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J Korean Med Rehabi 2018 Jan; 28(1): 133-144  
Analysis of the Medical Market Share of Traditional East Asian Medicine (TEAM) in Taiwan Using National Health Insurance Research Database (NHIRD)
Published online January 31, 2018
Copyright © 2018 The Society of Korean Medicine Rehabilitation.

Chang-Woon Jeung, Chang-Hyuk Choi, Hee-Geun Jo*, and Min-Yeong Song

Research Institute of Korean Medicine Policy,
* The Association of Korean Medicine Chung-Yeon Medical Institute,
Jangsu-gun Health Center and County Hospital
Correspondence to: Hee-Geun Jo, Chung-Yeon Medical Institute, 64 Sangmujungang-ro, Seo-gu, Gwangju 61949, Korea TEL (062) 371-1075 FAX (062) 371-1074 E-mailjho3366@hanmail.net
Received: November 7, 2017; Revised: December 13, 2017; Accepted: December 21, 2017
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract

Objectives

Since the health insurance coverage for traditional Korean medicine is very low, some physicians and researcher have suggested that government’s institutional support is needed for korean medicine field. Therefore We examine the use of traditional medicine and western medicine in Taiwan, which operates a similar health insurance system to Korea.

Methods

We selected several studies from Pubmed and NHIRD, that could be used to numerically evaluate the use of traditional medicine. We reviewed the current status of medical use in Taiwan and compare it with that of Korea.

Results

Through a total of 87 studies, We found that 26.59%∼31% of Taiwanese use Traditional medical institutions more than once a year, and the use of traditional medicine has been increasing since 2000. In adults than children, in women than men, the use rate of traditional medicine was high. Especially, herbal medicine was the most common intervention, accounting for 70% of traditional medical care.

Conclusions

The core of low insurance coverage for traditional Korean medicine is in lack of coverage for herbal medicine. Taiwan’s case shows that the unmet demand for traditional Korean medicine of the Korean population can exist widely.

Keywords : Traditional East Asia Medicine, Herbal Medicine, Acupuncture, Medical Market, Health Insurance Coverage
서론

2003년 한의약육성법 제정 이래, 2005년부터 한의약육성발전종합계획 등 한의약의 발전을 위한 여러 정책들이 추진되었다. 그러나 한의 진료에 대한 수요가 지속적으로 증가하였음에도 불구하고, 전체 요양기관 진료비를 기준으로 보았을 때 그 비중이 3.9∼4.2%에 정체되어 있다는 지적이 있다1). 특히 진료 대상이 근골격계 질환에 편중되어 있다는 문제점과 함께, 연간 300억 원 미만의 한약제제생산 및 처방의 정체 상황 역시 개선되지 않고 있다는 것 또한 한의약 분야의 건강보험에서 고질적인 문제로 지적되고 있는 상황이다1-3).

한의약이 지속적으로 겪고 있는 제도적 불균등 상황4)에도 불구하고 우리나라 국민들은 여전히 한의학에 대한 깊은 선호를 보이고 있다. 그러나 식민 통치를 경험한 국내의료제도 및 행정은 일본 메이지유신 기조를 따른 조선총독부의 서양의학 우대정책에 영향을 받아 서양의학이 주도하고 있다5). 이런 악조건에도 불구하고 근래에 들어 국민들의 한의학 이용이 지속적으로 증가하고 있다는 것은 대단히 주목할만한 점이라고 볼 수 있다6).

이와 관련하여 실제 의료현장에서 한의학과 경쟁관계7)에 있는 서양의학과의 비교에서 두 의료에 대한 건강보험 보장성이 동일하다면 서양의학보다 한의진료를 선호할 수 있다는 점, 특히 한약 치료를 선호할 것이라는 것이 교통사고 상해의 사례를 통해 일부 확인되었다8,9). 이러한 국민들의 한의학 선호는 한의학에 대한 공식적인 차별이 시작되던 일제시기부터 지속되어 왔다10). 따라서 현재 한의약의 저활용 실태는 국가의 건강보험보장체계가 환자들에게 서양의약에 대한 높은 보장성과, 한의약에 대한 낮은 보장성을 통해 의도적으로 서양의약을 이용하도록 왜곡한 결과물로 해석할 수 있는 한편, 이러한 정책의 근저에 뿌리 깊은 식민지적 시각이 현재까지도 우리 보건의료행정 안에 자리 잡고 있다는 것을 시사하고 있다11-13).

