건강보험 기초이론

제1부 건강보험 이론 ······························································· 1
Ⅰ. 건강보험제도 ··························································· 3
제1장 사회보장과 의료보장 ···················································· 3
제2장 건강보험 개념과 유형 ··················································· 8
제3장 국민건강보험법 개요 ··················································· 13
제4장 건강보험의 적용대상 ··················································· 16
제5장 건강보험증 ··························································· 23
Ⅱ. 국민건강보험공단 ····················································· 25
제1장 국민건강보험공단 ····················································· 25
Ⅲ. 건강보험심사평가원 ··················································· 40
제1장 건강보험심사평가원 ··················································· 40
Ⅳ. 건강보험 개요 ························································· 56
제1장 건강보험 제도 ························································ 56
제2장 건강보험 진료수가 ···················································· 60
제3장 건강보험 진료비 청구 및 지급관리 ······································ 68
제4장 건강보험 운영형태와 보수지불방식 ······································ 70
제5장 질병군별(DRG) 포괄수가제도 ··········································· 76
제6장 의료수가 비교검토 ····················································· 79
Ⅴ. 요양급여 규칙 ························································· 80
제1장 요양급여 규칙 및 비급여 대상 ·········································· 80
Ⅵ. 진료수가 산정 방법 ·················································· 159
제1장 일반원칙 ··························································· 159
제2장 수가, 약가 및 재료대 산정 ············································ 166
Ⅶ. 행위급여목록 ․ 상대가치점수표 및 산정지침 ························ 170
제1장 기본진료료 ························································· 170
제2장 검사료 ······························································ 185
제3장 영상진단 및 방사선 치료료 ············································ 188
제4장 투약 및 조제료 ······················································ 194
제5장 주사료 ······························································ 209
제6장 마취료 ······························································ 211
제7장 이학요법료 ·························································· 215
제8장 정신요법료 ·························································· 224
제9장 처치 및 수술료 등 ··················································· 226
제10장 치과처치⋅수술료 ··················································· 237
제11장 조산료 ····························································· 238
제12장 보건기관의 진료수가 ················································ 239
제13장 한방 검사료 ························································ 240
제14장 한방 시술 및 처치료 ················································· 241
제15장 약국 약제비 ························································ 242
제16장 전혈 및 혈액성분 제제료 ············································· 243
제17장 입원환자 식대 ······················································ 244
제18장 치과의 보철료 ······················································ 247
제19장 진료과목별 코드 ···················································· 248
Ⅷ. 질병군 급여·비급여 목록 및 급여 상대가치점수 ················· 264
제1장 일반원칙 ···························································· 264
제2장 질병군 급여 목록 ․ 상대가치점수표 및 적용지침 ························· 268
Ⅸ. 요양병원 급여 목록 및 상대가치점수 ······························ 288
제1장 요양병원 급여 일반원칙 ··············································· 288
제2장 요양병원 환자군 급여목록 ․ 상대가치점수 및 산정지침 ···················· 289
제3장 요양병원 행위 급여목록 ․ 상대가치점수 및 산정지침 ······················ 291
Ⅹ. 건강보험 요양급여비용 청구방법 ··································· 296
제1장 건강보험 요양급여비용 청구방법, 심사청구서 명세서 서식 및 작성 요령 ···· 296
제2장 요양급여비용 심사청구서 ·············································· 322
제3장 요양급여비용 심사조정 ················································ 331
XI. 건강보험 요약정리 ·················································· 340
제1장 요양기관 ···························································· 340
제2장 요양급여기준 ························································ 341
제3장 일반원칙 ···························································· 342
제4장 기본 진료료 ························································· 346
제5장 검사료 ······························································ 353
제6장 영상진단 및 방사선 치료료 ············································ 354
제7장 투약 및 조제료 ······················································ 355
제8장 주사료 ······························································ 357
제9장 마취료 ······························································ 358
제10장 이학요법료 ························································· 360
제11장 정신요법료 ·························································· 361
제12장 처치 및 수술료 등 ··················································· 361
제13장 치과처치·수술료 ····················································· 364
제14장 조산료 ····························································· 365
제15장 보건기관의 진료수가 ················································ 365
제16장 한방 검사료 ························································ 366
제17장 한방 시술 및 처치료 ················································· 367
제18장 약국 약제비 ························································ 368
제19장 전혈 및 혈액성분 제제료 ············································· 369
제20장 입원환자 식대 ······················································ 369
제21장 건강보험 요양급여비용 청구방법 및 처방전 요약정리 ···················· 374
제22장 심사평가원 요약정리 및 기타 ········································· 375
제23장 건강보험요양급여비용 및 요양급여 명세서 청구 요약정리 ················ 379
제24장 건강보험요양급여비용 핵심 요약정리 ·································· 381
제25장 건강보험 관련 전체 핵심 요약정리 ···································· 406

제2부 국민건강보험법 관련문제 ················································ 423
Ⅰ. 국민건강보험법 관련문제 ············································ 424
Ⅱ. 건강보험 요양급여비용 관련문제 ····································· 449
Ⅲ. 기타 건강보험 관련문제 (1) ··········································································· 476
Ⅳ. 기타 건강보험 관련문제 (2) ·········································································· 502
Ⅴ. 기타 건강보험 관련문제 (3) ··········································································· 517

정 답 ···································································· 532
참 고 문 헌 ······························································· 534