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| [20030925[건강보험심사평가원국정감사질의문 |
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질의문 2003. 9. 25(목)
김 홍 신
건강보험심사평가원 국정감사
＜질의1＞ 감기환자 주사제, 항생제 처방관련(※보도자료참조)
1. 올해 1분기 서울시내 15개 대형병원의 감기(급성상기도감염)환자에 대한 주사제 처방율을 동네의원과 비교했더니, 대형병원의 처방율은 9.08%인 반면에 동네의원은 40.21%였습니다. 동네의원 주사제 처방이 대형병원보다 4.4배인 31.13%나 더 높은 것입니다.
2. 동네의원은 주사제처방이 가장 적은 서울대병원1.88%보다 38.33%가 높아 21배였습니다. -하다못해 대형병원 중에 주사제 처방이 가장 높은 중대용산병원보다도 2배 이상이나 주사제를 처방했습니다.
-동네의원의 감기환자에 대한 주사제 처방의 심각성을 보여줍니다.
3. 항생제도 마찬가지입니다. 동네의원은 67.99%로 대형병원의 43.95%보다 24%가 더 높았습니다. 대형병원중 가장 낮은 서울대병원은 23.33%에 불과해 동네의원 처방율보다 44.66%나 낮았습니다.
4. 어떤 소아과 의원은 내원환자 4,375명중에 17명을 제외한 4358명에게 항생제를 투여했습니다. 거의 모든 감기환자에게 항생제를 투여 한 것입니다.
-이렇게 동네의원이 감기환자에게 주사제와 항생제를 많이 처방하는 이유가 뭡니까?
-주사제 항생제 처방을 감소시켜야 합니다.
5. 심평원이 만들었다가 의료계반대로 적용하지 못한 ‘감기 심사원칙’자료에 따르면, 우리와는 달리 외국의 경우 감기에 대한 항생제 사용을 제한하기 위해 상당한 노력을 기울이고 있습니다.
-미국의 경우 CDC(질병관리센터)나 FDA에서는 항생제 사용을 엄격하게 제안하는 가이드라인을 제안하고 있으며, FDA에서는 이미 감기와 독감에 대해서는 항생제 사용을 금하고 있습니다.
-영국, 호주, 뉴질랜드는 항생제 처방이 우리보다 심각하지 않은 상황인데도 감기항생제 처방을 줄이기 위해 노력하고 있습니다.
-그런데, 우리나라는 최근에 심사원칙을 만들었다가 무산된 것 외에는 감기항생제 처방을 줄이기 위한 노력이 전혀 없었습니다.
6. 서울대 병원은 우리나라 최고의 의료진과 의료기술을 갖추고 있는 병원입니다. 이런 서울대병원이 감기환자에게 주사제는 1.83%, 항생제는 23.33%만 처방하고 있습니다.
-항생제 남용이 심각한 우리나라로서는 시사하는 바가 크다고 할 수 있습니다. 감기환자 항생제 처방에 관한한 서울대 병원을 본보기로 삼아야 합니다.
7. 심평원이 만들었던 급성상기도감염에 대한 심사원칙은 권위있는 의학교과서, 선진국의 가이드라인, 공신력있는 지침 등을 참조하여 국내 의료인들이 참여한 가운데 만들어진 것입니다. 이러한 심사원칙은 항생제 오남용을 줄이고 적정진료를 유도하는 것입니다.
8. 의료계에서 스스로 감기 심사원칙을 개발하도록 하고, 의료계에서 개발된 것을 토대로 재논의 할 예정입니다. 물론 진료를 책임지고 있는 의료계 의견을 적극 수렴해야 하는 것은 사실이지만.... 심평원이 주도해서 감기환자 항생제, 주사제 과다처방에 대한 대책을 마련하고 노력해야 합니다.
＜질의2＞ 약물 오남용에 관련하여
1, 최근에 심평원은 부적절환 약물사용과 관련된 문제의 유형과 현황을 분석했습니다. 저는 이 연구 보고서에 나와 있는 약물오남용 실태를 보고난 후에 경악하지 않을 수 없었습니다.
2. 연구에 사용된 기준은 미국의 FDB기준에, 일부 식약청의 기준을 사용한 것으로 알고 있습니다.
3. 연구결과 약물상호작용시 심각한 부작용이 초래될 가능성이 있는 배합금지약제가 5,583건이 발견되었고, 최대/최소용량 등 부적절한 건이 4.78%나 되었습니다.