이같은 문제점에 대한 해결책을 찾기 위하여 유사한 식민지 경험을 갖춘 국가의 전통의학 의료현황과 그 특징을 검토하는 것은 한국 한의약의 보장성 강화를 위한 중요한 기초조사로써의 역할로 볼 수 있을 것이다. 동아시아에서는 대만이 이 조건에 가장 부합하는 국가이다. 그러나 현재까지 대만의 전통동아시아의학(traditional east asian medicine, 이하 TEAM) 의료이용에 대한 체계적인 조사연구는 부족한 실정이다. 이에 저자들은 대만의 전민건강보험연구자료고(全民健康保險硏究資料庫, National Health Insurance Research Database, NHIRD)의 자료 및 저자들이 발표한 대만의 TEAM 현황 관련 선행연구의 지견에 기반하여 대만에서의 TEAM 이용 현황을 분석하였다.

대상 및 방법

대만 전민건강보험연구자료고의 자료를 이용해 발표된 대만에서의 연구를 분석한 기존 연구15)에서 얻어진 일차자료를 바탕으로, 본 연구의 목적에 맞게 명시적으로 확인 가능한 한의약 의료이용현황의 자료를 담고 있는 연구를 선정하였다.

연구의 분류는 일차적으로 대만내 TEAM 이용 관련연구로 한정하고, 일차적으로 TEAM 이용 인구의 전체적 특성을 분석한 연구와 특정 질환군에서의 특성을 분석한 연구로 분류하였다. 다음으로, TEAM의 이용/비이용을 검토한 연구 및 TEAM과 서양의약의 이용을 검토한 연구로 분류하고, 보고된 연구들의 대상 질환, 이용률, 기타 특성 등을 분석하였다. 그리고 이를 현재 국내의 건강보험 이용현황과 비교 분석하여, 국내의 한의약분야의 보장현황의 실태를 평가하였다.

결과

2017년 1월 17일까지 발표된 관련문헌 143건 중 직접 평가가 가능한 대만내 TEAM 이용과 비이용의 현황을 제시한 연구 87건이 선정되었다. 이들 연구는 대만에서의 한-양방 의료이용에 대한 포괄적인 검토 10건과 특정 질환군별로 검토한 77건으로 나누어 볼 수 있었다.

1. 대만의 보편적 TEAM 이용 관련 연구

포괄적인 연구 10건에 대한 연구의 내용은 다음과 같다(Table I).

Table I. Studies on General Use of Traditional Medicine in Taiwan.

