 효과를 개인의 의료이용 및 건강수준을 중심으로 평가하였다. 2005년부터 시행된 건강보험 보장성 확대 정책은 암 등 의 중증질환자에 대한 본인부담 경감, 입원환자 식대의 급여전환, 비급여항목의 급여전환, 본인부담상한제 시행 등을 주요 내용으로 한다. 이러한 정책 변화에 대해 만성질환을 보유하고 있어 의료욕구가 일반적으로 높은 제도의 주요 수혜집단에 비해 급성질환 등으로 의료서비스를 이용한 집단의 입원이용이 상대적으로 증가한 것과 제도의 직접적인 수혜집단인 중증질환자 집단의 입원이용이 상당 정도 증가한 것을 확인하였다. 또한 이러한 건강보험제도의 변화가 입원이용에서 혜택을 누린 중증질환자의 단기간의 건강평가지표인 2주간이환경험 면에서 긍정적인 개선을 이끌어내고 있음을 확인하였다. 본 연구는 건강보험제도가 의료이용 및 건강수준에 인과적인 효과를 나타내고 있음을 확인하였고, 이후 건강보험보장성 확대의 정책설계에 대한 정책적 함의를 제공한다.

The purpose of this study is to identify the relationship between health insurance and health by evaluating the impacts of health insurance coverage expansion on health care utilization and health status. To analyze the causal relationship between health insurance and health, this study employed a “difference-in-difference method” that could compare changes in health care utilization and health status across groups in health insurance coverage expansion in 2005. The researcher predicted that the expansion of health insurance coverage would be an exogenous source of variation in the prices of health service use. First, the difference-in-differences estimator between ‘illness group’ and ‘non-illness group’ revealed that the increase in coverage of inpatient care services would result from the increases in the stay of length of ‘non-illness group’ rather than that of ‘illness group’. However, the difference-in-differences estimator between ‘serious illness group’ and ‘chronic illness group’ identified that the policy change that focuses on expansion of the coverage for ‘serious illness’ effects on the increases in health care utilization and promotion of health status. In summary, the changes of health insurance coverage focusing on serious illness and inpatient care have positive effects on health care utilization and health status of serious illness group. But, ‘non-illness groups’ with acute illness receive more benefits from the policy change than ‘illness group’ with chronic illness.

이 논문은 2005년 시행된 암 보장성 강화정책이 의료이용과 건강성과에 미친 효과를 분석하였다. 건강보험 보장성 확대가 모든 질환에 대해 동일하게 이루어지지 않았다는 사실에 착안하여 이중차분 분석을 수행함으로써 정책의 순수한 효과를 추정하고자 시도하였다. 보장성 강화정책의 대상은 아니지만 중증질환인 간질환을 암 상병의 대조군으로 설정하고 의료이용에 미친 효과를 분석한 결과는 보장성 강화정책이 사회⋅경제적 인구 특성에 관계없이 암 환자들의 의료이용을 증가시키는 역할을 했을 가능성을 시사한다. 보장성 확대로 인한 의료이용 증가가 최종적인 건강성과를 개선시켰는지에 대한 연구 결과는 사회⋅경제적 인구 특성에 따라 상이했다.

This study analyzes the effects of the health insurance coverage expansion for cancer on health care utilization and health outcomes. Noting that the coverage expansion was not applied equally across all diseases, I employ the DID method using liver disease as a control group. The results indicate that the coverage expansion for cancer significantly increased health care utilization among cancer patients compared to liver disease patients. Importantly, the coverage expansion alleviated patients’ economic burden regardless of their age and income. However, the downstream impact of this improved health care utilization on probability of death differed depending on age and income.

