우리나라 건강보험제도의 구조와 한국유방암학회 보험위원회의 역할

Abstract

The Korean National Health Insurance (NHI) system, founded under the Medical Insurance Act in 1963 and launched in 1977 for large enterprise employees, achieved universal coverage by 1989. It now ensures nationwide healthcare access through a compulsory enrollment system at birth. The NHI operates under a fee-for-service model using the Relative Value Scale (RVS), which quantifies medical services based on resource consumption, physician workload, and risk. Coverage is divided into insured, selective, and non-covered services, with reimbursement decisions managed by the Ministry of Health and Welfare after clinical and economic evaluation. The Korean Breast Cancer Society (KBCS) Insurance Committee, established in the mid-2000s, collaborates with the Ministry and the Health Insurance Review and Assessment Service to improve reimbursement policies for breast cancer treatment. Comprised of 16 expert members in three subcommittees, it reviews evidence, advises on new technology coverage, and advocates for equitable compensation. The Committee has been instrumental in expanding reimbursement for breast cancer surgery, systemic therapy and genetic testing while proposing revisions to cost policies for preoperative localization materials. Operating within the RVS framework, which balances efficiency and fairness, the KBCS Insurance Committee serves as a bridge between clinical evidence and national policy. Its continuous efforts ensure that Korean breast cancer patients have access to evidence-based, cost-effective, and high-quality care under the NHI system.