• Journal of Convergence for Information Technology
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• v.9 no.9
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• pp.195-200
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• 2019

The purpose of this study is to analyze the characteristics of National Health Insurance claim data and to construct a pilot medical episode data considering it. In this study, the trends of respiratory disease (ICD10: J00-J99) cardiovascular disease (ICD10: I00-I99) from the day of onset of treatment to re-admission after admission were confirmed in Seoul, and the largest decrease was observed when the no-treatment period was 0 day. The data reduction rate when the no-treatment period is 0 day is judged to be due to the monthly separation claim of the health insurance claim data. Also, the result that there is a tendency of monthly separation request according to the type of medical treatment. Through this study, we constructed epidemic data for the pilot medical treatment considering the characteristics of the claim data of health insurance, and based on this, it can be used as a data processing method for calculating basic epidemiological information.

• Health Policy and Management
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• v.32 no.2
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• pp.137-153
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• 2022

In the process of promoting policies to strengthen health insurance coverage, the relationship between public health insurance and private health insurance, along with the management of non-benefit, is also emphasized as a policy issue. First, the concept and scope of non-benefit were comparatively analyzed by country. Second, the interaction between the public and private health insurance was classified as 'large or small,' and the government's regulation and management policy on private health insurance was classified as 'strong or weak.' Korea has relatively smaller benefits covered by public health insurance, higher copayment expenses, and more areas and scope of non-benefits. In countries where the interaction between public and private health insurance is small, private health insurance-related policies are weak. And in countries with large interactions had public-private partnerships and the government's management policies were also strong. On the other hand, Korea has a large interaction, but the actual structure of cooperation between public and private insurance and management policies were weak. Because the non-benefit sector in Korea is relatively wide, it is difficult to manage compared to other countries where the concept of non-benefit is limited. In addition, the health authorities rarely perform the role of supervision over private health insurance, and they have so few linkages and cooperation for public-private insurance. Therefore, practical policy enforcement is necessary to achieve the easing of the burden of national medical expenses through linkage and cooperation of public-private health insurance with reference to relevant other countries' cases.

• Korean Journal of Social Welfare
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• v.63 no.2
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• pp.5-29
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• 2011

This paper analyzed the integration cases of the social insurance systems of Germany, Sweden and United Kingdom. On the basis of the two dimensions - institutional and organizational integration, this study reviewed the historical processes of the social insurance integration of the three countries. In Germany, the institutions and the organizations are divided still now and the sickness insurance funds take charge of the entitlement and collection services. In Sweden, the social insurance system is divided by institutions but the organizations were united. the Inland Revenue has charge of the entitlement and collection. In UK, the institutions and the organizations were united and the entitlement and collection services is assigned to the Inland Revenue. Regarding these historical processes of the social insurance integration of developed countries, this paper evaluated the transfer of the collection service to the National Health Insurance Corporation in Korea, which was enforced in 2011.

• KDI Journal of Economic Policy
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• v.11 no.3
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• pp.61-85
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• 1989

본고(本稿)에서는 최근 달성된 전국민의료보험(全國民醫療保險)(NHI)의 재원조달방식(財源調達方式)을 개관한 다음 소득재분배관점(所得再分配觀點)에서 이론적(理論的), 실증적(實證的) 분석(分析)을 행하고자 한다. 의료보험(醫療保險)은 주로 건강한 사람으로 부터 병든 사람으로 의료(醫療)의 수평적(水平的) 재분배기능(再分配機能)을 행하나 결과적으로 수직적(垂直的) 재분배(再分配)에도 영향을 주게 된다. 형평(衡平)과 관련하여 모든 국민(國民)들에게 필요한 최저수준(最低水準)의 의료이용(醫療利用)을 보장한다든가 의료이용(醫療利用)에 따른 경제적(經濟的) 부담(負擔)을 균등하게 한다든가 하는 제기준(諸基準)의 선택은 결국 우리 사회(社會)가 내려야 할 가치판단(價値判斷)의 문제일 것이나 우리의 여건에 비추어 전자(前者)를 기조(基調)로 하되 후자(後者)를 지향하는 접근방식이 바람직하고 평가된다. 실증분석(實證分析)의 결과는 비록 작은 크기이기는 하나 어느 정도 재분배효과(再分配效果)를 보여주었으나 프로그램간 급여(給與)와 보험료부담(保險料負擔)의 측면에서 격차가 벌어지고 있는 실정이어서 NHI 재정통합(財政統合)이라는 장기목표(長期目標) 아래 소득연계적(所得連繫的)인 보험료부담(保險料負擔) 및 급여체계(給與體系)를 단계적으로 확립해 나가되 우선은 의료보호(醫療保護)부터 이 방안(方案)을 실천에 옮기도록 권고한다.

