• Health Policy and Management
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• v.19 no.1
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• pp.1-30
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• 2009

Korean medical fee contract system between the insurer and healthproviders was introduced in 2000. However, a continuous discord among contracting parties concerned and an irrational operation of an arbitration committee of Ministry for Health, Welfare and Family Affairs (MIHWAF) have made it difficult for them to reach to an agreement over last 8 years. The purpose of this study is to observe the current problems of contract system from the view of health insurance law and actual examples. Furthermore, I examined the of breakdown of negotiation by analyzing the eligibility of contracting parties, rationality of Resource Based Relative Value System (RBRVS) and contracting method and fairness of arbitration method in case of negotiation rupture. The results were as follows: First, since the introduction of medical fee contract system, there has been a problem in that both the president of National Health Insurance Corporation (NHIC) and health care provider association have not held strong negotiation power. Second, the frequent changes and notifications of Relative Value Units (RVUs) without any mutual consent between the insurer and provider association negatively have influenced the conversion factors and finally hindered the agreement of contract. Third, a current process that the conversion factors are mediated and determined at the arbitration committee of MIHWAF in the case of contract breakdown between contracting parties has some flaw in that the irrational composition of committee provoked the lack of fairness and objectivity of mediation. Fourth, we can not prospect a satisfactory outcome of arbitration committee because the mediation always has failed to proceed smoothly due to boycott of both committee members from insurer and providers over last 8 years. As a result, we have to make an every effort to resolve problems mentioned above and then dream of an advanced national health insurance system.

• Journal of Society of Preventive Korean Medicine
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• v.21 no.3
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• pp.29-42
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• 2017

Background : Efforts towards increasing insurance coverage for traditional Korean medicine (TKM) are being continued. However, various difficulties are faced in generating evidence for TKM due to limited financial support and the low quality of research methodology. Objectives : The objectives of this study were to review the Swiss evaluation program for complementary and alternative medicine (CAM) and assess the expansion in public health insurance coverage of complementary medicine as approved by referendum in Switzerland. Methods : The regulations of CAM in the European Union were assessed. Research articles, reports, government publications and websites which deal with the 'Programm Evaluation $Komplement{\ddot{a}}rmedizin$ (PEK)' and the referendum in Switzerland were searched for and analyzed. Results : The PEK was conducted from 1998 to 2005. The PEK evaluated the efficacy, utilization and cost-effectiveness of anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese medicine. However, clear conclusions could not be drawn from the evaluation according to the PEK Report. Later, a referendum was implemented in which 5 therapies would be added to the Switzerland Constitution with the support of the public. The coverage of CAM was approved by Swiss a plebiscite with an approval rate of 67.0%. Conclusions : The reason for the successful referendum is suggested to be public support and the solidarity with CAM experts and politicians. It may be surmised that recognition of the political efforts and scientific aspects required to expand insurance coverage of TKM, and towards obtaining public support, is necessary.

• Health Policy and Management
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• v.18 no.3
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• pp.90-109
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• 2008

Government has extended the benefit coverage and reduced out-of-pocket (OOP) payment for cancer patients in 2005. This paper intends to examine the impact of the above policy on the equity in health care utilization. This paper analyzed the national health insurance data and compared the health care utilization of cancer patients before and after the policy change for people with 10 different income levels. For the equity in health care utilization, we examined the change in concentration index (CI) for visit days, inpatient days, and health expenditure. In the case of outpatient care, CI of visit days and health expenditure were positive(favoring the rich) in both regional and employee health insurance members and both 'before' and 'after' the policy change. CI values rarely changed after the policy change, and the policy change seems to have little impact on the equity of outpatient care utilization except expenditure of regional subscriber. In the case of inpatient care, CI of inpatient days was negative and CI of health expenditure was positive in both regional and work subscriber and both 'before' and 'after' the policy change. After the policy change, CI of inpatient expenditure in both groups of members decreased. CI of inpatient days changed in the direction favoring the poor in regional insurance members, but it rarely changed in employee insurance members. These results suggest that the policy of reducing OOP payment has a positive impact and reduced the inequity particularly in the utilization of inpatient care of cancer patients.

