• Title, Summary, Keyword: healthcare insurance

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Difference in Healthcare Utilization for Percutaneous Transluminal Coronary Angioplasty Inpatients by Insurance Types: Propensity Score Matching Analysis (의료보장유형에 따른 Percutaneous Transluminal Coronary Angioplasty 입원 환자의 의료이용 차이 분석: Propensity Score Matching을 이용하여)

  • Seo, Eun-Won;Lee, Kwang-Soo
    • Health Policy and Management
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    • v.25 no.1
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    • pp.3-10
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    • 2015
  • Background: Previous studies showed differences in healthcare utilization among insurance types. This study aimed to analyze the difference in healthcare utilization for percutaneous transluminal coronary angioplasty inpatients by insurance types after controlling factors affecting healthcare utilization using propensity score matching (PSM). Methods: The 2011 national inpatient sample based on health insurance claims data was used for analysis. PSM was used to control factors influencing healthcare utilization except insurance types. Length of stay and total charges were used as healthcare utilization variables. Patients were divided into National Health Insurance (NHI) and Medical Aid (MA) patients. Factors representing inpatients (gender, age, admission sources, and Elixhauser comorbidity index) and hospitals (number of doctors, number of beds, and location of hospitals) were used as covariates in PSM. Results: Tertiary hospitals didn't show significant difference in length of stay and total charges after PSM between two insurance types. However, MA patients showed significantly longer length of stay than that of NHI patients after PSM in general hospitals. Multivariate regression analysis provided that admission sources, Elixhauser comorbidity index, insurance types, number of doctors, and location of hospitals (province) had significant influences on the length of stay in general hospitals. Conclusion: Study results provided evidences that healthcare utilization was differed by insurance types in general hospitals. Health policy makers will need to prepare interventions to influence the healthcare utilization differences between insurance types.

Factors Affecting the Purchase of Indemnity Private Health Insurance and Related Factors of Outpatient Healthcare Utilization among Chronic Disease Patients (만성질환자에서 실손형 민간의료보험의 가입 관련 요인과 외래 의료이용의 관련 요인)

  • Hur, Jung Won;Kwon, Young Dae
    • Korea Journal of Hospital Management
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    • v.24 no.3
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    • pp.1-10
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    • 2019
  • Purpose: The purpose of this study was to investigate determinants of purchasing indemnity private health insurance and its impact on the healthcare utilization among outpatients with chronic disease. Methods: The study analyzed 4,997 chronic ill patients using 2015 Korean Health Panel data. Logistic regression analysis was conducted to analyze the factors affecting the purchase of indemnity private health insurance and multiple regression analysis was conducted to analyze the effect of private health insurance on the number of outpatient visits and outpatient expenditures. Findings: The age, education level, and number of chronic diseases were significant factors affecting the purchasing of indemnity private health insurance among chronic patients. As a result of analyzing the impact of indemnity private health insurance on healthcare utilization, the number of outpatient visits for those who enrolled in the indemnity private health insurance was higher than the number of outpatient visits for those who did not. But there was no statistically significant difference in outpatient medical expenses. Practical Implications: The results of this study shows that indemnity private health insurance may cause inequality in the healthcare utilization of the socially vulnerable. It is necessary to seek ways to strengthen the health security of chronic disease patients and high-risk elderly people who need more healthcare.

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Priority analysis of the healthcare policy using analytic hierarchy process (계층의사결정 방법론을 이용한 보건의료정책 우선 순위 분석)

  • Kim, Jin Suk;Park, Yoon Sung
    • Journal of the Korean Medical Association
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    • v.60 no.2
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    • pp.164-172
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    • 2017
  • The purpose of this study was to suggest signposting strategy for healthcare policy. Analytic hierarchy process analysis was used to classify the decision levels of healthcare policies using the Delphi professional survey and a literature review. National health insurance was identified as a priority healthcare policy. After that, arranged in order of priority, were the healthcare delivery system, health and medical care, and healthcare resources. Among the sub-levels in healthcare policy, the reimbursement system was a priority policy. This study confirmed that healthcare providers are interested in national health insurance. because their greatest concern was the reimbursement system. Consequently, in order to determine and implement healthcare policy efficiently, the government should consider the opinions of healthcare providers.