• 한국노년학
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• v.31 no.2
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• pp.259-276
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• 2011

If frail elderly could use home care services adequately, quality of their life might improve and their costs of service would be decreased. The purpose of this study is to examine the factors on institutionalization of elderly using home care services in Korean long-term care insurance system. This study used the data of '2009 satisfaction survey of Korean long-term care system'. The survey proceeded using sampling data by region, level of long-term care need, and insurance type among beneficiaries from August 2009 to September 2010. The onset dates of institutionalization of 1,230 participants were ascertained from long-term care insurance claim data. This study calculated hazard ratio through Cox Proportional Hazard Model. The results showed that if elderly using home care services suffer a fracture, the hazard ratio of institutionalization is higher significantly. Although not significant, if older persons have more items of damaged cognitive functions, the hazard ratio of institutionalization is higher. The results have policy implications to supplement of home care service system and postpone institutionalization of elderly.

• The Journal of the Korea Contents Association
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• v.11 no.4
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• pp.263-272
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• 2011

The purpose of this study is suggesting proper management methods for the national health expenditures by considering advanced countries and analysing the problems of national health expenditures management in korea. The majors results of the research are as follows. First, most advanced countries is integrating the management of national health expenditures about health insurance, workmen's accident compensation insurance and auto insurance etc, and medical prices and benefit standards are same regardless of insurance type. Second, national health expenditures has been managing separately by national health systems in korea, and there are many problems like the differences medical expenditure review and payment, medical prices and benefit standards etc. Although same symptoms and disease, there is great difference in health service utilization. Hereafter, management system of national health expenditures must be integrated, and must change same medical prices and benefit standards.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.5
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• pp.274-280
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• 2020

The purpose of this study was to identify the average cost and present status of non-benefit medical expenses by using the data of tertiary hospitals released by the Health Insurance Review and Assessment Service(HIRA), and to compare the data to find cost variations. The target of analysis was the present status of the non-benefit medical expenses reported by 41 tertiary hospitals among the 44 previously designated hospitals (three were excluded due to revocation or new designation) for 2015, 2016, 2017, and 2018 (until April). This study was conducted after approval of using the released data of the HIRA's data opening system. This study was analyzed by its general characteristics, annual non-benefit medical expenses by frequency analysis, and annual understanding of variation by designating Coefficient of Variation (C.V.). The research found out that the number of details of non-benefit medical expense was gradually increased: the numbers of categories were 51 in 2015, 53 in 2016, and 98 in 2017, but there was a rapid increase in 2018 by 193. As a result, to standardize non-benefit medical expense items across tertiary hospitals due to their variations in the expenses, the government should expand standardized non-benefit medical expenses and make it mandatory for medical institutions to use the standardized items or names of such expenses.

• Journal of Korean society of Dental Hygiene
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• v.21 no.1
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• pp.89-98
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• 2021

Objectives: The purpose of this study was to investigate the perception and satisfaction of caregivers and parents after being covered by health insurance for light-curing composite resin fillings, and to contribute to the settlement of the expansion and coverage of health insurance. Methods: A survey was conducted on caregivers who visited two dental institutions in the Gyeonggi-do area, and parents who joined internet cafes (online communities) in the Gyeonggi-do area from June 2 to September 2, 2020. 225 responses were collected eventually, and 212 valid responses were used as analysis data. Results: 67.0% of the study subjects were aware of the permanent teeth resin fillings being covered by health insurance and the satisfaction was relatively high (91.5%). There was a statistically significant difference in the perception of permanent tooth resin filling benefits according to the child's oral condition (p=0.025) and the parents' own interest in oral health (p=0.039). Conclusions: Based on the results of this study, it is necessary to increase the accessibility to the initial treatment for dental care of children through active promotion of detailed items of permanent teeth resin fillings.

• Journal of the Korea Convergence Society
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• v.6 no.6
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• pp.247-253
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• 2015

The purpose of this convergence study was to analysis the current status of the cancer screening and background healthcare systems in Korea and Japan. First, Cancer Screening Program is coordinated well with National Health Insurance Service(NHIS) under a unified insurer system in Korea. But in Japan, there are over 3,500 insurer and coordinating a comprehensive strategy for cancer screening promotion has been very difficult. Second, Rate of cancer screening is influenced by public healthcare system. In Korea public healthcare does not cover a wide rage of services. Almost free cancer screening provides high incentive to participation. It is very important to understand the impacts of each healthcare system when designing an efficient cancer screening system.

• 한국노년학
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• v.29 no.2
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• pp.645-656
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• 2009

The purpose of this study was to address the current status of hospital-based home care(HBHC). We analyzed the data on HBHC from national electronic data information of Health Insurance Review Agency. Beside, we surveyed 75 hospital-based home care agency. In 2006, 20,343 elderly(64.0% from all HBHC user) used 333,889 visits(76.8%from all visits). Medical diagnosis was composed of circulatory disease including cerebrovascular diseases 41.3%, endocrine system disease including Diabetes mellitus 10.4%, neoplasm 9.7%. Some of subjects used HBHC in excess of maximum covered 8 visits a month by National Health Insurance, decubitus 7.0%, the cancer 5.4%, the diabetes 2.5%, the hypertension 1.1%, and the stroke 0.9%. This results will contribute to expand the coverage of hospital-based home care by National Health Insurance. There was distribution difference in medical diagnosis and nursing intervention between HBHC and Public health center-based home care(PBHC) subjects. Therefore, HBHC subjects had more severe medical diagnosis, and were intervened more injections, examinations, than PBHC subjects. These differences must be considered to set up functional role among the three types of home visit care.