  AuthorYearTarget populationIntervention  Key findings
Fang-Pey Chen et al18)2006AllAcupunctureIn 2002, 6.2% of health insurance contractors used acupuncture treatment
In 1996∼2002, the population using acupuncture for 7 years accounted for 23%
Musculoskeletal diseases (ICD9-CM 710∼739), injury and poisoning (ICD9-CM 800∼999) accounted for 88% of the target diseases
Fang-Pey Chen et al19)2007All-In 2001, 28.4% of health insurance contractors used TEAM clinic
By 1996∼2001, 62.5% of health insurance contractors visited TEAM clinic at least once
The frequency of use was 12.3% under 10 years of age, but 52.3∼66.0% by age group in the age of 11 years or older
The major treatment contents were herbal medicine 82.5%, acupuncture 11.0% and manual therapy 3.1%
The major diseases were respiratory 27%, musculoskeletal 16.6%, other symptoms and signs 14.3%, injury and poisoning 13.1%, digestive system 12.7%, etc.
Shu-Ching Hsieh et al20)2008AllHerbal medicineIn 2004, 28.1% of the population who visited a medical institution at least once used herbal medicine
The main prescription target disease for herbal medicine are respiratory diseases such as cold, sleep disorders, allergic rhinitis, menstrual-related disorders, etc.
Lee-Chin Chang et al21)2008All-From 1997 to 2003, the use of medical clinic through health insurance has increased.
The use rate of TEAM was lower than that of western medicine
The use of herbal medicine was 68.4∼70.8%, the use of manual therapy was 15.6∼17.2% and the use of acupuncture was 9.2∼13.0%
Tu C-C et al22)2011All-In 1999, in a sample of 200,000 health insurance data, The population using Western medicine alone was 60%, the population using TEAM and Western medicine together was 29%, and the population using TEAM alone was 2%.
Shih C-C et al23)2012All-In 2001, among the aged 20∼69 (Taiwan National Health Interview Survey subject), the use rate of TEAM by gender was 31.8% for women and 22.4% for men
Hsing-Yu Chen et al24)2012Child-In 2006, TEAM use rate was 18.32% and non-use rate was 81.68% among 107377 children aged 0∼12 years old
Factors that have a positive effect on the use of TEAM in children include age and the presence of allergic diseases such as atopic dermatitis, eczema and allergic rhinitis, respiratory diseases such as asthma, digestive diseases such as diarrhea, digestive disorders, constipation and musculoskeletal diseases
Tzu-Ping Huang et al25)2014Child-In 2005 and 2010, the use of TEAM by children was 22% in 2005 and 22.5% in 2010
Diseases that increase the use of TEAM include menstrual disorders, musculoskeletal disorders, dyspepsia, and allergic rhinitis
Herbal medicine was prescribed from 98.7%∼99.7% of allergic rhinitis, dyspepsia, and menstrual disorders patients
Pei-Rung Yang et al26)2015Elderly-From 2005 to 2009, 48.23% of the 97210 sample population over 65 years of age using medical institutions used TEAM
The major prescriptions were as follows: Shujinghuoxuetang, Duhuojishengtang, Pingweisan, Mazirenwan, Zhigancaotang, liuweidihuangwan, Zishengshenqiwan, Banxiaxiexintang, Chuanxiongchadiaosan, etc.
The major single herb prescriptions were as follows: Salviae Radix, Rhizoma Corydalis, Fritillariae Rhizoma, Eucommiae Cortex, Rhei Rhizoma, Platycadi Radix, Achyranthis Radix, Puerariae Radix, Panax Notoginseng, Scutellariae Radix, etc.
Yuh-Hsiang Yeh et al27)2016All-In 2000, 2005 and 2010, TEAM usage increased slightly from 26.59% in 2000 to 28.29% in 2005 and to 28.66% in 2010.
In 2010, compared to 2000, use of TEAM was increased in all fields except infectious and parasitic diseases and respiratory diseases
The use of TEAM in neoplasms, congenital anomalies, pregnancy, labor and postpartum diseases was significantly increased to 41.9%∼343.7%

이들 연구에서는 명확히 대만에서의 한약처방에 대한 포괄적인 보장28)을 통해 한약투약이 한의약분야의 주요 항목임이 드러났다. 이는 한국에서 56종 단미엑스산제라는 제한적 품목에 비해 300여종 이상의 한약제제 품목이 건강보험적용이 되는 대만과의 차이를 보여준다.

2. 대만의 질환군별 TEAM 이용 현황

다음으로, 질환군별로 나누어 77건을 검토하였다. 이들 연구들은 TEAM의 임상적 활용현황과 한약에 따른 임상적 이점을 평가15)하기 위한 연구들이다(Table II).

Table II. Current Status of Traditional Medicine Use by Disease Group in Taiwan.

