• Title/Summary/Keyword: 보험급여

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The Analysis of Main Diseases and Herbal Preparations in Herbal Health Insurance (한약제제 보험급여 주상병과 처방분석)

  • Park, Hye-Jung;Oh, Mun-Su;Kim, Eun-Jeong;Lee, Sang-Gyu;Park, Seong-Kyu;Kim, Yun-Kyung
    • The Korea Journal of Herbology
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    • v.21 no.4
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    • pp.1-10
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    • 2006
  • Objectives : Recently, the total medical expenses of the korean oriental medical service in national health insurance is on the increase every year. Herbal medicines are one of the major methods of the medical treatment. But the expenses of these herbal preparations that can receive benefits from insurance system are decreasing. Methods : In this research, we obtained statistical data of the benefit states of herbal preparations in herbal heath insurance during year 2001-2003 from Health Insurance Review Agency. We analyzed top twenty main diseases in herbal health insurance and mainly used prescription in these diseases. Results : There were wide differences in the application of prescriptions among diseases. For example, musculoskeletal diseases occupied an important position and Ojucksan took more than 50 percentage. Conclusion : We hope that this study could be a basic data for improving the benefit system of herbal health insurance and further studies should be carried out subsequently.

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Review of Economic Evaluation Studies for Drug Reimbursement Decision (의약품 보험급여 결정을 위한 경제성평가 연구의 평가)

  • Choi Sang-Eun;Sullivan Sean D.
    • Health Policy and Management
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    • v.15 no.4
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    • pp.1-25
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    • 2005
  • Legislation on pharmaceutical reimbursement decision using economic evaluation results was made in Korea in fm, but has yet to be fully implemented. We evaluated the quality of Korean economic evaluation studies of pharmaceuticals to understand gaps between legislation and implementation. From this evaluation, we propose policy options that might strengthen the research Infrastructure In order to support such studies. We reviewed 23 published studies for drugs conducted between 1996 and 2004. Evaluation criteria included methodological characteristics, healthcare system characteristics, population characteristics, and applicability of results. Large variation in study quality was observed, particularly with study design, outcome data, treatment patterns and interpretation. Korean clinical data used was mostly from observational studies of 1-2 hospitals. Foreign data was extracted from clinical trials that did not Include Asian population and their selection criterion was not clarified. With respect to treatment patterns, medical records and hospital bills were used without adjustment regarding area, hospital type, and others. And next frequent situation relied on expert opinion from academic physicians in specialty practice. preference measures, when used, were not elicited from the Korean population. $78.3\%$ of studies did not clarify the funding source. If the Korean economic evaluation policy is to provide meaningful data for decision makers, the quality of cost-effectiveness studies will need to improve dramatically. This may involve access to or creation of better data, more diverse funding, unproved training of researchers and evaluators, and partnerships with technology manufacturers.

Type of medical institutions according to the Equipment List and inspection fee computed tomogaphy relationship between (의료기관 종별에 따른 전산화단층촬영장비 보유현황과 검사료간의 관계)

  • Kim, Min-Cheol;Lim, Cheong-Hwan
    • 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.

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A New Healthcare Policy in Korea Part 3: Ultrasound and MRI in Urogenital Disorders (새로운 건강보험 보장성 강화 대책 3부: 비뇨생식기 초음파 및 MRI 급여 확대)

  • Young Sup Shim;Kye Jin Park
    • Journal of the Korean Society of Radiology
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    • v.81 no.5
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    • pp.1083-1095
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    • 2020
  • Since 2019, ultrasound and magnetic resonance imaging for evaluation of urogenital disorders have been covered by the National Health Insurance (NHI) in Korea. Patients with urogenital malignancies were already insured by NHI for ultrasound and MRI. With the expansion of NHI coverage, patients with suspected prostate or gynecologic cancer, uterine fibroids before myomectomy and some other benign disease such as congenital anomaly can receive benefits of NHI. In consideration of these changes, radiologists and other clinicians should be aware of the indications and standard images of each examination and the required reporting forms. Clinical application based upon thorough understanding of the NHI guidelines will aid in improving the standard care of patients.

Job Transition Process by Reasons of Job Separation and Its Determining Factors (이직사유별 일자리 이행경로 및 결정요인 분석)

  • Yoon, Yoon-Gyu
    • Journal of Labour Economics
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    • v.33 no.2
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    • pp.91-134
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    • 2010
  • This study examines job transition process and its lahor market performance by reasons of job separation, using the Employment Insurance DB(2000~07). The findings show that involuntary job changers lend to suffer greater loss in job spell and real wage than voluntary job changers, which seems to reflect their characteristics such as lower quality of job matching due to unsystematic job search, negative signaling effect in the labor market and decreasing availability of human capital in previous job. In addition, unemployment benefit eligible for involuntary job changers tends to prolong the period of unemployment, while increasing job spell in the following employment.

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건설산업기본법 시행령.시행규칙 개정

  • 대한설비건설협회
    • 월간 기계설비
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    • s.223
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    • pp.47-57
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    • 2009
  • 건설산업기본법 시행령 시행규칙이 개정, 2008년 12월 31일 공포되었다. 이번에 개정된 건산법 시행령은 ${\bullet}$원도급자의 공사금액 조종사유 통보 내용과 절차 구체화 ${\bullet}$소규모 공사의 건설기술자 중복배치 허용 현장 수 확대, 건산법 시행규칙은 ${\bullet}$건설공사 하도급계약통보서 및 건설공사대장에 4대 보험료 등의 내용 명시 ${\bullet}$건설업 양도 공고절차 간소화 등의 내용이 개정되었다. 개정된 건산법 시행령은 오는 7월 1일부터, 시행규칙은 오는 4월 1일로부터 시행된다.