본 연구는 치석제거에 대한 인식과 치석제거 건강보험 급여화에 대한 인식도 및 만족도를 파악하여 치과건강보험의 효율적인 보건정책을 위해 전북지역 거주민 389명을 대상으로 2016년 5월 30일부터 7월 30일까지 설문조사를 실시하여 다음과 같은 결론을 얻었다. 첫째, 치석제거 적정횟수는 ‘연 2회’가 가장 높게 나타났고, 적정 연령은 ‘20대부터’가 가장 높게 나타났다. 둘째, 치석제거 급여화 인식도는 여자에서, 치주건강 관심도가 높은 경우 높게 나타났다. 셋째, 적용 만족도도 여 자에서, 치주건강 관심도가 높은 경우 높게 나타났다. 넷째, 치석제거 인식도는 치석제거 급여화 인식도, 치석제거 급여화 만족도와, 치석제거 급여화 인식도는 치석제거 급여화 만족도와 양의 상관관계를 나타냈다. 이에 치석제거에 대한 지속적인 인식 향상을 위해 올바른 정보 제공과 적극적으로 교육매체를 활용한 홍보가 이루어져야 할 것으로 사료된다.

This study aimed to investigate recognition of dental scaling and recognition of and satisfaction with health insurance coverage of dental scaling and make an efficient healthcare policy for dental health insurance; to do this, a survey was conducted in 389 residents in North Jeolla Province, drawing the following conclusion: First, the respondents were most likely to suggest that it was desirable to get dental scaling ‘twice a year’ and to start it ‘in their twenties’. Second, those who were female and who were more concerned about periodontal health were more likely to recognize coverage of dental scaling. Third, those who were female and who were more concerned about periodontal health were also more satisfied with the coverage. It is therefore necessary to make PRs by using teaching media positively as well as by giving correct information with the objective of improving recognition of dental scaling on a continuous basis.

Purpose: The purpose of this study was to examine the recognition of dental technician's about including denture into the coverage of the national health insurance. Methods: This study carried out self-administered questionnaire survey from June 10, 2012 to June 20 by having research subjects as 230 dental technician. Except 22 copies with incomplete response, 208 copies were used as the materials of final analysis. Results: The recognition of dental technician on the national health insurance of denture was 48%, but there was a low recognition on the details. The rates of dental technician who approved of the inclusion of denture into the coverage of the health insurance respectively stood at 59%. Conclusion: The coverage of the health insurance should be extended to dental medicine in a manner to satisfy dental technicians, dental service providers and receivers. Also, further studies for the extending coverage of the details are needed.

This survey was compared and analyzed using a questionnaire to survey 385 in Busan․Kyungnam province, South Korea. It was conducted from August 1, through August 30, 2010. Attending pediatric dentistry and kindergarten children based caregivers to target, perception of Parents on Pit & Fissure Sealant and its National Health Insurance Coverage. The data was analyzed using the SPSS WIN 18.0 program. The following conclusion were reached. 1. General characteristics women 254(66%), men 131(34%) of the women was higher than that of men. Age In the ages 6 and 14 years old with children 30s 191(49.6%), housewife 169(43.9%) was the most. 2. Whether the permanent teeth eruption, according to general characteristics women 154(40%), in age 40s 156(40.5%), housewife in the profession 103(26.8%), number of children for two 170(44.2%) was the highest. 3. Experience the presence of your child's dental visit, according to gender, occupation visit did have men 121(31.4%), women 248(64.4%), housewife in the profession 165(42.9%) was the highest. 4. Experience the presence of your child's dental visit, according to gender, occupation have regular check-ups in age women 147(38.2%), housewife in the profession 100(26.0%) was the highest. 5. Health insurance coverage to the fact Linealized rates of about Pit & Fissure Sealent, is well survey do not know, as well know is, in gender men-no 97(25.2%) women 155(40.3%), in age 40s 128(33.2%) was the highest. housewife in the profession 104(27%), number of children for two 148(38.4%), Health insurance coverage to the fact Linealized rates of about Pit & Fissure Sealent do not know the fact that the perception was. 6. Health insurance in accordance with the general characteristics in the target age, Age In the ages 6 and 14 years old with children 30s 81(21%) women 107(27.8%) housewife in the profession 73(19%), number of children for two 102(26.5%) was the highest. 7. Health insurance in accordance with the general characteristics in the target tooth, in gender women 85(22.1%), in age 40s 65(16.9%), housewife in the profession 59(15.3%), number of children for two 85(22.1%) first molars from the highest. See more results. of health insurance coverage recognized standards Pit & Fissure Sealent most of the participants in the survey do not know were. Utilizing the mass media at the national level, sustained by a public service announcement. Offers better health benefits to maintain a healthy oral health.