  Disease group*  Disease  Key findings
Infectious and parasitic diseases (1.36%)HepatitisIn 2002, 1.9% of chronic hepatitis patients used TEAM29)
In 2000∼2010, 66.43% of newly diagnosed hepatitis C patients used TEAM30)
Neoplasms (3.82%)Liver cancerIn 1996∼2010, 16.65%∼25.11% of liver cancer patients used TEAM31,32)
LeukemiaIn 2001∼2010, 12.4% of child and 9.17% of adult leukemia patients used TEAM33)
In 1997∼2010, 9.25% patients with newly diagnosed acute myeloid leukemia and received radiotherapy and chemotherapy used TEAM34)
Colon cancerIn 2004∼2008, 19.81% of newly diagnosed colon cancer patients used TEAM35)
In 2007, 26.9% of newly diagnosed colorectal cancer patients used TEAM36)
Head and neck cancerIn 2000∼2011, 37.51% of newly diagnosed head and neck cancer patients used TEAM37)
Pediatric cancerIn 2001∼2011, 62.37% of newly diagnosed pediatric cancer patients used TEAM38)
Breast cancerIn 1999∼2008, 81.55% of newly diagnosed breast cancer patients used TEAM39)
In 2007, 35.6% of breast cancer patients used TEAM40)
In 2009, 37.33% of breast cancer patients used TEAM41)
Uterine fibroidIn 2000∼2003, 73.33% of newly diagnosed uterine fibroid patients used TEAM42)
In 1996∼2010, 25.84% of uterine fibroid patients used TEAM43)
In 2002∼2010, 87.08% of newly diagnosed uterine fibroid patients used TEAM44)
Prostate cancerIn 1996∼2008, 38.8% of prostate cancer patients used TEAM45)
In 1998∼2003, 64.5% of newly diagnosed prostate cancer patients used TEAM46)
In 2003∼2008, 52.6% of prostate cancer patients used TEAM47)
In 2007, 22.4% of outpatients with prostate cancer received prescription of herbal medicine48)
Lung cancerIn 1996∼2010, Of the lung cancer patients, 31.17% of the operation patients and 26.32% of the non-operation patients used TEAM49)
Endocrine, nutritional and metabolic diseases, and immunity disorders (3.59%)HyperlipidemiaIn 2003∼2009, 82.95% of hyperlipidemia patients used TEAM50)
Diabetes mellitusIn 2000∼2011, 20.55% of type I diabetes mellitus patients used TEAM51)
In 1998∼2008, 77.91% of newly diagnosed type II diabetes mellitus adult patients used TEAM52)
Mental disorders (3.10%)Insomnia and depressionIn 2002∼2010, 37% of patients diagnosed with insomnia used hypnotic drug and herbal medicine in combination53)
In 2003, 42.73% of patients with major and mild depressive disorder who were prescribed antidepressant used TEAM54)
In 2007∼2011, 12.79% of patients with sleep disorder, 1.57% of patients with depressive disorder were prescribed herbal medicine55)
SchizophreniaIn 2004, 9.2% of schizophrenia patients used TEAM56)
DementiaIn 1997∼2008, 43.3∼78.2% of newly diagnosed dementia patient used TEAM57-59)
Diseases of the nervous system (4.19%)MigraineIn 1998∼2008, 89.26% of newly diagnosed migraine patients used TEAM60)
VertigoIn 1998∼2007, 47.31% of newly diagnosed vertigo patients used TEAM61)
Diseases of tde circulatory system (3.42%)HypertensionIn 2003∼2009, 79.89% of hypertension patients used TEAM62)
In 2006∼2010, 49.74% of newly diagnosed hypertension patients used TEAM63)
StrokeIn 2000∼2004, 9.27∼12.85% of newly diagnosed stroke patients used acupuncture64,65)
In 2008, The acupuncture utilization rate of stroke patients increased to 17%66)
In 2000, 24% of stroke patients used TEAM, but in 2009, they increased to 32%67)
In 2000∼2010, 77.30% of newly diagnosed ischemic stroke patients used TEAM68)
Atrial fibrillationIn 2000∼2011, 15.35% of newly diagnosed atrial fibrillation patients used TEAM within 7 days69)
Heart failureIn 2001∼2010, 78.50% of newly diagnosed heart failure patients used TEAM70)