• Journal of Society of Preventive Korean Medicine
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• v.23 no.3
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• pp.1-12
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• 2019

Objectives : Korean national health insurance data is a useful real-world data representing whole medical bills submitted to Health Insurance Review Agency. This study aims to understand recent benefit trend of insurance herbal preparations for treating bronchiectasis(disease code J47) utilizing insurance data. Methods : We reviewed national health insurance claims data from 2013 to 2017 which have main diagnosis or sub diagnosis code of J47 and with the record of prescribing insurance herbal medication. Frequency analysis was performed to analyze the most frequently prescribed prescription. Results & Conclusions : Both the number of claims statement(770 to 1,746cases) and patients(266 to 484) of insurance herbal preparations increased considerably from 2013 to 2017. Top 10 preparations based on the number of claims statement were 'Samso-eum', 'Yeonkyopaedok-san', 'Socheongryong-tang', 'Bojungikgi-tang', 'Hyangsapyungwi-san', 'Yijin-tang', 'Saengmaek-san', 'Jaeumganghwa-tang', 'Ojeok-san' and 'Gungha-tang'. Top 10 preparations based on the number of patients were 'Samso-eum', 'Socheongryong-Tang', 'Saengmaek-san', 'Yeonkyopaedok-san', 'Haengso-tang', 'Hyangsapyungwi-san', Yijin-tang', 'Jaeumganghwa-tang', 'Bojungikgi-tang' and 'Hyeonggaeyeongyo-tang' in respectiv order. Claims of top 10 frequent preparations occupied more than 60% of total claims. We hope this finding to be utilized as basic data for future research of evidence-based bronchiectasis treatment utilizing Korean traditional medicine.

• Journal of Society of Preventive Korean Medicine
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• v.23 no.3
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• pp.109-119
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• 2019

Background : Germany is the first country in the world to introduce modern systems of public health insurance, and the country which most widely uses complementary alternative medicine(CAM) in Europe. In early 21^st century, a large evaluation studies were conducted to include acupuncture in health insurance payments, which were eventually decided. Objectives : This study is to investigate and analyze the process of public policy determination on insurance coverage for acupuncture in German health insurance system. Methods : We collected the data and information through the literature search and from the websites of German government departments and health insurance organizations. To obtain contextual information, German experts of health insurance and acupuncture clinical study were interviewed. Results : As use of acupuncture had been growing, German public health insurers wanted to evaluate the validity of acupuncture coverage and sponsored three evaluation projects for clinical effectiveness of acupuncture using randomized clinical trials, systematic reviews, and pragmatic trials from 2001 to 2005. For some pain condition, acupuncture was founded not to be effective than sham acupuncture, but more effective than standard care. The federal joint committee of health insurance decided to cover acupuncture for chronic pain of lumbar spine and chronic pain in at least one knee joint due to gonarthrosis. Conclusions : Considering the controversial subject matter in the process of acupuncture's health insurance coverage in Germany, expanding the benefits of Korean medicine in Korea needs to come up with ways to overcome the difficulties of placebo effect, standardization and lack of literature evidence.

• The Journal of the Convergence on Culture Technology
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• v.5 no.4
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• pp.137-145
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• 2019

Among the participants of the 2012 Korea Medical Panel survey, 308 people who have used emergency, hospitalization and outpatient services for cancer have been selected. The average annual direct cost per cancer patient was analyzed by adding up the patient's medical expenses, industrial copayments, and non-salary costs. The average annual direct direct cost of cancer spent by cancer patients is about 129,093,792 per male, 158,100,612 won for men and 110,482,075 for women.For those with health insurance, the total direct cost per person from cancer was 183,095,125 won and the beneficiaries were 46,241,705 won. By household income, the average annual direct direct costs per person were 112,459,971 won per patient in the household income quartile, 137,910,890 won for patients in the second quartile, 149,556,570 won in the third quartile and 112,730,461 won, quartile 5, respectively.Was 142,926,331 won.

• YAKHAK HOEJI
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• v.57 no.1
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• pp.63-69
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• 2013

The objectives of the study are to investigate pharmacy remuneration levels stratified by the number of prescriptions dispensing and the type of nearby medical facilities using the Korean National Health Insurance (NHI) database, and to classify community pharmacies based on the characteristics. Claims data of all community pharmacies were extracted from the Korean NHI database from January 1 to June 30, 2010. A total of 14,985 pharmacies were included for the analysis. The remuneration amounts per pharmacist were directly associated with the number of prescription dispensing, and varied by the type of nearby medical facilities where more than 90% of prescriptions dispensed at the pharmacy are issued from. We classified pharmacies to six groups according to the number of prescription dispensing and the type of nearby medical facilities; (1) pharmacies with equal to or less than 200 prescriptions per month per pharmacist, (2) pharmacies near a general hospital, (3) pharmacies near a regular hospital, (4) pharmacies near a clinic, (5) pharmacies near multi clinics, and (6) pharmacies that do not belong to the above types. Compared to pharmacies near a clinic or multi clinics, pharmacies near a general hospital showed a lower number of prescription dispensing per pharmacist, but the income from dispensing fees was higher (p<0.05). The new taxonomy of community pharmacies can be a useful basis for further policy development in pharmacy remuneration system.

