Care Benefit Process

1. 1.
   The health care delivery system is introduced to utilize medical resources efficiently(to limit patients’ herd behavior to seek tertiary hospital services), establish the roles of medical institutions, and help curb the rise in national medical expenditures and to secure financial sustainability.
2. 2.
   Health care benefits are delivered by 2 phases.
3. 3.
   1st phase of care benefit means the benefit from health care institutions(such as a clinic, a hospital, and a general hospital) except tertiary hospitals (specialized general hospitals).
   2nd phase of care benefit means the benefit from tertiary hospitals.

   1. ※

      Tertiary general hospital

   Tertiary general hospital table

   Area	Total	Upper-level general hospital
   Seoul	14	Kangbuk Samsung Hospital, Konkuk University Medical Center, Kyunghee University Hospital, Korea University Guro Hospital, Samsung Medical Center, Seoul National University Hospital, Gangnam Severance Hospital, Ewha Womans University Mokdong Hospital, Asan Medical Center, Chung-ang University Hospital, Korea University Anam Hospital, The Catholic University of Korea Seoul St.Mary’s Hospital, Yonsei University Severance Hospital, Hanyang University Seoul Hospital
   Gyeonggi North western area	4	The Catholic University of Korea Incheon St.Mary’s Hospital, Gachon University Gil Medical Center, Soonchunhyang University Hospital Bucheon, Inha University Hospital
   Gyeonggi southern area	5	St. Vincent Hospital of Catholic University of Korea, Korea University Ansan Hospital, Seoul National University Bundang Hospital, Ajou University Hospital, Hallym University Sacred Heart Hospital
   Gangwon	2	Gangneung Asan Hospital, Wonju Severance Christian Hospital
   Chungbuk	1	Chungbuk National University Hospital
   Chungnam	3	Dankook University Hospital, Chungnam National University Hospital, Soonchunhyang University Hospital Cheonan
   Cheonbuk	2	Wonkwang University Hospital, Jeonbuk National University Hospital
   Cheonnam	3	Chonnam National University Hospital, Chosun University Hospital, Chonnam National Uinversity Hwasun Hospital
   Gyeongbuk	5	Kyungpook University Hospital, Keimyung University Dongsan Medical Center, Daegu Catholic University Medical Center, Yeungnam University Hospital, Kyungpook National University Chilgok Hospital
   Gyeongnam eastern area	6	Kosin University Gospel Hospital, Dong-A University Hospital, Pusan National University Hospital, Pusan National University Yangsan Hospital, Inje University Busan Paik Hospital, Ulsan Universtiy Hospital
   Gyeongnam western area	2	Gyeongsang National University Hospital, Samsung Changwon Hospital

4. 4.
   The Exceptions of the Referral system (Care Delivery Process)

   1. 1)

      When patients with severe conditions under the ‘Emergency medical treatment Article 2-1’, can get the health care benefit in the tertiary hospital

   2. 2)

      When a patient gives birth to in the tertiary hospital

   3. 3)

      When a patient get a dental health care benefit

   4. 4)
      When the following persons receive health care benefit at the department of rehabilitation and medical treatment:

      1. Disabled persons under article 32 of ‘the disabled’s welfare law’ or
      2. Persons who acknowledged to need rehabilitation treatments such as, vocational treatment or kinesiatrics, etc (not simple physical therapy)
   5. 5)

      When receives health care benefit at the department of the family medicine.

   6. 6)

      When a patient is an employee of the tertiary hospital

   7. 7)

      When a hemophiliac patient receives health care benefits in the tertiary hospital.

5. 5.

   For the 2nd phase of care benefit, the patient must present a referral slip issued by the doctor who saw the patient first. The referral slip must include the fact that the benefit beneficiary needs the 2nd phase of care benefit from a tertiary general hospital. Issuing a doctor’s referral slip based on a health care delivery system enables appropriate treatment according to the doctor’s decision at the 1st primary care institution; thus aiding in the effective management of medical resources. Issuing a doctor’s referral slip at a patient’s request is never allowed because it is against the primary purpose of the health care delivery system.

6. 6.

   When receiving medical treatment against the care delivery process the health care delivery system, the patient must pay the entire care benefit expense (co-payment: 100% of total expenses) pursuant to Article 10 of the enforcement regulations of the National Health Insurance Act.