Ischemic heart diseaseIn 2000∼2010, 81.59% of newly diagnosed ischemic heart disease patients used TEAM71)
Diseases of the respiratory system (7.53%)Upper respiratory infectionIn 2009, 9.92% of upper respiratory infection(including influenza) patients used TEAM72)
RhinosinusitisIn 2000∼2011, 29% of newly diagnosed choronic rhinosinustis patients used TEAM73)
Allergic rhinitisIn 2002, 2.4% of patients used western medicine, 1.4% of patients used TEAM to treat allergic rhinitis74)
In 2009∼2010, 80.5% used only western medicine, 12.73% used only TEAM, 6.77% used western medicine and TEAM in combination to treat allergic rhinitis75)
In 2009, 80.2% used only western medicine, 12.93% used only TEAM, 6.82% used western medicine and TEAM in combination to treat allergic rhinitis76)
In 2002∼2010, 63.11% of newly diagnosed child allergic rhinitis patients used TEAM77)
AsthmaIn 1997∼2008, 85.7% of newly diagnosed adult asthma patients used TEAM78)
In 1997∼2009, Herbal medicine was prescribed at 35.28% of total visits in school age (6∼18 years old)79)
In 2002∼2010, 57.95% of child asthma patients used TEAM80)
In 2000∼2011, Despite the gradual increase in asthma patients, the use of TEAM decreased from 38.58% to 29.26%81)
In 2005∼2010, 18.7∼23.2% of child asthma patients used TEAM82)
Diseases of the digestive system (8.30%)ConstipationIn 2004, 2.45% of patients were treated with a single disease of constipation among the patients who received TEAM treatment83)
Peptic ulcer diseaseIn 2001∼2010, 15.5% of peptic ulcer disease patients used TEAM84)
Inflammatory bowel diseaseIn 2004, 37% of inflammatory bowel disease patients used TEAM85)
Diseases of the skin and subcutaneous tissue (8.07%)PsoriasisIn 2000∼2010, 70.45% of newly diagnosed psoriasis patients used TEAM86)
UrticariaIn 1998∼2008, 0.5% of patients were treated with a single disease of urticaria in the TEAM clinic87)
Atopic dermatitisIn 2007, 0.4% had experienced using TEAM for atopic dermatitis in children under 12 years88,89)
Diseases of the musculoskeletal system and connective tissue (17.05%)OsteoarthritisIn 2002, 37163 (0.6% of the total TEAM users) osteoarthritis patients used TEAM90)
OsteoporosisIn 2003∼2009, 72.6% of osteoporosis patients used TEAM91)
Rheumatoid arthritisIn 2001∼2009, 27.28% of newly diagnosed rheumatoid arthritis patients used TEAM92)
Sjögren’s syndromeIn 1997∼2008, 91.23% of newly diagnosed Sjögren’s syndrome patients used TEAM93)
Systemic lupus erythematosusIn 2000∼2009, 40.14% of newly diagnosed systemic lupus erythematosus patients used TEAM94)
In 1997∼2011, 14.28% of the patients visited the TEAM clinic for SLE treatment95)
Diseases of the genitourinary system (16.49%)Menopausal syndromeIn 1997∼2004, 64.9% of 45∼55 year old women had experience using TEAM96)
In 2002, 75.1% of patients diagnosed with menopausal syndrome had experience using TEAM97)
InfertilityIn 2000∼2011, 96.17% of patients diagnosed with infertility had experience using TEAM98)
Renal diseaseIn 2000∼2005, 45.46% of newly diagnosed chronic renal disease patients used TEAM99)
UrolithiasisIn 1997∼2008, 62.61% of newly diagnosed urolithiasis patients used TEAM100)
DysmenorrheaIn 2003∼2008, 53.4% of newly diagnosed primary dysmenorrhea patients used TEAM101)
EndometriosisIn 1998∼2008, 90.82% of newly diagnosed endometriosis patients used TEAM102)
Injury and poisoning (26.82%)FractureIn 2001∼2010, 4.97% of newly diagnosed fracture patients used TEAM103)
Traumatic brain injuryIn 2000∼2008, 31.39% of the traumatic brain injury survivors received acupuncture treatment within 1 year after injury104)