Having Private Cancer Insurance in Korea: Gender Differences

  • Yoo, Ki-Bong;Noh, Jin-Won;Kwon, Young Dae;Cho, Kyoung Hee;Choi, Young;Kim, Jae-Hyun
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.17
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    • pp.7981-7986
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    • 2015
  • Background: As coverage of public insurance is not sufficient to cover diagnosis or treatment of cancer, having private health insurance is important to prepare for unexpected expenses of cancer. The purpose of this study was to assess factors associated with having private cancer insurance, considering gender among the socio-demographic factors and health behavior. Materials and Methods: We used data from the 2011 Korea Health Panel, which included 10,871 participants aged 20 years and older. Socio-demographics, health behavior, and perceived cancer risk were the independent variables and having private cancer insurance was the dependent variable. Multivariable logistic regression analysis was used to identify factors associated with having private cancer insurance. Results: The variables relating to middle age, higher education, higher household income, married men, and the perceived cancer risk groups of 1-10% and 11-30% were significantly associated with having private cancer insurance. Additionally, females who had private non-cancer health insurance were positively associated with the dependent variables (OR=1.36; 95% CI=1.17-1.57). Education, smoking status, exercise, and perceived cancer risk possibility were significantly associated with having private cancer insurance only among women. The men lowered the overall percentages of those having private cancer insurance (OR=0.53, 95% CI=0.45-0.63). Conclusions: We found that there were significant differences between men and women who had private cancer insurance. Women with private cancer insurance are more likely to follow precautionary health behavior than men. This could be interpreted as resulting from masculine ideologies. It is important to make males recognize the seriousness of the cancer risk. In general, household income was highly associated with private cancer insurance. These results reveal an inequity among the buyers of private cancer insurance in terms of economic status level, education level, and health condition.

Gender Differences in Factors Affecting Purchase of Indemnity Private Health Insurance and Impact of Indemnity Private Health Insurance on Healthcare Use: Korea Health Panel Survey Data from 2010 to 2016 (실손형 민간의료보험 가입의 영향요인과 실손형 민간의료보험이 의료이용에 미치는 영향에서 성별 차이: 한국의료패널(2010-2016))

  • You, Chang Hoon;Kwon, Young Dae
    • The Journal of the Korea Contents Association
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    • v.20 no.3
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    • pp.92-105
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    • 2020
  • This study was aimed to identify factors affecting the purchase of indemnity private health insurance and analyze its effect on healthcare utilization by gender. This study analyzed data of the 2010-2016 Korea Health Panel Survey using panel logit model and panel regression model. Men were less likely to purchase indemnity private health insurance than women. Self-rated health and unmet need for healthcare in women were related to insurance purchases. In men, married people and residents of the metropolitan area were more likely to purchase. The indemnity private health insurance did not affect the women's outpatient expenses per visit, but for men it increased. The indemnity private health insurance significantly increased women's inpatient expenses per admission, but it did not affect men's inpatient expenses. This study confirmed gender differences in the factors affecting the purchase of indemnity health insurance and the impact of indemnity health insurance on healthcare utilization. This suggests that gender differences should be taken into account in private health insurance research and institutional operation.

Establishment of Healthcare Delivery System through Improvement of Health Insurance System (건강보험수가제도 개선을 통한 의료전달체계 확립방안)

  • Oh, Youngho
    • Health Policy and Management
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    • v.29 no.3
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    • pp.248-261
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    • 2019
  • Establishing a healthcare delivery system is key to building a cost-effective healthcare system that can prevent the waste of healthcare resources and increase efficiency. Recently, the rapid increase in the national medical expenditures due to the aging of the population and the increase in chronic diseases has raised the question about the sustainability of the healthcare system including the health insurance system. This is why we need to reform the medical delivery system, including the function setting of medical institutions. Accordingly, gradual and practical efforts based on the recognition of reality are needed for solving the problems and improving the medical delivery system. The first effort is to secure policy measures to establish functions and roles of medical institutions which are the basis of the healthcare delivery system, and a systematic medical use system for appropriate medical use. This approach can be achieved through a reasonable health insurance schemes. Without reasonable reform efforts, it will be difficult for Korea's health care system to develop into a system that can provide cost-effective and high-quality medical services that the people want.

