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A Study on the Improvement Plan for the Automobile Insurance Medical Fee Determination System - Focusing on the Enhancement of Medical Fee Standard Research and Survey Functions -

  • Legal Theory & Practice Review
  • Abbr : LTPR
  • 2025, 13(3), pp.53~85
  • Publisher : The Korea Society for Legal Theory and Practice Inc.
  • Research Area : Social Science > Law
  • Received : July 31, 2025
  • Accepted : August 22, 2025
  • Published : August 31, 2025

Youngkook Kim 1

1국회입법조사처

Accredited

ABSTRACT

This study comprehensively analyzes the causes of the continuously increasing medical expenses for minor injuries in automobile insurance since 2014, specifically focusing on presenting concrete solutions for supplementing the functions related to the ‘generation’ and ‘management’ of medical fee standards. This increase in medical expenses is primarily attributed to the ambiguity of medical fee standards for non-covered items and the structural limitations of the current fee determination and review system. Particularly, following the entrustment of automobile insurance medical fee reviews to the Health Insurance Review & Assessment Service(hereinafter, HIRA) in July 2013, the supplementary role of the Automobile Insurance Medical Fee Dispute Review Committee(hereinafter, the Review Committee) has weakened. This has made it challenging to establish timely medical fee standards for new non-covered items and to adapt to evolving medical environments. Consequently, this has led to HIRA's limited review capacity and the Ministry of Land, Infrastructure and Transport's(MOILT) insufficient function in developing new medical fee standards, becoming major causes for the ineffective control of unreasonable medical claims, which include inducing overtreatment and increasing unnecessary medical shopping. To resolve these issues, this study proposes not only strengthening HIRA's review capabilities for non-covered items to effectively screen out unreasonable claims, but also emphasizes the critical need to reinforce the systematic research and survey functions for medical fee standards. The core proposal suggests establishing a dedicated organization within the Review Committee, which already possesses the authority for medical fee standard deliberation and dispute resolution. This approach highlights that professional and systematic research is an essential prerequisite for establishing reasonable fee standards and is efficient in terms of operational connectivity, given the Committee's existing authority. In conclusion, this improvement plan is expected to enhance the efficiency and professionalism of the medical fee determination process by entrusting these functions to a specialized institution. Ultimately, it aims to promote an overall improvement of the automobile insurance medical fee determination system, secure the financial soundness of the insurance system, and greatly contribute to protecting the rights and interests of insurance consumers.

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