최근 대법원은 의료기관에서의 요양급여기준 외 치료행위, 소위 ‘임의비급여(arbitrary uninsured benefits)’ 사건에 대해 최종 판단을 내렸고, 판결의 의미와 관련하여 의료계, 정부, 환자 측의 다양한 해석이 이루어지고 있는 상황이다. 임의비급여란 국민건강보험법령에서 법정 본인부담 또는 비급여로 인정한 경우 이외에 환자로부터 비용을 받는 것을 통칭한다. 주로 요양급여기준에서 인정하지 않는 새로운 의료기술이나 재료를 사용하여 환자를 진료하고 환자에게 직접 비용을 청구한 사안이 문제되고 있다. 최근 대법원에서는 의학적 판단에 의해 꼭 필요한 시술 및 치료재료, 주사제, 약제 등의 사용이 요양급여기준에 따라 급여기준에 해당되지 않고, 환자의 동의 하에 ‘임의비급여’를 처리하는 경우 제한적으로 임의비급여 진료행위를 인정하고자 하는 취지의 판결을 내린 바 있다. 즉, 대법원도 현행 건강보험제도 구조상 필연적으로 발생할 수 밖에 없는 임의비급여를 단순히 불법으로 단정 짓던 기존의 태도에서 변화하고 있는 것으로 판단된다. 다만, 대법원이 제한적으로 임의비급여 진료행위를 인정하고자 하는 취지의 판결을 내렸으나 그 입증 및 세부 요건에 관한 문제에 있어 여전히 분쟁의 소지를 안고 있다고 본다. 국민의 건강증진을 그 취지로 하는 국민건강보험법은 국민 개개인의 건강권과 이를 유지하기 위한 국민의 적절한 치료를 받을 권리를 제약해서는 안 된다. 국민건강보험법의 경우 요양급여에 관한 사항에 한하여 규율해야 할 것이며, 국민건강보험과 무관한 의료인과 환자간 계약에 의한 의료서비스 이용까지 규율하는 것은 국민의 수진권을 침해할 우려가 있다. 이에 해당 판결의 내용을 고려하여 국민건강보험 체계상의 문제점을 해소하기 위해 관련 규정을 개선해야 한다고 본다.

Recently, the Supreme court has made a final decision about the so-called 'arbitrary uninsured benefits' case, and various interpretations from sides of medical profession, government, and patient are being made regarding the meaning of the ruling. Arbitrary uninsured benefits means collecting the cost from the patient other than statutory personal expense or uninsured benefits acknowledged by the National health insurance act, and problems were mainly raised on the issues when new medical technology or materials that are not recognized by the treatment benefits standard were used to treat patients and costs were directly charged to the patients. The national health insurance act determining the standard, insured benefits targets, and uninsured benefits targets of medical care benefits is merely setting the frames of the health insurance system to make insurance coverage happen in the scope of the insurance by executing the treatment benefits within the reasonable range, and it is hard to view it as regulations to the medical connections occurring outside the framework of the national insurance system. Recently, the Supreme court has made a ruling that partially acknowledges the act of arbitrary uninsured benefits treatment act when the use of procedure, treatment materials, injectables, and medications are judged to be medically necessary but not meeting the treatment benefits standard and the 'Arbitrary uninsured benefits' is processed under the consent of the patient. In other words, it seems that the Supreme court also is changing the attitudes that simply concluded the arbitrary uninsured benefits as illegal, acknowledging the arbitrary uninsured benefits is inevitable to occur within the structure of the current national insurance system. The ruling of the Supreme court that wishes to partially acknowledge the arbitrary uninsured benefits was made, however, it seems that there ar still some controversial issues regarding the proof and detailed requirements. Therefore, the relevant provisions are to be improved and amended to solve the problems that resides in the system of the national health insurance by taking into account the contents of ruling of the supreme court.

Recently, the Supreme court has made a final decision about the so-called 'arbitrary uninsured benefits' case, and various interpretations from sides of medical profession, government, and patient are being made regarding the meaning of the ruling. Arbitrary uninsured benefits means collecting the cost from the patient other than statutory personal expense or uninsured benefits acknowledged by the National health insurance act, and problems were mainly raised on the issues when new medical technology or materials that are not recognized by the treatment benefits standard were used to treat patients and costs were directly charged to the patients. The national health insurance act determining the standard, insured benefits targets, and uninsured benefits targets of medical care benefits is merely setting the frames of the health insurance system to make insurance coverage happen in the scope of the insurance by executing the treatment benefits within the reasonable range, and it is hard to view it as regulations to the medical connections occurring outside the framework of the national insurance system. Recently, the Supreme court has made a ruling that partially acknowledges the act of arbitrary uninsured benefits treatment act when the use of procedure, treatment materials, injectables, and medications are judged to be medically necessary but not meeting the treatment benefits standard and the 'Arbitrary uninsured benefits' is processed under the consent of the patient. In other words, it seems that the Supreme court also is changing the attitudes that simply concluded the arbitrary uninsured benefits as illegal, acknowledging the arbitrary uninsured benefits is inevitable to occur within the structure of the current national insurance system. The ruling of the Supreme court that wishes to partially acknowledge the arbitrary uninsured benefits was made, however, it seems that there ar still some controversial issues regarding the proof and detailed requirements. Therefore, the relevant provisions are to be improved and amended to solve the problems that resides in the system of the national health insurance by taking into account the contents of ruling of the supreme court.

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