• The Korean Society of Law and Medicine
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• v.21 no.1
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• pp.33-67
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• 2020

The hospitals that are owned by non-medical personnel result when non-medical personnel with resources conspire with newly graduated medical doctors who cannot afford the enormous amount of capital required at the beginning of the establishment of a medical institution. Such hospitals, though they may have met the external requirements as medical institutions, disrupt the medical market as it should be centered by medical personnels, In addition, such hospitals are causing a huge social problem as it is illegally receiving and reducing various benefits such as medical care benefits and subsidies from the government, resulting in a significant financial leak in the national health insurance. The illegality of the opening of a non-medical personnel hospital is so high that it nullifies the contractual arrangement for the establishment, imposes criminal penalties on all persons involved in the establishment under the Korean Medical Law, and imposes administrative sanctions on medical personnel. In case the hospital was aware of the illegality of its opening, but had applied to receive medical care benefits from the National Health Insurance Act and the Medical Care Act, such actions will result in the return of the benefits under the National Health Insurance Act and the Medical Care Assistance Act, subject to the penalty for the crime of fraud, and aggravated punishment for specific economic crimes based on the amount of gain, as well as civil liability for torts. In this study, we will examine the current status of the regulations on the non-medical personnel hospital and present the basis for future legislative directions by looking at the legal regulations and the attitude of the precedents.

• Journal of Digital Convergence
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• v.18 no.1
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• pp.257-263
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• 2020

This study was conducted to improve the quality of National Health Policy by analysing the effects of sociodemographic characteristics, Medical institutions characteristics and characteristics of Admission-Discharge on the length of stay in hospital for schizophrenic patients from the data of Health Insurance Review & Assessment Service. The subjects were 4,692 patients who were diagnosed with schizophrenia as main diagnosis from the data records of HIRA-NIS 2016. Regression analysis was performed to evaluate the effect on the length of stay. Sociodemographic characteristics, hospital characteristics and characteristics of Admission-Discharge were used as explanatory variables and length of stay in hospital was used as a dependent variable. The result of study showed that female, age, medical aid, the kind of hospital, gangweon-do and with mental disease were found to be the factors that affect the length of stay. The significance of this study is to use the public data for evaluating factors that affect the length of stay in hospital for schizophrenic patients. But this study did not consider disease severity, so further study is needed for evaluation of the effects of factors on the length of stay according to disease severity.

• Journal of Korean society of Dental Hygiene
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• v.17 no.3
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• pp.539-551
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• 2017

Objectives: The purpose of this study was to investigate the changes in factors on unmet dental scaling rate before and after the national health insurance. Methods: This study used the $2^{nd}$ data from the Community Health Survey. The study participants numbered 209,341 in 2011 and 219,517 in 2013.The average age was $51{\pm}17$ in 2011 and $52{\pm}17$ in 2013. Data were analyzed by descriptive statistics, chi -squared test and logistic regression using SPSS 23.0. Results: The scaling experienced rate of Korean adults has fallen by 3.5% from 66% to 69.5%. Logistic regression analysis showed that 2.7 times more 'people who were educated at elementary school level or lower' did not use dental scaling compared to higher educated children. Agriculture, forestry and fisheries workers did not use scaling at 2.0 times. Local residents with an income of less than one million won did not use 1.7times scaling. Local residents of 'no private insurance' did not use scaling at 1.5 times. In the case of the predisposing factors, the 20s had less than 1.8 times scaling compared to 50s. In the case of needs factor, local residents who experienced 'bad oral health status' and 'dental calculus' were treated scaling 1.3 times less compared to people with good oral health status and normal periodontal symptoms. Conclusions: In Korea, local residents are less frequently treated scaling due to enabling factors such as accessibility. In addition, predisposing factors such as age and sex, and oral health status and periodontal symptoms were related to not using the dental scaling. Therefore, the universality of health care services should be considered so that people who need periodontal care can use scaling.

• The Journal of the Korea Contents Association
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• v.20 no.7
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• pp.149-160
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• 2020

The purpose of this study is to analyze factors affecting a grade maintenance of the non-graded group by LTCI(Long-Term Care Insurance, NHIS). The predictors were examined grade maintenance of the non-graded group(non-grade of A, B, C). The results were as follows: this study found that predisposing factors of the grade maintenance of non-graded of LTCI were significantly related to age, sex, death. Enabling factors of the grade maintenance of non-graded of LTCI were significantly related to household state, income level. Need factors of the grade maintenance of non-graded of LTCI were significantly related to dementia, grade of first grading, retry of applying for long-term care assessment. Based on the finding of study, implications and future research directions were discussed for policy considerations.