Objectives: The study aimed to compare the periodontal tissue status in middle-aged and elderly people before and after scaling health insurance coverage, using data from the 2013 and 2018 National Health and Nutrition Examination Surveys. Methods: Data were analyzed using IBM SPSS version 24.0 (IBM Co., Armonk, NY, USA). A total of 5,109 people were included in the study, including 2,593 persons from 2013 and 2,516 from 2018, whose insurance was scaled according to the following age groups: 40～64 years and 65 years or older. Results: The factors affecting the periodontal tissue status of the middle-aged and the elderly from the time when insurance began to cover tartar removal (a method of preventing and treating periodontal disease) differed significantly after five years. Conclusions: It is necessary to establish measures to improve access to oral health education for the prevention and treatment of periodontal diseases in the middle-aged and elderly population.

비정규직 근로자를 직장보험에 편입하는 내용의 2001년 개정법이 비정규직 근로자의 인구사회학적, 직장규모, 직업과 산업유형 특성에 따라 서로 다른 영향을 미쳤다는 뚜렷한 증거를 발견하지 못하였다. 단지 전문관리직에 종사하는 비정규직 근로자가 다른 비정규직 근로자에 비하여 2001년 이후에 더 큰 증가율을 보였을 뿐이다.4. 정규직 근로자와 비정규직 근로자의 하위집단간 비교를 통한 정책효과분석

A person is injured in car accident caused by his/her slight negligence except he/she causes accident by his/her willfulness or gross negligence. Because the National Health Insurance Corporation(hereinafter called “Corporation”) shall not provide any insurance benefit “when he has intentionally or through gross negligence caused a criminal conduct or intentionally contributed to the occurrence of an accident” referred to in Article 48(1) 1 of the National Health Insurance Act. So, if he/she is insured by his/her own bodily injury coverage, he/she can be compensated for his/her medical expenses. The injured have the rights to file either National Health Insurance claim and Automobile Insurance claim but there is no clear and definite adjustment clause. The claim disputes between National Health Insurance(hereinafter called “NHI”) and Automobile Insurance(hereinafter called “AI”) in the own bodily injury coverage makes some problems. Firstly, there are some differences in co-payments which he/she chooses between NHI and AI. Profit per a patient is higher in the NHI than in the AI. Secondly, it can provoke criticism that people shall unnecessarily pay double contributions. Lastly, it can raise moral hazards. For example, if he/she can cover the compensations when the insured receives the compensations from his/her insurer, the Corporation can be claimed by medical care institution payment of the health care benefit costs. In conclusion, first of all, to improve the national health and preserve the insured's rights the Corporation shall keep notice these facts.

본 연구는 의료소비자를 대상으로 실시되고 있는 치과건강보험급여화의 인식도를 조사하여 미래 치석제거 국민들 의 구강건강향상을 위해 치과건강보험급여가 확대되고자 하는데 목적이 있다. 연 1회 치석제거급여 연령에 대한 적절성 여 부는 나이와 교육수준에서 유의한 차이가 있었고(p<0.05), 연 1회 치석제거 급여횟수에 대한 적절성 여부는 결혼여부, 지역 (구), 자가구강건강인지에서 유의하였으며(p<0.05), 연 1회 치석제거 급여수가에 대한 적절성 여부에서는 하루잇솔질총횟수 가 통계적으로 유의하였다(p<0.05). 결국 연령이 증가하면서 나타나는 치주질환의 증가로 국가 차원에서의 건강보험급여 항목이 추가되어야 하며, 본 연구결과에서와 같이 치석제거 건강보험급여화는 연령, 횟수, 수가부분에서 더욱 확대 되어야 하며, 향후 치과건강보험 급여정책 향상을 위한 노력은 국민의 구강건강을 위해 계속되어야 한다.

