• Journal of the korean academy of Pediatric Dentistry
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• v.50 no.3
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• pp.292-306
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• 2023

Antibiotics are used for the prevention and treatment of infections. This study aimed to investigate the patterns of dental antibiotic prescription in children and adolescents. The Health Insurance Review and Assessment Service provided data on patients who visited medical institutions. It was categorized according to year, sex, age, insurance type, dental institution, and region. Chi-square tests, Fisher's exact tests, and one-way analyses of variance were performed. Statistical analyses were performed using SAS software (ver. 9.2; SAS Institute, Cary, NC, USA). Amoxicillin and cephalosporins, the most commonly used antibiotics, accounted for approximately 96% of the prescriptions. The younger the child, the more antibiotics were prescribed for trauma, pulpitis, and dental abscesses. However, closer to adolescence, the antibiotics were primarily prescribed to manage impacted teeth and periodontal problems. Antibiotics were prescribed for 3.13 days on average. There were significant differences in the prescription rates according to age, sex, type of insurance, type of medical institution, and region (p < 0.05). This study suggested that antibiotic prescriptions should be closely monitored to ensure appropriate usage of antibiotics.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.3
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• pp.1920-1927
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• 2015

This study examined health insurance costs of occupational therapy in stroke patients. The subjects were stroke patients, who underwent occupational therapy by hospitalization or out-patient centers in 2010. The cost of occupational therapy was analyzed from the insurance claims data of Health Insurance Review and Assessment Service in 2010. The kinds of occupational therapy were divided according to the insurance fee of occupational therapy in 2010. In-patients who received occupational therapy paid the highest rehabilitation treatment fee, whereas outpatients paid the highest nervous system function test fee. The cost of occupational therapy in the special rehabilitation treatment fee was highest by 25.3 billion won. The number of uses of general hospitals was the highest by 180 thousand but the total cost of long-term care hospital was highest by 10.4 billion won. The number of uses and cost by regional groups was highest in Seoul and Gyeonggi-do province. This study is meaningful in that a cost analysis of occupational therapy in stroke patients was performed for the first time using the stroke data from the whole country. The result can be used to provide basic data to improve the insurance fee in the future.

• Journal of the korean academy of Pediatric Dentistry
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• v.50 no.4
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• pp.409-420
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• 2023

The purpose of this study is to analyze trends in the prevalence of dental caries and demand for dental caries treatment among children under 14 years old using Health Insurance Review and Assessment data. The analysis was conducted using treatment records from a random sample of approximately 1 million pediatric patients from a population that included all children and adolescents for each year from 2011 to 2020. In this study, the number of children diagnosed with K02 dental caries and the number of children receiving dental caries treatment across all ages have increased. However, the number of children aged 10 to 14 who received pulp treatment or extraction has decreased. In the National Survey of Children's Oral Health, the decay-missing-filled teeth index for 5- and 12-year-olds has stagnated or increased slightly, but the percentage of the population with active dental caries has decreased. Accessibility and local environments for dental caries treatment have generally improved compared to the past, but preventive dental care has stagnated over the past decade. Therefore, it is necessary to evaluate the effectiveness of oral health programs implemented in Korea to promote and prevent dental caries among children.

• The Journal of the Korea Contents Association
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• v.20 no.5
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• pp.525-535
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• 2020

This study aims to evaluate the economic value of the heat wave watch/warning (HW/W) forecast provided by the KMA (Korea Meteorological Administration) for the public sector. Local govermenments of Korea currently use the HW/W forecasts as a major input variable to determine the preparative requisite level for reducing potential damage by extreme heat events. To assess the value of the HW/W, which is not a marketable commodity, a decision-making model taking into account the cost and loss was established. The 'cost' variable was defined as the heat wave countermeasures budget for Seoul and Busan in 2016, and the 'loss' variable was set as the amount of health insurance claims for those 65 and older obtained from the Health Insurance Review and Assessment Service. Using this model, the value of the HW/W in 2016 was calculated as KRW 4,133M and KRW1,090M for Seoul and Busan, respectively. In addition, if the KMA reduces the False Alarm of the HW/W by a single instance, the value will be increased by KRW 76.6M and KRW 16.8M for the two cities. The results of this study are useful in quantitatively estimation of the value of the HW/W forthe public sector.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.6
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• pp.119-128
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• 2017

This study estimated the optimal nursing workforce and financial costs of providing comprehensive nursing services at hospitals under the national health insurance system. Data on registered nurses, nursing aids, medical institutions, and number of patients were obtained from the Health Insurance Review and Assessment Service. The optimal size of the nursing workforce was calculated using the workload model. A bottom-up approach was used to estimate the annual total financial cost of comprehensive nursing services. The number of registered nurses and nursing aids would need to be increased by 81.75% and 83.23%, respectively, in order to fully apply comprehensive nursing care on a national scale. The additional financial costs for comprehensive nursing services at all hospitals was estimated to be as much as 110.39% of the current cost. For the comprehensive nursing service, nurses with a career and newcomers need to be retained at their hospitals, and the validity of the nurse-patient ratio should be continuously checked. The financial shock to the national health insurance system could be minimized by gradually extending the system to all hospitals.

• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.123-164
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• 2014

Under the new system of 'Separation of pharmaceutical prescription and dispensing' in Korea, which was implemented in 2000, physician could not dispense a medicine, and outpatient should have a physician's prescription filled at a drugstore. After pharmacist makes up outpatient's prescription, National Health Insurance Service(NHIS) pay for outpatient's medicine to pharmacist, except an outpatient's own medicine charge. And NHIS only pay for outpatient's prescription fee to physician and, physician doesn't derive profit from dispensing medicine in itself. Nevertheless, if physician writes out a prescription with violation of 'Criteria for the Medical Care Benefits', NHIS clawed back the payment of outpatient's prescription and medicine from the physician or the medical institution which the physician belongs to. In the past, NHIS's confiscation was in accordance with 'the National Health Care Insurance Act, Article 52, Clause 1'. But, since 2006 when the Supreme Court declared that there was no legal basis on the NHIS's confiscation of outpatient's medicine payment, NHIS had put in a claim for illegal prescriptions on the basis 'the Korean Civil law, Article 750(tort)'. So, Many medical institutions filed civil actions against NHIS. The key point of this actions was whether the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits constitute of the law of tort. On this point, the first trial and the second trial took different position. Finally the Supreme Court acknowledged the constitution of the law of tort in 2013. In this paper, the author will review critically the decision of the Supreme Court, and consider the relativeness between the legal effect of Criteria for the Medical Care Benefits and the constitution of the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits as the law of tort.

• Journal of the korean academy of Pediatric Dentistry
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• v.48 no.2
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• pp.129-139
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• 2021

The purpose of this study was to analyze the characteristics of pediatric and adolescent patients who received sealant after health insurance coverage based on demographic factors such as gender, age, insurance type, care institution and region. Patient Sample Data from the Health Insurance Review and Assessment Service were used for this study. A total of 8,454,636 patients' data were obtained from 2010 to 2017. Of these, 114,680 patients got sealant treatment. Females were more likely to receive sealant treatment than males. 5 - 9 year age group showed the highest number of patients and proportion of treatment. Patients with health insurance were more likely to receive pit and fissure sealant treatment compared to patients with medical aid program. The number of sealant patients and the proportion of sealant treatment were the highest in dental clinics, followed by dental hospitals and public health centers. The number of sealant patients were the highest in Gyeonggi and proportion of sealant patients were the highest in Jeonbuk.

• 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.

• Korean Journal of Clinical Pharmacy
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• v.21 no.3
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• pp.249-255
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• 2011

Objective: To examine the drug use (prescribing) pattern of serious drug-drug interactions (DDIs, contraindicated drug interactions) using real world data. Prescription patterns were examined in terms of dispensing types. Method: Retrospective drug utilization review (DUR) study was performed. One hundred and six datasets of serious DDIs (DDI pairs) were determined among DDI datasets that Ministry of Health & Welfare announced for the DUR system from 2004 to 2005. Electronically transacted ambulatory patients' prescription database to Health Insurance Assessment and Review Services (HIRA) from July, 2005 to June, 2006 was collected with personal information deidentified and analyzed in terms of types of dispensing as a contributing factor. Results: After prescription data analysis per each patient, total number of DDI cases using 95 DDI pairs was 5,511, which accounted for 2.6 cases per patients. DDI cases between two drugs from each of community pharmacy dispensing- type prescription were considerable (63% vs. 24% in those from each of in-institutional dispensing-type prescription and vs. 13% in those from a community pharmacy dispensing-type prescription and an in-institutional dispensingtype prescription). Conclusions: DDI cases from different prescribers were found to be significant. Thus, the concurrent DUR process between prescriptions from different physicians and institutions should be implemented for the safe drug use.

• Journal of Society of Preventive Korean Medicine
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• v.19 no.2
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• pp.51-56
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• 2015

Objective : We analyzed present condition of cooperative medical care using claims data of HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE form patients treated by Korean-Western cooperative medicine. The study aimed to offer guidelines in selecting disease-related research in developing Korean-Western convergence technology. Method : Based on the patients using Korean medical service, we analyzed claims data of patients using Korean medical service and western medical service from January 2012 to December 2013. We were assigned to the server remotely. With the concept of 'episode of care', we rebuilt claims data and analyzed present condition of cooperative medical usage. Results : We analyzed present condition of cooperative medical care per episode of care. Among outpatients, Low back pain, lumbar region(M5456) was the highest number. Among inpatients, Sciatica due to intervertebral disc disorder(M511) was the highest number. Conclusion : Based on the claims data provided by HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE, we have derived a list of multy frequently disease frequently treated by cooperative medical care by analyzing present condition.