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A Study on the Problems and Development of the Benefits in Work Injury Insurance (산재보험 급여체계의 합리화 방안에 관한 연구)

  • Kim, Jin-Soo
    • Korean Journal of Social Welfare
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    • v.37
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    • pp.119-141
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    • 1999
  • Korea paid attention to the work injury insurance in the early economic development stage as other developed countries did. Thus "The industrial Accident Compensation Insurance Law" was legislated in 1963 and it is now expanded to apply to the workplace with five or more employees. Beside the low coverage of the number of employees, the scope of benefits are the problem of work injury insurance. The work injury insurance's main benefits are for the loss of income and the medical cost caused by occupational accidents. On the other hand, the investment on the prevention accident and the medical, social and employment rehabilitation is very low, even though the occupational accident pension is higher than that in other OECD countries. Practically lay-off benefits and survivor' benefit for some special workers are paid more than they need, therefore they want to remain under the benefit condition and the medical care days are longer. This paper indicates the problems of work injury insurance and suggest how to improve the functions of it.

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Factors Affecting Medical Treatment and Expenses for the Inpatients under Coverage of Car Insurance by Traffic Accident (교통사고로 인한 자동차보험 입원환자의 진료현황과 진료비 특성 분석)

  • Ko, Min-Seok;Choi, Joon-Young;Kim, Seung-Hee
    • The Journal of the Korea Contents Association
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    • v.11 no.11
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    • pp.274-285
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    • 2011
  • This study deals with an analysis into the details of medical treatment and expenses by items of treatment as well as the factors related to the ratio between the medical treatment and expenses for 1583 patients who were hospitalized in and discharged from 2 general hospitals located at a city under the coverage of car insurance during the year 2009. As a result, there was statistically significant difference in the details of medical treatment and expenses by items of treatment as well as their composition ratio depending on the individual characters as sex, age and the number of days staying in hospital. Each medical institution should conduct a close analysis of its patients under the car insurance program as well as the factors related to medical expenses with a view to utilize them as basic data for mapping out plans for effective operation of its organization in consideration of the characters as a medicalinstitution.

Analysis of factors affecting antibiotic use at hospitals and clinics based on the defined daily dose (병원 및 의원급 일일사용량 기준 항생제 사용량에 영향을 미치는 요인)

  • Lee, Eun Jee;Lee, GeunWoo;Park, Juhee;Kim, Dong-Sook;Ahn, Hyeong Sik
    • Journal of the Korean Medical Association
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    • v.61 no.11
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    • pp.687-698
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    • 2018
  • Inappropriate antibiotic use significantly contributes to antibiotic resistance, resulting in reduced antibiotic efficacy and an increased burden of disease. The objective of this study was to investigate the characteristics of prescribers whose antibiotics use was high and to explore factors affecting the use of antibiotics by medical institutions. This study analyzed the National Health Insurance claims data from 2015. Antibiotic prescription data were analyzed in terms of the number of defined daily doses per 1,000 patients per day, according to the World Health Organization anatomical-therapeutic-chemical classification and methodologies for measuring the defined daily dose. We investigated the characteristics of prescribers and medical institutions with high antibiotic use. Multivariate regression analyses were performed on the basis of characteristics of the medical institution (number of patients, type of medical institution [hospital or clinic], age of the physician, etc.). The number of patients and number of beds were found to be significant factors affecting antibiotic use in hospitals, and the number of patients, region, and medical department were significant factors affecting antibiotic use at the level of medical institutions. These findings are expected to help policy-makers to better target future interventions to promote prudent antibiotic prescription.

The way to achieve Universal Health Coverage: Focusing on the Historical and Cultural Context of Health Care Sector in Vietnam (보편적 건강보장을 향한 노정 : 베트남 보건의료 부문의 역사·문화적 맥락을 중심으로)

  • BEAK, Yong Hun
    • The Southeast Asian review
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    • v.28 no.1
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    • pp.173-218
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    • 2018
  • This study focuses on the healthcare sector in Vietnam which is promoting universal health insurance for the achievement of Universal Health Coverage (UHC) under Sustainable Development Goals (SDGs). The purpose of this study is to examine the characteristics of the reform process of the health care system and the law on health insurance through the historical and cultural contexts and its implications from the perspective of development. Based on the three dimensions of UHC - extension of protection for population, provision of various medical services, and financial protection, the current status of the Vietnam healthcare sector is summarized respectively as follows. First, according to the revised Health Insurance law which came into effect in 2015, the mandatory health insurance premiums are calculated based on household units. Second, there is a medical network that can provide preventive and healthcare services centered on primary health care facilities, for example commune health stations (trạm y $t{\hat{e}}$ $X{\tilde{a}}$). Third, out-of-pocket expenditure is still a large proportion although public spending has increased and private spending has decreased since the enforcement of the health insurance law and various schemes. Vietnam is currently striving towards a universal health care system. The development of institutions and systems should be designed in a way that is appropriate for the members of the society rather than efficiency. This article findings shed light on the role of social values, family culture, and informal institutions.