The purpose of the study is to investigate dental health insurance coverage the awareness and dental health insurance coverage extension to scaling in service consumers. There were significant differences according to education level, age on the appropriateness of the age of yearly scaling benefit, and to married, regions, self-oral health of the frequency of yearly scaling benefit, who their teeth brushed frequence a day on the appropriateness of the fee of yearly scaling benefit. It implies that should be added to the coverage list national health insurance every age group after increasing periodontal disease. It is to be more extension as to age, frequency and fee health insurance coverage of scaling, the effort to improve dental health insurance coverage policy must be continue for oral health in the future.

The National Health Insurance Corporation has been retrieving from health care providers the payments made to them by insured patients as a result of the health care providers’ arbitrary denial of coverage under the National Health Insurance, and has been disbursing such retrieved monies back to the patients, pursuant to Article 57, Sections 1 and 4 of the National Health Insurance Act. However, such practice is an application of the law that lacks legal exactitude. Another problem with such practice is that there is no legal provision under any laws or notices that expressly prohibits arbitrary denial of coverage. A legislative solution, therefore, is called for to address these issues.

The purpose of this study was to identify the experience of medical disputes arising from tasks and clinical practices of dental hygienists. The conclusions of this study are as follows: Of all respondents, 59.4% experienced patients' complaints and dissatisfaction and medical disputes, 24.0% experienced the progression of complaints to legal affairs. Moreover, 95.3% had a feeling of anxiety or doubt about the risk of potential medical disputes. In the resolution process of medical disputes, 84.9% answered that the duty to obtain a patient's informed consent is crucial prior to treatment, and 32.5% answered that errors in medical records can be completely erased and rewritten entirely, showing the highest rate of wrong answers. No significant difference was found in the incidence of medical disputes according to work places. On the other hand, significant difference was found in the progression of complaints to legal proceedings according to work place and work experience. The degree of burden on medical dispute was more significant in respondents with an experience of dispute.

Objectives. Compliance with positive airway pressure (PAP) in patients with obstructive sleep apnea (OSA) directly affects its treatment efficacy. Since July 2018, polysomnography and PAP therapy have been covered by the National Health Insurance (NHI), which has reduced the price barrier and promoted PAP therapy in Korea. This study aimed to compare changes in PAP compliance before and after NHI implementation. Methods. This study is a retrospective analysis in a tertiary hospital setting in Korea. From 2011 to 2019, patients with OSA (apnea-hypopnea index ≥5) treated using a PAP device for ≥1 month were included. They were classified as belonging to the pre-insurance (PI) group (having started PAP before July 2018) or the NHI group (having received a PAP reimbursement by the NHI service). We collected and analyzed medical records and PAP use information for between-group comparisons of compliance. We defined compliance as the percentage of usage days, the percentage of days with usage for ≥4 night hours, and average daily usage hours. Results. We included 146 and 100 patients in the PI and NHI groups, respectively. Automatic PAP mode and NHI were independent predictors of compliance B at the 3- and 9-month follow-up points. The NHI group showed significantly higher compliance A at 3, but not 9 months. For compliance B, the NHI group showed significantly higher compliance than the PI group at 1 month and 3 months, but not at 9 months. Compared with the PI group, the NHI group showed significantly higher compliance C only at 3 months. Conclusion. The NHI has positively affected PAP therapy in patients with OSA. Insurance policy may affect compliance within the first 3 months of PAP therapy.