-연구자의 말에 의하면, 배합금기 약제 뿐만아니라 최대용량 초과사용도 환자건강에 심각한 악영향을 줄 수도 있다고 합니다.
-원장께서는 연구결과에 대해 어떻게 생각합니까?
4. 어떻게 이런 일이 일어날 수 있는지 이해하기 어렵습니다. 안전성에 심각한 문제를 일으킬 수 있는 약들을 의사와 약사가 처방, 조제하고 있고 환자들이 그대로 복용하고 있는 것입니다.
-고치려고 먹는 약이 되레 병을 키우고 다른 병까지 줄 수도 있을 것입니다.
5. 연구를 통해서 드러난 약의 오남용 상황을 보면, 우리나라에는 약의 최저/최대용량기준이나 배합금기기준이 명확히 없고, 또 이것이 제대로 의료인들에게 전달이 안 되기 때문이라고 봅니다.
-현재, 어느 정도의 용량을 사용하는 것이 최대/최소인지, 어떤 것을 배합하면 안 되는지 기준이 있습니까? 또 기준이 의료인들에게 확인할 수 있을 만큼 정확한 경로를 통해 전달이 됩니까?
-사후에라도 제대로 용법에 따라 처방, 조제되는지 모니터하고 있습니까? 그리고 안전성이 확보되지 않은 잘못된 처방과 배합에 대해 통보하고 있습니까?
6. 약의 안전성에 관련된 정보를 수시로 수집하고, 학계와 제약사, 실무의료진에서 실제로 사용된 임상결과들이 보고될 때마다 이를 의약계에 수시로 전달해서 안전하지 못한 약이 처방, 조제가 되지 않도록 해야 합니다.
-또, 상시 모니터를 통해서 적정치 약처방으로 환자건강에 위험이 발생할 수 있는 경우에는 해당 의료인에게 통보해서 환자의 건강을 보호해야 합니다.
7. 늦었지만 빨리 대책을 세우셔야 합니다. 무엇보다도 급한 것은 배합금기약물처럼 안전성 위험도가 높은 것부터 사용되지 않도록 병의원과 약국에 알려주기 바랍니다. 안이하게 대처해서는 안 됩니다.
8. 다른 나라들처럼 한국인에 맞는 성인/노인/소인의 최소용량과 최대용량 기준을 만들어야 합니다. 이를 토대로 약효가 전혀 없는데도 처방하는 최소용량 미달처방이나 안정성에 위협하는 용량 초과처방을 막아야 합니다.
9. 무엇보다도, 이런 기준과 금기사항들을 의료인이 수시로 확인할 수 있는 시스템이 마련되어야 합니다. 보고서에 따르면, 주요 선진국에서는 이미 약사용기준을 의약계와 보건당국이 머리를 맞대고 만들어서 의료인들이 처방과 조제시에 이를 확인할 수 있는 시스템을 보편적으로 운영하고 있다고 합니다.
-우리에 맞는 시스템 개발에 나서야 합니다.
＜질의3＞ 포괄수가제 관련
1. 포괄수가제 시행이 논란이 되고 있습니다. 현재 심평원에서 DRG를 관리하고 모니터링하고 있으니 몇 가지 묻겠습니다.
2. 포괄수가제 시행예정인 7개질병군에 대해서 같은 수가를 지불하기 때문에 의료의 질이 떨어질 것이라는 지적이 있습니다.
-현재, 심평원에서 포괄수가제를 모니터링을 하고 있는데, 그 과정에서 환자들로부터 의료의 질에 대한 문제제기나 그런 내용이 보고된 것이 있습니까?
-또 포괄수가제를 실시하는 기관과 실시하지 않는 기관간에 차이가 발생했습니까?
3. 진료최소화 규격화와 신기술개발이나 임상분야 발전에 장애가 예상되어 전체적으로 의료의 질적 수준이 하향평준화된다는 주장이 있습니다.
-그러나, 무조건 많은 서비스를 많이 준다고 해서 양질의 서비스라고 생각하지는 않고, 의료기관관의 경쟁이 생겨서 그런 문제는 없을 것으로 보는데... 이점에 대해 어떻게 생각합니까?
4. 만약, 환자가 포괄수가제 때문에 불편을 느끼고 양질의 서비스를 못 받았다고 주장한다면, 실제로 문제가 있는 것인데요... 그동안 환자들로부터 심평원이 그런 지적이나 민원을 받은 적이 있습니까?