Relationship between Income and Healthcare Utilization in Cancer Patients (암환자의 소득수준과 의료이용의 관련성)

  • Kim, Jin-Hee;Kim, Kyung-Joo;Park, Jong-Hyock
    • Health Policy and Management
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    • v.21 no.3
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    • pp.397-413
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    • 2011
  • Purpose: The purpose of this study is to examine the relationship between the income level and the healthcare utilization by health insurance type in all cancer patients in year 2005. Methods: The target population was cancer patients with health insurance who used healthcare as a diagnosis code (C00-C97) from January 1 to December 31 of 2005. The Korea Central Cancer Registry Center's Cancer Patient Registry Data, the list of cancer patients of the National Health Insurance Corporation, and the claim data of the Health Insurance Review & Assessment Service were used. The I was the wealthiest, followed by II, III, IV. The V was the poorest in this study. For the analysis, the $x^2$-test, ANOVA (and Kruskal-Wallis test), and regression were used. Results: Outpatient and hospitalization medical expenses, and outpatient visit days of cancer patients with self-employed health insurance were highest in I (p<.001, respectively), and the hospitalization days were the highest in II (p<.001, respectively). Outpatient and hospitalization medical expenses, and outpatient visit and hospitalization days of cancer patients with occupational health insurance were the highest in I (p<.001, respectively). Outpatient and hospitalization medical expenses, and outpatient visit and hospitalization days in cancer patients were higher in I compared to V, and higher in II and III, IV compared to V (p<.001, respectively). Conclusion: Supporting plan for cancer patients' outpatient healthcare utilization are necessary. Moreover, we should make specialized strategy for low income cancer patients with self-employed health insurance when we develop quality improvement policy for inpatient service.

Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data

  • Kim, Jee-Ae;Yoon, Seokjun;Kim, Log-Young;Kim, Dong-Sook
    • Journal of Korean Medical Science
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    • v.32 no.5
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    • pp.718-728
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    • 2017
  • Health Insurance and Review Assessment (HIRA) in South Korea, also called National Health Insurance (NHI) data, is a repository of claims data collected in the process of reimbursing healthcare providers. Under the universal coverage system, having fee-for-services covering all citizens in South Korea, HIRA contains comprehensive and rich information pertaining to healthcare services such as treatments, pharmaceuticals, procedures, and diagnoses for almost 50 million beneficiaries. This corpus of HIRA data, which constitutes a large repository of data in the healthcare sector, has enormous potential to create value in several ways: enhancing the efficiency of the healthcare delivery system without compromising quality of care; adding supporting evidence for a given intervention; and providing the information needed to prevent (or monitor) adverse events. In order to actualize this potential, HIRA data need to actively be utilized for research. Thus understanding this data would greatly enhance this potential. We introduce HIRA data as an important source for health research and provide guidelines for researchers who are currently utilizing HIRA, or interested in doing so, to answer their research questions. We present the characteristics and structure of HIRA data. We discuss strengths and limitations that should be considered in conducting research with HIRA data and suggest strategies for optimal utilization of HIRA data by reviewing published research using HIRA data.

Private Health Insurance and the Use of Health Care Services: a Review of Empirical Research in Korea (민영의료보험이 의료이용에 미치는 영향 : 국내 실증적 연구의 고찰)

  • Kim, Seung-Mo;Kwon, Young-Dae
    • The Korean Journal of Health Service Management
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    • v.5 no.4
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    • pp.177-192
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    • 2011
  • The arguments exist that private health insurance(PHI) policy holders tend to use the health care services more than non-policy holders due to their little out-of-pocket spending, resulting in the adverse effects on the finances of National Health Insurance. This study aims to increase the objective understanding of the issue and to draw a direction of further research, by reviewing the articles, reports and statistics which examined the effects of purchasing PHI policies on health care utilization. Significant differences in healthcare utilization, except for the very partial increase of utilization in outpatient settings, have been not found. The similar trends of the results have existed in a few previous studies which tried to control the endogeneity of medical use and health insurance with latent variables which affect the decision on medical use and health insurance. However, we can not exclude the potential change of healthcare utilization patterns because the portion of the insured of indemnity PHI is becoming rapidly larger in the market. For further research, we should try to obtain the objective information of subjects' past medical history, health status, health related behavior, and income affecting purchase of PHI and utilization of healthcare services. And the efforts of controlling the endogeneity of medical use and health insurance with latent variables which affect the decision on medical use and health insurance, are very considerable.