*In parentheses, frequency of use of TEAM for Western medicine use by ICD-9 disease classification. Extracted from Yuh-Hsiang Yeh et al105) .


고찰

본 연구를 통해, 현재 국내 건강보험의 한의약에 대한 낮은 보장성으로 인해 한의 의료 관련국민 수요가 충족되고 있지 못하고 있음을 확인하였다. 이는 잠정적으로 한약 투약에 대한 정부의 원칙적 비급여 정책이 실질적으로 국내 환자들의 서양의학의 이용만을 강제하는 등 강력한 왜곡을 만들어냈음을 시사하는 것이다.

국가건강보험체계에서 한의약의 저활용은 국내 건강보험 환자 진료비 실태조사2)를 통해 그 원인을 찾아 볼 수 있는데, 2015년 현재 한방병원의 건강보험 보장률은 21.0%, 한의원은 47.1%로 양방병원의 41.3∼53.0% 및 양방의원의 66.0%에 비해 크게 낮아 서양의약 대비 한의약에 대한 불공정한 건강보험 보장에 기인하고 있음을 시사한다. 이러한 문제 해결을 위하여 제 3차 한의약육성발전종합계획은 다양한 한의약 건강보험 수가 개발 및 급여확대, 보험급여 한약제제의 개선, 한의약 보장성 확대를 위한 장기적 추진체계 구축 등을 목표로 진행되고 있다3). 그러나, 국내의 한 보고12)에 따르면, 국내 인구의 한의학에 대한 이용에 있어 “특히 요통 등 근골격계질환에 대해 한의학적 치료에 대해 서양의학과 중복경향이 강하다”고 언급하고 있는데, 이는 근골격계 질환의 치료법인 침구치료만이 사실상 유일하게 포괄적인 보장이 이루어지는데 따르는 것으로 역설적으로 한의약의 다른 분야에 대해서는 건강보험 보장이 전혀 이루어지지 않는다는 것을 보여준다. 이러한 사정 때문에 특정한 발전계획 등만을 바탕으로 한의약의 저활용이라는 문제를 완전히 해결할 수 있을지의 여부는 미지수이다.

2016년을 기준으로 현재, 건강보험이 적용되는 한의진료 내원일수는 1억 6백만일이며 5100만 인구가 한해 2일 정도는 한의의료기관을 이용하였다14). 전체 의료기관 내원일의 10.36%를 차지하고 있음을 알 수 있으며, 상대적으로 보장률이 높은 의원급에서의 한의외래진료 내원일수는 서양의학의 15.9% 수준이다14). 이러한 데이터는 한의사의 수가 서양의사 수의 16.8% 수준이라는 점을 감안할 때, 철저한 제도적 소외에도 불구하고 한의학의 국민 건강에 대한 역할이 서양의학에 뒤지지 않음을 시사한다. 한국과 같이 일제의 식민지 통치를 받은 대만은 보건의료분야에서도 유사한, 혹은 더 철저한 식민지성의 상흔을 가지고 있다15). 뿐만 아니라 국민건강보험제도 등 의료제도적 측면에서도 다수의 유사성을 가지고 있어16), 국내 의료제도와 비교연구가 가능한 특징을 가지고 있다. 특히, 대만은 총액계약제를 통해 사실상 모든 의료행위에 대한 모니터링이 이루어지고 있어, 국내에서는 대부분 비급여로 투약되어 정확히 파악하기 어려운 한약처방의 현황에 대해서도 대만건강보험공단의 자료를 통해 그 일면을 파악해볼 수 있었다17).

대만의 보편적 TEAM 이용 연구를 통하여 다음의 지견을 얻을 수 있었다. 우선, 침구치료의 경우, 대상 질환에 있어서는 국내와 큰 차이를 보이지 않았으나, 대만에서는 침구치료 이용군이 전체 의료기관 이용자중 6.2% (1996)에 불과한데 반해, 2002∼2013년의 국내 건강보험을 통한 TEAM 이용 인구는 24%에서 29.1%로 증가하여, 국내 환자들의 한의약 이용 선호를 보여주는 한편, 1996년 대만의 연간 침구치료 이용 환자들이 전체 보험계약자의 6.2%라는 점은, 침구시술에 국한된 국내 건강보험의 협소한 보장성이 한의약 이용의 증가를 제한하는 요소임을 시사한다. 또한, 대만에서 침구치료에 비해 훨씬 높은 이용을 보이는 한약처방의 현황19,23,24)은 국내의 서양의학에 편중된 건강보험제도로 인한 한의약의 광범위한 미이용이 존재하고 있음을 시사한다.