5. 그동안 전액 환자가 부담하던 불필요한 급여 또는 비급여 부분이 상당부분 줄어들기 때문에 전체적인 국민의료비는 감소할 것으로 생각되는데요.... 포괄수가제를 시행하면 불필요한 급여 또는 비급여 진료가 줄어든다는 의견에 대해 어떻게 생각합니까?
6. 비급여 진료부분이 감소되어 환자 부담이 줄어들기 때문에, 간혹 환자분들이 포괄수가제를 시행하는 지역병원을 문의하는 것으로 알고 있습니다. 실제로 그런가요?
7. 포괄수가제를 시행하면 심평원입장에서는 심사업무 부담도 줄여서 다른 심사업무를 더욱 정밀하게 할 수 있을 것이고, 적용 7개질병군에 대해서는 의사의 진료자율권 시비가 없어질 것으로 보입니다.
-원장의 견해는 어떻습니까?
8. 포괄수가제를 시행에 대해서 원장의 견해는 어떻습니까?
＜질의4＞ 차등수가제 관련
1. 차등수가제는 진료시간을 적정수준으로 조정하여 의료서비스의 질을 높이기 위한 것입니다. 특정 의원에 대한 환자집중을 막아 진료 대기시간을 단축할 수도 있습니다.
-그런데, 의사1인당 평균환자수가 100명이 넘는 기관이 1,813개기관(9.6%)나 되구요, 150명이 넘는 기관도 215개입니다.
2. 차등수가제가 보험재정을 얼마나 절감시켰느냐?를 따지기 이전에, 먼저 생각해야할 것이 ‘의료의 질’입니다.
-어떤 소아과 의사는 하루에 278명의 환자를 보기도 했습니다. 이 의사는 1.7분당 한명의 환자를 진료하고 처방까지 마친 것인데요....이런 의료기관에서 환자들이 좋은 의료서비스를 받지 못하는 것은 분명한 것 아니겠습니까?
3. 진료환자가 지나치게 많은 기관에 대해서도 심평원이 모니터링을 해서 적정환자를 볼 수 있도록 해야 합니다. 그래야 환자가 질 높은 의료서비스를 받을 수 있습니다.
4. 한편, 의사 1인당 환자 75명인 차등수가제 기준도 재검토해야 합니다. 이 기준은 의사가 환자 1명을 진료하는 ‘적정 진료시간’을 고려하지 않은 것입니다. 환자가 의사로부터 충분한 진료를 받을 수 있는 시간을 고려하여 개선해야합니다.
-원장의 견해는 어떻습니까?
5. 약국의 경우도 마찬가지 입니다. 하루에 100명이상 보는 약국이 425개이고, 151명이상을 보는 약국도 15개입니다. 불과 2~3분 만에 조제와 복약지도를 한다는 것은 믿기 어려운 일입니다.
-조제와 복약지도가 제대로 안 될 가능성이 많습니다.
6. 환자들을 지나치게 많이 받아서 제대로 된 의료서비스를 제공하지 않는 병의원이나 약국은 서비스는 하지 않고 진찰료나 조제를 받고 있는 것이나 마찬가지 입니다.
-이런 병원들의 경우 적정진료를 할 수 있도록 권고조치하고, 정밀 심사기관 선정자료에 반영하는 등 양질의 서비스를 제공할 수 있도록 유도해야 합니다. 답변바랍니다.
<질의5＞ 저가약 대체조제 관련
1. 약가차이가 가장 큰 상위 20개를 분류하고 청구액을 비교해 봤더니, 최고가약 한 제품 청구액이 값싼 약 여러 개를 합친 것보다 훨씬 많은 것으로 나타났습니다.
2. 가장 비싼약 하나를 값싼약 여러 개가 이기지 못하는 것입니다.
-이런 고가약 처방은 건강보험 지출이 증가하는 큰 이유 중의 하나입니다. 고가약사용이 계속된다면 차츰 안정화되고 있는 건보재정에 심각한 장애가 될 수 있습니다.
3. 또한 오리지널 고가약을 무기로 국내시장을 잠식해하고 있는 다국적제약사에게 국내 제약시장은 완전히 잠식당하게 될 것입니다. 곧 국내시장 점유율이 70%에 이른다는 주장도 있습니다.