• Journal of Hospice and Palliative Care
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• v.22 no.1
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• pp.1-7
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• 2019

The first hospice care center in Korea dates back to the East West Infirmaries (Dongseodaebiwon in the Korean language) of the Goryeo period in the early 11th century. It has been 50 years since hospice care was introduced in Korea. Initially hospice care was provided in the private sector, including those with a religious background, and its development was slow. In the 1990s, related religious organizations and academic associations were established, and then, a full-swing growth phase was ushered in as the Korean government institutionalized hospice care in the early 2000s. As a result, enhanced quality of hospice care service could be provided, which meant better pain management and higher quality of life for late stage cancer patients and their families. Still, the nation lacked a realistic reimbursement system which was needed to for financial stability of the affected patients. However, the national health insurance scheme began to cover hospice palliative expenses in 2015. In 2016, the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life was legislated, allowing terminally-ill patients to refuse meaningless life-sustaining treatments. As the range of diseases subject to hospice palliative care was expanded, more challenges and issues need to be addressed by the service providers.

• Journal of Society of Preventive Korean Medicine
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• v.23 no.2
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• pp.1-10
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• 2019

Backgrounds : In 2017, National Health Insurance implemented the pilot coverage program for Chuna manual therapy(CMT). 65 Korean Medicine(KM) hospitals and clinics were selected in the program to monitor the effectiveness and patients' satisfaction of insured CMT. Objectives : This study aimed to evaluate patients' satisfaction of CMT in the pilot coverage program of National Health Insurance. Methods : Survey participants were recruited among the patients who used CMT at the designated organizations. On-line questionnaire link was sent to the smart phones of patients who agreed to participate in the survey and provide personal contact information. The questionnaire consisted of the basic charactersitics of respondents, imformation on using CMT satisfaction with CMT and willingness to recommend CMT to others. The answers that were automatically coded and saved were statistically analyzed. Results : Of 386 participants who completed the questionnaire, 92.8% satisfied or strongly satisfied with the CMT. Most frequent reason of satisfaction was 'Good effectiveness', and there was no difference in satisfaction between patients of hospital and those of clinics. Patients with the highest and the lowest level of pain satisfied more than those with other pain levels(p=0.003), but the level of copayment and reasons of CMT use did not affect the satisfaction results(p=0.405). The proportions of respondents who had willingness to recommend CMT to others and to revisit for CMT use were 97.8% and 98.8%, respectively. Conclusions : Most patients were satisfied with CMT in the pilot coverage program, and it can provide the rationale for expanding the insurance coverage of CMT to all KM hospitals and clinics.

• Journal of Society of Preventive Korean Medicine
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• v.23 no.1
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• pp.1-13
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• 2019

Backgrounds : The market of Complementary Alternative Medicine(CAM) in the United State(U.S.) accounts for a large proportion of the global CAM market and has a high growth rate. The recent introduction of Obama Care has brought the change in the health insurance system for CAM, and we need to analyze it for its implication to Korean system. Objectives : The purpose of this study is to investigate the current status of acupuncture and chiropractic health insurance in the U.S., and to draw implications for expanding the health insurance coverage for Korean traditional medicine through the comparison between the U.S. and Korean health insurance systems. Methods : We examined the data through the literature search and from the websites of both U.S. government departments and related organizations for the health insurance policy. Based on the collected data, we analyzed its CAM health insurance system in Korea. Results : The acupuncture covered by public health insurance in the U.S. has a limit in the number of treatments and a range of applied diseases compared with Korea. In addition, the practice of acupuncture is not subdivided. However, the chiropractic in the U.S. which also has a limited number of coverage and only three categories of practices are similar to that of Korea. Conclusions : Although the use of CAM by public health insurance is not active in the U.S., but the organizations such as Veterans Health Administration in Vermont is already discussing the use of acupuncture to solve the problem of opioid overuse. Thus Korea also needs to discuss to promote the expansion of the insurance system for CAM.