Background: This study aimed to investigate the association between the Korean national health insurance coverage benefit extension policy and clinical outcomes of patients who were ventilated owing to various respiratory diseases.Methods: Data from 515 patients (male, 69.7%; mean age, 69.8±12.1 years; in-hospital mortality rate, 28.3%) who were hospitalized in a respiratory intensive care unit were retrospectively analyzed over five years.Results: Of total enrolled patients, 356 (69.1%) had one benefit items under this policy during their hospital stay. They had significantly higher medical expenditure (total: median, 23,683 vs. 12,742 USD, P<0.001), out-of-pocket (median, 5,932 vs. 4,081 USD; P=0.008), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (median, 26.0% vs. 32.2%; P<0.001). Patients without benefit items associated with higher in-hospital mortality (hazard ratio [HR], 2.825; 95% confidence interval [CI], 1.995?4.000; P<0.001). In analysis of patients with benefit items, patients with three items (“cancer”, “tuberculosis,” and “disability”) had significantly lower out-of-pocket medical expenditure (3,441 vs. 6,517 USD, P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (17.2% vs. 27.8%, P<0.001). They were associated with higher in-hospital mortality (HR, 3.996; 95% CI, 2.535?6.295, P<0.001).Conclusions: Our study showed patients with benefit items had more medical resources and associated improved in-hospital survival. Patients with the aforementioned three benefit items had lower out-of-pocket medical expenditure due to the implementation of this policy, but higher in-hospital mortality.

Purpose: This paper aims to appraise if the health financing system of the National Hospital Insurance Fund (NHIF) in Kenya is feasible to attain universal health coverage (UHC) with a specific research interest in expanding enrolment and retention of the population in the informal economy. Originality: The Kenyan government has committed to achieving UHC by 2022, and the NHIF has been used as one of the key strategies to expand population coverage with a contributory, prepaid mechanism through several reforms undertaken. Nevertheless, NHIF coverage is less than one-fifth of the population as of 2018. This means that more than 80 percent of the total population needs financial protection from healthcare costs. Methodology: Comparable information and secondary data on the Kenya informal sector and health domain were compiled from published and grey literature. Health financing configurations of the NHIF were assessed based on the framework that considers efficiency, equity in resource distribution, transparency, and accountability. Result: It was found that inequitable premium contributions rate and benefit package do not appeal to informal sector individuals to be a member of the prepaid insurance scheme. Administrative inefficiency serves as a deterrence to enrolment. Differential payer mechanisms incentivize the providers to prioritize civil servants members for a higher reimbursement rate. Inconsistent information on the entitlements and weak accountability mechanism undermined monitoring of the quality of service provided and encouraged fraudulent claims and corruption cases. Conclusions and Implication: The paper concludes that the health financing arrangement of the NHIF is required to improve its equity, efficiency, and transparency/accountability to expand population coverage to the informal sector and to attain UHC in Kenya. Vigorous additional research on the marginalized population group is urged to fill the knowledge gap in risk exposure and health outcomes per subgroup in the informal sector.

Purpose The purpose of this study is to determine the level of health equity in relation to cancer incidence. Materials and Methods We used the National Health Insurance (NHI) claims data of the National Health Insurance Service between 2005 and 2022 and annual health insurance and medical aid beneficiaries between 2011 and 2021 to investigate the disparities of cancer incidence. We calculated age-sex standardized cancer incidence rates by cancer and year according to the type of insurance and the trend over time using the annual percentage change. We also compared the hospital type of the first diagnosis by cancer type and year and cancer incidence rates by cancer type and region in 2021 according to the type of insurance. Results The total cancer incidence increased from 255,971 in 2011 to 325,772 cases in 2021. The absolute difference of total cancer incidence rate between the NHI beneficiaries and the medical aid (MA) recipients increased from 510.1 cases per 100,000 population to 536.9 cases per 100,000 population. The odds ratio of total cancer incidence for the MA recipients increased from 1.79 (95% confidence interval [CI], 1.77 to 1.82) to 1.90 (95% CI, 1.88 to 1.93). Disparities in access to hospitals and regional cancer incidence were profound. Conclusion This study examined health inequities in relation to cancer incidence over the last decade. Cancer incidence was higher in the MA recipients, and the gap was widening. We also found that regional differences in cancer incidence still exist and are getting worse. Investigating these disparities between the NHI beneficiaries and the MA recipients is crucial for implementing of public health policies to reduce health inequities.