-국내제약산업이 붕괴직전에 있는 것입니다. 국내제약산업이 붕괴되어 저가의 국내 대체약이 없어지면, 약값의 통제권한은 다국적제약사로 넘어갑니다.
-최근에 겪었던 글리백문제는 국내제약산업 붕괴이후의 모습을 잘 보여주는 것입니다.
4. 현재로써 할 수 있는 가장 최선의 방법은 생동성실험을 계속 확대하면서 저가약 대체조제를 활성화시키는 것입니다.
-그런데 저가약 대체조제 결과는 미미하기 짝이 없습니다. 올해 상반기에 저가약 대체조제액은 약4천만원에 불과하고 재정절감액은 550만원에 불과합니다.
5. 가뜩이나 저가약대체조제가 잘 안되고 있는데, 환자와 의사에게 사후에 통보해야 하고, 그렇지 않으면 행정처분을 받게 되기 때문에, 약국에서 저가약 대체조제를 꺼리게 됩니다.
-보험재정 절감하고 국내제약산업도 보호하기 위해서는 저가약 사용을 활성화 할 수 있는 방법이 마련되어야 합니다. 저가약 대체조제 활성화 방안에 대해 답변바랍니다.
6. 한편, ‘원가분석제도’를 도입해 고가 약값을 내려야 합니다. 혁신적 신약은 G7국가의 약값을 참조하고 있고, 카피약은 오리지널약 값의 80%선에서 결정하고 있습니다.
-즉, 다른 약값을 참조하는 방식이이고, 약을 만드는데 얼마가 드는지는 전혀 반영하지 않고 있습니다. 이런 약값결정방식은 약값을 부풀 릴 수밖에 없습니다.
-약값을 제대로 책정하기 위해서는 원가를 분석해 약가를 결정할 수 있어야 합니다. 이에 대한 견해를 밝혀 주십시오
＜질의6＞ 병원마다 진료비 천차만별과 관련
*CI(고가도)에 대해
1. 심평원이 진료비CI(고가도) 분석결과, 정신요법료CI가 병원별로 최고 4.6배, 이학요법료CI 3.9배, 검사료CI 2.1배, 주사료CI 1.9배로 나타났습니다.
-즉, 병원별로 같은 치료를 받는 환자들에 대한 고가도가 다르게 나타난 것입니다.
-보험혜택이 되는 치료인데도 진료비가 제각각인 것입니다.
2. 환자의 상태에 따라 진료가 다를 수는 있지만, 4.6배까지 차이가 나는 것은 문제가 있습니다. 과잉진료를 했을 가능성도 있는 것입니다. 고가도 자료를 같은 요양기관종별로 비교분석해서 정밀심사기관을 선정하는 자료로 사용하는 방안을 마련해야 한다고 봅니다.
-답변바랍니다.
* 비급여진료에 대하여
3. 비급여 진료비 차이도 큽니다. 이번에 23개종합병원급 이상 의료기관에 대해 고가 의료장비 진료비를 조사해보니, MRI는 1.7배, 초음파2.8배, 심파음파1.8배 차이였습니다.
4. 이렇게 가격차이가 많이 나는 것은 구체적인 원가분석 없이 인근 경쟁병원 혹은 유사 규모병원의 진료비를 단순비교하여 결정했기 때문입니다. 일부 의료의 질과 장비성능면에서의 차이를 인정한다고 하다라도 이렇게 차이가 많이 나는 것은 문제가 많습니다.
5. 우리나라의 급여수준이 50%정도 밖에 안 된다는 점을 감안하면, 국민부담이 크기 때문에 비급여에 대한 진료비관리는 시급하고 중요한 문제입니다.
6. 환자가 어디가 싸고 좋은 진료를 받을 수 있는지, 비싸더라도 어디에 가면 양질의 진료를 받을 수 있는지 환자들이 알 수 있다면 문제가 안 될 것입니다. 환자 스스로 선택해서 적정한 비용에 장비를 이용할 수 있기 때문입니다.
-환자 알권리 차원에서라도 비급여 진료의 질과 비용을 환자들에게 공개할 수 있어야 합니다. 답변바랍니다.
＜질의7＞ 소화기관용약제 사용 권장지침 관련
1. 소화기관용약제 사용기준은 작년 7월에 시행했다가 환자들의 민원이 제기되어 문제가 되었습니다.
-복지부는 의료계와 소화기관용약 급여기준을 폐지하는 대신에 의협이 자율적인 표준처방지침을 제정하고 약제사용을 적절히 하는 것을 합의하였습니다.