• Journal of Internet of Things and Convergence
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• v.8 no.2
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• pp.13-24
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• 2022

In order to explore the context of fraudulent claims and the measures for preventing them targeting the long-term care institutions for the elderly, which is increasing every year in Korea, this study conducted the text mining analysis using the media report articles. The media report articles were collected from the news big data analysis system called 'BIG KINDS' for about 15 years from July 2008 when the Long-Term Care Insurance for the Elderly took effect, to February 28^th 2022. During this period of time, total 2,627 articles were collected under keywords like 'elderly care+fraudulent claims' and 'long-term care+fraudulent claims', and among them, total 946 articles were selected after excluding overlapped articles. In the results of the text mining analysis in this study, first, the top 10 keywords mentioned in the highest frequency in every section(July 1^st 2008-February 28^th 2022) were shown in the order of long-term care institution for the elderly, fraudulent claims, National Health Insurance Service, Long-Term Care Insurance for the Elderly, long-term care benefits(expenses), elderly care facilities, The Ministry of Health & Welfare, the elderly, report, and reward(payment). Second, in the results of the N-gram analysis, they were shown in the order of long-term care benefits(expenses) and fraudulent claims, fraudulent claims and long-care institution for the elderly, falsehood and fraudulent claims, report and reward(payment), and long-term care institution for the elderly and report. Third, the analysis of TF-IDF was similar to the results of the frequency analysis while the rankings of report, reward(payment), and increase moved up. Based on such results of the analysis above, this study presented the future direction for the prevention of fraudulent claims of long-term care institutions for the elderly.

• The Journal of the Convergence on Culture Technology
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• v.9 no.1
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• pp.443-448
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• 2023

Over the past five years, the number of patients with sleep disorders has increased by about 250,000 from 840,000 in 2017 to 1.09 million in 2021. In addition, sleep disorder is a factor that causes dementia risk factors, and furthermore, the population with sleep disorder is a very important policy issue in terms of stable health insurance financial management in the future in terms of national health management in the super-aging trend. Therefore, this study aims to establish an efficient treatment environment in medical institutions responsible for the current status of polysomnography and effective reimbursement policies for the recently increasing population with sleep disorders, and appropriate sleep management policies for future sleep disorders through correct implementation. We are trying to find out the actual condition and improvement plan through interviews with related organizations and experts.

• Health Policy and Management
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• v.27 no.4
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• pp.372-374
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• 2017

Korea is one of the fastest aging country in the world. The increase in health expenditure is an inevitable problem in an aging country. We examined trend of benefit expenditure in National Health Insurance (NHI) by age group during 2001 to 2016. The benefit expenditure of NHI was 13.0 trillion won (2001) and 48.7 trillion won (2016); that is 3.76 times to 2001. This rapid increase was mostly due to people aged 65 and over. Proportion of beneficiaries aged 65 and over was 6.9% (2001) and 13.7% (2016), benefit expenditure per capita aged 65 and over was 279 thousand won (2001) and 960 thousand won (2016), and utilization days per capita aged 65 and over 21.44 (2001) and 30.23 (2016). This phenomenon was more pronounced in 75 or 85 aged and over. To contain the health costs for older people, the NHI system should be reformed.

• Journal of Society of Preventive Korean Medicine
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• v.11 no.1
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• pp.139-151
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• 2007

This paper evaluated the benefits of the National Health Insurance(NHI) and suggested the necessity of extending some oriental medical services into the benefits schedule in the NHI. Comparing the rate of public financing in national health expenditure in OECD countries and measuring out-of-pocket payments in total medical cost showed the level of insurance payments to total medical cost is approximately $50%{\sim}60%$ in Korea, which is quite insufficient to pay household medical expenses, although the NHI covers the whole population. A few of consumers' priority surveys for medical needs suggested herb medicine, muscle treatment, and manufactured herb medicine be included in the list of the NHI benefits, based on efficiency and equity criteria. It was estimated that the NHI can afford to cover these three items of oriental medical services.

• Proceedings of the Korea Contents Association Conference
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• 2011.05a
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• pp.195-196
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• 2011

1996년 이후부터 전산화단층촬영 검사가 건강보험급여대상이 되면서 이용률과 보급률이 더욱 증가되고 있으며 검사범위의 확대, 검사시간의 단축, 반복검사의 용이성, 이용의 편리성, 결과의 신뢰성, 장치의 구조적인 요소 및 검사 시행 횟수의 증가 등으로 검사량이 증가되고 있는 실정이다. CT 검사 건수의 증가요인으로 새로운 CT장비의 개발과 더불어 급격한 장비도입 증가 추세가 있으므로 이에 본 연구에서는 의료기관 종별 및 시기별 CT 장치 보유현황과 검사료간의 관계를 파악하였다. CT 장비는 병원급은 증가하고 있는 추세이나 의원급은 감소하고 있는 것으로 나타났다. CT진료비 청구는 80%이상이 종합전문요양기관과 종합병원에서 청구하는 것으로 나타났다. 이에 본 연구에서는 고가의료영상 진단 장비인 CT의 세대별 발달장비 도입 시기에 따른 우리나라 CT의 현황을 조사 분석하여 제시하여 고가의료장비 수급의 정책수립의 계기 및 기여하고자 한다.

• Journal of Technologic Dentistry
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• v.34 no.4
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• pp.423-431
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• 2012

Purpose: The purpose of this study was to examine the recognition of dental technician's about including denture into the coverage of the national health insurance. Methods: This study carried out self-administered questionnaire survey from June 10, 2012 to June 20 by having research subjects as 230 dental technician. Except 22 copies with incomplete response, 208 copies were used as the materials of final analysis. Results: The recognition of dental technician on the national health insurance of denture was 48%, but there was a low recognition on the details. The rates of dental technician who approved of the inclusion of denture into the coverage of the health insurance respectively stood at 59%. Conclusion: The coverage of the health insurance should be extended to dental medicine in a manner to satisfy dental technicians, dental service providers and receivers. Also, further studies for the extending coverage of the details are needed.