국민건강보험은 전(全) 국민 가입과 보험자 통합 이후인 2000년대 초반부터 보장성 확대ㆍ강화에 대한 논의가 본격적으로 시작되었고, 현재도 보장성 강화는 국민건강보험제도의 가장 큰 이슈라고 할 수 있다. 그러나 정부의 지속적인 보장성 강화 정책 추진과 막대한 건강보험 재정의 투입에도 불구하고 지난 10년간 건강보험 보장률은 60% 초반에 정체되어 있는 실정이다. 국민건강보험의 보장성 강화는 우리 헌법이 사회국가원리를 헌법의 기본원리로 채택하고 있는 이상 그 헌법적 정당성에 대해서는 이론이 있을 수 없다. 그러나 한정된 의료자원과 보험재정이라는 현실적 조건하에서 국민건강보험의 보장성을 강화하기 위해서는 어떠한 의료서비스를 국민건강보험의 급여대상으로 포함할 것인지, 어떠한 의료서비스를 먼저 급여화할 것인지, 환자들의 본인부담을 낮추는 조치는 어떠한 기준으로 시행할 것인지 등에 대하여 사회적 합의를 바탕으로 한 일정한 원칙과 기준이 있어야 한다. 이와 같이, 국민건강보험의 보장성 강화에 있어 법치국가적 한계는 무엇이고, 보장성 강화 정책의 결정에 있어 민주적 합의에 기초한 절차적 정당성을 어떻게 확보할 것인가에 대한 연구의 필요성이 존재하고, 이는 국민건강보험의 보장성 수준을 결정하는 요양급여제도의 문제점과 이에 대한 개선방안을 검토하는 것에서 출발해야 한다. 따라서 이 논문은 국민건강보험의 보장성 강화를 위한 법적ㆍ제도적 수단으로 기능하는 요양급여제도에 대한 검토를 통해 현행 법제의 문제점을 분석하고, 이를 개선하기 위한 방안은 무엇인지 고찰하는 것을 목적으로 한다. 국민건강보험의 보장성 강화와 그 법적ㆍ제도적 기초로서 요양급여제도에 대한 이해를 바탕으로, 이 논문은 요양급여제도의 문제점과 개선방안으로서 국민건강보험 보장성 강화에 관한 일관된 원칙과 기준의 정립, 전문적 평가절차의 실질화, 건강보험정책심의위원회의 민주적 운영에 대하여 고찰하였다.

Since the early 2000s, when the application of National Health Insurance was mandated to all citizens and insurance carriers were integrated, discussions on the expansion and augmentation of coverage have been ongoing. Even today, enhancing coverage is one of the most contentious issues regarding National Health Insurance. However, despite consistent enforcement of government policy to enhance coverage and considerable investment in health insurance, the coverage rate of health insurance for incurred medical charges covered has been stagnant in the low 60 % for the past decade. It is incontestable that enhancing National Health Insurance coverage has constitutional justification since the Korean Constitution adopts the Social State Principle as one of its fundamental constitutional principles. Even so, enhancing National Health Insurance coverage within the realistic context of limited health care resources and insurance finance necessitates the establishment of principles and standards derived from a social consensus regarding the specific health care services that should be included in National Health Insurance benefits, determination of the health care services that should be provided first, and establishment of standards for the measures that should be undertaken to reduce patient co-payments. Therefore, there is the need for examination regarding the limitation of improving coverage of National Health Insurance provided by a constitutional state and approaches to ensure procedural justification based on a democratically-derived consensus over policy decisions regarding coverage augmentation. Such research should start from an investigation of problems and formulation of improvement options for the health care benefit system with the aim of determining the level of National Health Insurance coverage. Thus, the purpose of the present study is as follows: examination of the health care benefit system, which function as legal and systematical means to increase National Health Insurance coverage regarding medical expenses; analysis of the deviation of the current legal system; identify options to ameliorate such problems. Based on the understanding of the health care benefit system that form the legal and systematic basis for National Health Insurance coverage enhancement, measures for such can be proposed as follows: Providing principles and standards for coverage improvement should be established, professional evaluation methods should be implemented, and the Deliberation Committee of National Health Insurance Policy should be administered democratically.