-당시 김성호장관은 의료계와 정부가 의견을 모은 보기드믄 사례라고 강조했습니다.
2. 그런데 실제로 의료계가 만들어온 지침은 실망스럽습니다.
-의료계가 만들어서 제시하고 의협회원들에게 배포한 소화기관용약 권장지침 중 5가지가 식약청 허가사항을 벗어난 것 이었습니다.
-그렇죠?
3. 한편, 의협이 회원들에게 권장지침을 배포한 것은 4월23일인데, 심평원이 검토의견을 복지부에 보낸 것은 5월말입니다.
-결국. 의협은 허가에도 없는 것을 처방하도록 지침으로 내린 것이나 마찬가지입니다.
-물론 이부분이 심평원에 청구된다 하더라도 삭감되겠지만, 삭감되기 이전에 약은 이미 처방되어 환자가 복용한 후이기 때문에 환자건강에 악영향을 줄 수밖에 없습니다.
4. 심평원에서 소화기관용약 사용을 6개월간 모니터링을 실시한 후에, 처방행태에 변동이 없을 경우 복지부와 함께 나름의 권장지침을 만들어 적용할 것으로 알고 있습니다.
-의료계 의견을 수렴하고 적용하는 것은 바람직합니다. 그러나, 원칙이 흔들려서는 안 됩니다. 모니터링을 철저히하고 잘못이 드러나면 잘못된 처방관행이 바뀌도록 분명한 지침을 제시해야 할 것입니다.
＜질의8＞ 질병코드 불일치에 대해
1. 제가 지난번 국정감사에서 질병코드 불일치 문제를 지적한 바 있습니다.
-질병코드가 불일치하면, 심평원 심사업무에 많은 혼란이 발생시키고, 허위, 착오청구의 위험이 있으며, 환자와 의료기관사이에 의료사고로 분쟁이 생겼을 때 분쟁을 조정하기 어려워집니다. 그렇죠?
2. 앞으로도 문제입니다. 심평원이 추진하고 있는 지표심사나 심사기준의 개발이 질병코드 불일치 때문에 제대로 수행되지 않을 수도 있습니다. 따라서 빠른시일내에 이 문제를 해결해야 합니다.
3. 우선, 요양기관들의 코드작성 기준이 제각각인 것 같습니다. 기관별로 코드작성 방식이 다르니깐 불일치 할 수밖에 없습니다. 심평원에서 코드 작성지침을 의료기관에 제시한다면 코드일치에 효과가 있을 것으로 생각합니다.
-원장의 견해는 어떻습니까?
4. 또, 주기적으로 기관별로 코드 불일치여부를 모니터해야 합니다. 그래서 문제가 있는 기관에 대해 지도하고, 실제로 어떤 이유로 그런 문제가 생겼는지 확인해서 적정한 조치를 해야 합니다.
＜질의9＞ 녹색인증기관에 대해
1. 녹색인증기관제도는 자율적으로 부당, 과잉청구를 줄이도록 하고자 한 것입니다. 시행취지에 대해서는 동감합니다.
-그런데 녹색인증기관과 아닌 기관과 어떤 차이가 있는지, 구분이 잘 안됩니다.
-수적으로 녹색인증기관은 전체 의료기관의 18%수준입니다. 너무 많이 인정해 주어서 제도의 의미를 격감시킬 수 있습니다.
2. 현재 녹색인증기간은 전산심사만 하고 있습니다. 그런데, 전산심사만 적용하는 것은 녹색인증기관이 아닌 지표심사기관도 마찬가지 입니다. 인센티브도 거의 없는 것입니다.
3. 얻은 성과도 별로 없는 듯 합니다.
-녹색인증기관 심사삭감율, 비인증기관보다 훨씬 낮습니다. 그러나 녹색인증기관에 대한 사후심사결과 심사삭감율이 훨씬 높아지는 것으로 나타났습니다.
-또, 2003년 6월 심평원 녹색인증제도 분석자료에 따르면, 사후심사로 320개기관, 행정처분으로 283개기관, 현지조사로 20개기관이 해지되었습니다.
-제도의 취지는 좋지만 의료기관에 심사만 면해주는 꼴이 되어 버린 것은 아닌가하는 생각이 듭니다.
4. 공단의 입장에서 볼 때는 심사를 제대로 안 해 보험재정의 누수가 있다고 판단할 수 있습니다.