또한, 질환군 및 특정 질환을 대상으로 한 대만의 TEAM 이용 현황을 통해, 다양한 질환에서 한의약의 이용이 활성화되어 있음을 확인할 수 있었다. 대만의 서양의사 대비 중의사의 비율이 1995년 서양의사 8.62명당 중의사 1명에서 2013년 현재 7.02명대 1명 수준으로 증가하고 있음을 감안106)하면, 산술적으로 서양의학 진료의 11.60∼14.25%선을 중의사가 담당할 것으로 예측할 수 있으며, 2014년 현재 외래에서 서양의학 진료대비 12.58%를 중의사가 담당하고 있고, 이중 침구치료의 비중이 10%내로, 80% 이상에 달하는 한약처방이 이뤄지고 있음을 감안할 때, 국내에서 침구치료만으로도 전체 외래 방문자수의 15.9%14)를 담당하고 있는 상황에서 한의약의 이용은 국민들의 잠재적으로 높은 수요에도 불구하고 매우 제한적으로만 급여가 이루어지고 있는 것으로 볼 수 있으며, 이는 곧 국내에서 한의학의 뚜렷한 저활용이 존재하고 있음을 보이는 것이다.

대만의 경우 중의사 협회와 정부간 매년 협약을 통해 포괄적으로 300여종 이상의 한약제제에 대한 급여목록을 정비한다는 점을 고려해본다면26), 한국의 한의약 분야에 대한 건강보험 보장성 개선에 대한 특단의 조치가 필요하다는 것을 보여준다. 실제 한약제제의 다수가 건강보험적용이 되지 않는 약국에서의 매약으로 활용1)되고 있으므로, 이들 품목을 한방의료기관의 급여항목으로 전환시키는 것 역시 한 가지 해결책이 될 수 있다. 중국의 경우 이미 1000종 이상의 한약제제가 건강보험급여대상26)이며, 그 외에도 중의사에 의한 다양한 처치 및 투약에 대해 폭넓은 정부차원의 보장이 있음이 알려져 있다. 이러한 중국에서의 한의약에 대한 폭넓은 보장성과 제도적 지원에는 자국의 전통의학을 국가적 보물110)로 생각하는 국가적 풍토와 국가 지도자들이 앞 다투어 한의약을 국가적 상징이자 자랑으로 여기는 문화111,112)가 기본에 자리 잡고 있음은 잘 알려져 있다.

일본제국주의로 인한 식민지성을 극복한 중국의 사례와 한국과 동일한 식민경험을 가진 대만의 사례는 한국에서의 한의학의 저활용이 자연스러운 것이 아닌, 식민지 경험과 제국주의적 식민지 통치를 통한 서양의학의 국가권력과의 유착이 빚어낸 식민지성에 의한 것임을 보여주며, 국내 서양의학계는 국가정책에서의 지위를 ‘적산’으로서 불하받아 정부수립이래 수십 년간 특권을 누리고 있다는 것을 확인케 한다. 그리고 대만에서 한의약 분야에 대해 상대가치점수에서의 불이익106)이 존재하는 한편, ‘식민모국’ 일본은 한의약 육성에 나서고 있는 것113)과 같은 대조적 상황은 한의학에 대한 불공정한 정부지원은 그 자체가 식민지의 유산이라는 것을 암시한다.

결론

본 연구에서는 국내 건강보험이 보여주고 있는 낮은 한의약분야에의 지원의 문제는 한약에 대한 건강보험 급여가 미비한 것이 가장 큰 요인이며, 한국 국민들은 특히 한약에 대한 광범위한 미충족 수요를 가지고 있음이 시사되었다. 이는 한의약 분야의 보장성강화에서 무엇보다 한약에 대한 보장성 강화가 이루어져야 함을 보여준다. 유사한 사회적 배경을 가진 대만의 사례는 한의약 분야의 적절한 국민의료에서의 활용은 어떤 보건의료 및 보장성의 형태보다는, 정부와 관료들의 한의약에 대한 시각이 더욱 중요하다는 것을 보여주는 한편, 한국의 보건의료제도가 걸어갈 수 있었던 ‘또 다른 모습’으로서 국내 한의 의료정책과 만성적 한의학 저활용 문제 해결책에서 참고할 수 있는 다양한 시사점을 주고 있다.

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