노인 의치의 의료보험 적용시 급여기준과 공여체계에 관한 고찰

Abstract

Denture Services are excluded from the program coverage under the National Health Insurance. The study aims at suggesting reasonable criteria for the benefit coverage of denture services for the elderly. It consists of the eligibility standard, benefit package, cost-sharing, and the system of provision. The main findings were summarized as follows; 1. Various eligibility criteria such as age, percentage of people needing dentures, income of the eldery, unused denture years due to death, cases of other countries were reviewed ; The priority beneficiary found to be the aged over 70 and followed by the eledrly at 65-69. 2. As for the scope of benefits for denture services, the degree of need and wear percentage of full and partial denture, examples of other countries were reviewed ; full denture, partial denture and surveyed crowns should simultaneously be covered, and follow-up services be provided even after denture delivery. 3. Based on the above finding, the study recommends that it is necessary to cut the current cost-sharing formulae fmm 30% to 20% for the poor elderly. It is also proposed that, for the covenience`s sake, denture services be provided by both hospital/clinics and health centers(sub-centers). The inclusion of denture services obviously depends on financial conditions of NHI. Therefore, a study is urgently called for the cost estimation of denture services of the elderly.