5. 이런 점들을 고려해서 제도를 전반적으로 재검토 해주기 바랍니다.
①녹색인증기관제도가 재정안정대책으로 시행되었는데, 그 성과가 있었는지를 검토해 주시고, 이를 근거로 사업의 지속여부를 원점에서 핀딘해야 합니다.
②또, 제도를 계속 시행하게 된다면 인증절차를 까다롭게 해 소수기관을 엄선해 지정하고, 비인증기관과 차이를 분명히 할 만큼의 인센티브를 주어야 합니다.
-답변바랍니다.
＜질의10＞ 지표/정밀심사기관 관리에 대해
1. 청구명세서에 대해 일정기간 청구내역 심사를 하지 않고 지표관리만 하는 지표심사기관도 심사방식도 문제가 있습니다.
-인력과 장비등 행정능력 부족 때문에 ‘심사봐주기’를 하고 있는 것이 아닌가 싶습니다.
2. 지표심사기관이 되기 위해서는 진료비 상대지표, 고가도지표(CI)가 일정수준미만이어야 하고, 또 삭감율도 평균이하여야 합니다.
-진료비지표나 삭감율이 다른 기관에 비해 월등이 좋은 기관을 지표심사기관으로 분류하는 것도 아니고 평균이하면 됩니다. 즉, 평균보다 약간 낮기만 해도 청구명세서에 대한 심사를 면제받을 수 있는 것입니다.
3. 정밀과 지표심사기관사이의 삭감율 차이는 큽니다. 조정액 대비로 볼때(2003.1분기), 지표심사기관 조정율은 0.67인데, 정밀심사시관은 2.17로 조정율이 3배이상 차이가 납니다.
-제가 보기엔 이 차이가 지표심사기관이 청구를 잘해서 라기보다는(물론 그런 측면도 있겠지만), 청구명세서를 심사하지 않고 단순히 전산심사만 했기 때문이라고 봅니다.
4. 결국, 지표심사기관을 분류하지 않고 정밀심사시관처럼 심사한다면 지금보다 더 많은 심사조정액이 나올 가능성이 큰 것입니다.
-지표심사기관에 대해서 청구내역까지 심사해 볼 필요가 있다고 봅니다. 그래서 지표/정밀기관 분류가 정당한지 확인해 봐야 합니다. 이점에 대해서 원장께서는 어떻게 봅니까?
＜질의11＞ 심사기간이 길어지는 것에 대하여
1. 법정 심사기간은 서면 40일, EDI 15일입니다. 그런데, 전혀 심사기간이 지켜지지 않고 있습니다.
-서면의 경우 의원과 치과의원만 간신히 기준을 지켰고, 나머지는 모두 40일을 초과했습니다. 치과의원의 경우 일주일이나 초과해서 심사가 끝났습니다.
-EDI도 약국만 기준을 지켰고 나머지는 기준을 훨씬 초과했습니다. 종합전문병원의 경우 36.40으로 법정심사기간 15일보다 21일을 더 초과했습니다.
-이유가 뭡니까?
2. 해결방법은 없습니까?
＜질의12＞ 영상검사 증가와 미판독에 관해
1. 의약분업 실시이후에 병의원들이 매출이 감소하면서 엑스레이, 컴퓨터 단층촬영등 영상검사 건수가 증가하고 있지만, 전문적으로 판독할 전문인력이 부족해 판독이 제대로 이루어지지 않고 있고, 필수 의무기록인 판독지 부착이 제대로 이루어지지 않고 있습니다.
2. 이 때문에 심평원에서 최근에 ‘현지확인심사’를 하고 있는 것으로 알고 있습니다.
-그런데, 병원들입장에서는 환수금액이 영상검사로 인한 청구액에 비해 매우 작기 때문에 판독지를 의무적으로 첨부하는 것보다는 벌금을 내는 것이 유리하다고 판단해 개선의 여지가 없다고 합니다.
-이런 지적에 대해 어떻게 생각합니까?
3. 영상검사에 대한 ‘현지확인심사’를 내실 있게 해주기 바랍니다. 또 병원들이 영상검사를 하고 전문적으로 판독하고, 판독지를 부착해 기록할 수 있도록 대책을 만들어야 합니다.
-그래야 과잉검사와 의무기록 미작성등에 의한 의료질의 저하를 막을 수 있습니다.
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