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Health policy and management = 보건행정학회지, v.24 no.4, 2014년, pp.396 - 412
서경화 (대한의사협회 의료정책연구소) , 정유민 (이화여자대학교 대학원 의과학과) , 김민지 (이화여자대학교 대학원 의과학과) , 이선희 (이화여자대학교 의과대학.의학전문대학원 예방의학교실)
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Background: As a reform plan of health care system, Accountable Care Organization (ACO) has became an object of attention in the United States after Patient Protection and Affordable Care Act was enacted. ACO is a group of various health care providers and provide coordinated care to its assigned be...
| 핵심어 | 질문 | 논문에서 추출한 답변 |
|---|---|---|
| ACO란 무엇인가? | ACO는 다양한 형태의 의료공급자조직으로 구성된 연합체로서 보험자와 계약하여 계약된 지역 환자들에게 통합적이고 잘 연계된 의료서비스를 제공하고, 정해진 질적 기준을 충족하면서 의료비를 절감하였을 경우 계약된 총액에 추가하여 성과급을 지불받는 체계라고 정의할 수 있다[4]. 즉 ACO는 의료공급자조직이 보험자와 의료제공방식 및 지불방식을 통합적으로 계약하는 시스템이라고 할 수 있으며, 제공된 서비스의 질적 지표수준에 기반하여 진료비를 보상받는 점이 기존 의료제공모델과의 가장 큰 차이점이다. | |
| ACO가 기존 의료제공모델과 가장 큰 차이점은 무엇인가? | ACO는 다양한 형태의 의료공급자조직으로 구성된 연합체로서 보험자와 계약하여 계약된 지역 환자들에게 통합적이고 잘 연계된 의료서비스를 제공하고, 정해진 질적 기준을 충족하면서 의료비를 절감하였을 경우 계약된 총액에 추가하여 성과급을 지불받는 체계라고 정의할 수 있다[4]. 즉 ACO는 의료공급자조직이 보험자와 의료제공방식 및 지불방식을 통합적으로 계약하는 시스템이라고 할 수 있으며, 제공된 서비스의 질적 지표수준에 기반하여 진료비를 보상받는 점이 기존 의료제공모델과의 가장 큰 차이점이다. 접근성 개선, 의료비 절감 그리고 의료의 질 향상이라는 정책목표를 달성하기 위해 ACO는 미국에서 지속적으로 추구해온 다양한 의료개혁의 연장선상에 있으면서도 그동안의 성과와 시행착오에 대한 개선노력을 집약하였다는 점에서 단기적 성과를 차치하고라도 이러한 정책적 시도의 다각적 영향에 대해 정책연구자들이 주목하고 있다[5]. | |
| ACO의 개념을 메디케어 중심으로 살펴볼때 가지는 핵심적 특성은 무엇인가? | ACO의 개념은 계속 진화하면서 변화를 보이고 있으나 메디케어의 공식 제도로 정착되면서 명시적으로 정립되었으며, 메디케어를 중심으로 살펴보면 다음과 같은 핵심적 특성을 가진 조직으로 정의될 수 있다[4,9]. 첫째, 병원을 포함하여 일차 의료제공자에 이르기까지 다양한 유형의 의료공급자들이 연합체로서 구성되며 둘째, 메디케어 보험자와 계약된 범위의 수급자들에게 책임 있는 진료를 제공한다는 조건하에 포괄적인 지불단위에 따라 진료비를 상환받도록 하며 셋째, 제공되는 의료서비스는 예방부터 급성진료는 물론이고 만성질환관리와 재활에 이르는 다양한 스펙트럼의 서비스 범위를 가지고, 서비스 제공절차의 개선과 효율적 관리를 통해 통합적이고 잘 조정된 방식으로 제공하도록 하며 넷째, 계약 시 메디케어가 요구하는 질 지표들에 대해 일정 수준의 성과목표를 약속하며 다섯째, 질적 성과 달성을 기반으로 각 ACO의 진료비 상승추계액보다 실제 발생된 진료비가 낮을 경우 발생 진료비의 상환은 물론이고 절감액의 일정 부분을 성과급으로 추가 지급받는다는 것이 ACO의 핵심개요라고 할 수 있다. |
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