• 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.

• The Journal of the Korea Contents Association
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• v.14 no.10
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• pp.562-569
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• 2014

The purpose of this study was to investigate the determinants of total payment for mental and behavioral disorders patients admitted through the emergency room. Study data was selected from the Korean National Health Insurance sample data in 2009. This data was consisted of 753 inpatients who are 331 inpatients with only main sick(F31-F39) and 422 inpatients with main sick codes(F31-F39) and sub sick(F00-F99) admitted through the emergency room. SPSS v.18 was used for the statistical analysis such as descriptive analysis, t-test, ANOVA, and multiple regression analysis. In multiple regression analysis, significant variables affecting total payment of main sick patients were gender(p<.01), treatment result(p<.001), path of the emergency room(p<.001), and length of stay(p<.001). Also, main sick patients with sub sick were gender(p<.01), age(p<.001), treatment result(p<.001), path of the emergency room(p<.001), and length of stay(p<.001). These findings implied that it is necessary to build short, middle, and longterm program and system for high risk mental and behavioral disorders groups.

• Journal of agricultural medicine and community health
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• v.44 no.4
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• pp.195-208
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• 2019

Objectives: The purpose of this study was to analyze whether there are differences in medical expenses according to medical security type in the use of medical services with high disease burden such as coronary intervention. Methods: Chi-square test and covariance analysis(ANCOVA) were conducted to identify the differences in the characteristics and costs according to medical security type of 1,904 patients who underwent coronary intervention in a university hospital from 2011 to 2012. Hierarchical regression analysis was conducted to determine whether the cost affects medical expenses. Results: In the medical aid group, the proportion of women, those without a job, those without a spouse, and those who received hemodialysis was high, length of stay was high, patients using the emergency room and those who died was high. The medical aid patients were significantly higher in the non-benefit medical expenses, optional medical expenses, physician and admission, meals, medications and injections. National health insurance patients were significantly higher in procedure. The medical security type was found to be significant as a variable affecting the medical expenses. Conclusions: Provision of medical expenses should be managed in advance by providing prevention and education services for the vulnerable, and care services in the region should be provided to suppress the occurrence of medical expenses due to the increase in the number of days spent. In addition, it is necessary to support medical expenses to prevent unsatisfactory medical services from occurring for non-benefit and optional care.

• Health Policy and Management
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• v.34 no.2
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• pp.196-210
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• 2024

Background: In January 2018, revised elderly fixed outpatient copayment for the elderly were implemented. When people ages 65 years and older receive outpatient treatment at clinic-level medical institutions (clinic, dental clinic, Korean medicine clinic), with medical expenses exceeding 15,000 won but not exceeding 25,000 won, their copayment rates have decreased differentially from 30%. This study aimed to examine the changes of health utilization of elderly after revised elderly fixed outpatient copayment. Methods: We used Korea health panel data from 2016 to 2018. The time period is divided into before and after the revised elderly fixed outpatient copayment. We conducted Poisson segmented regression to estimate the changes in outpatient utilization and inpatient utilization and conducted segmented regression to estimate the changes in medical expenses. Results: Immediately after the revised policy, the number of clinic and Korean medicine outpatient visits of medical expenses under 15,000 won decreased. But the number of clinic outpatient visits in the range of 15,000 to 20,000 won and Korean medicine clinic in the range of 20,000 to 25,000 won increased. Copayment in outpatient temporarily decreased. The inpatient admission rates and total medical expenses temporarily decreased but increased again. Conclusion: We confirmed the temporary increase in outpatient utilization in the medical expense segment with reduced copayment rates. And a temporary decrease in medical expenses followed by an increase again. To reduce the burden of medical expense among elderly in the long run, efforts to establish chronic disease management policies aimed at preventing disease occurrence and deterioration in advance need to continue.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.1
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• pp.121-130
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• 2019

Automobile insurance medical expenses increased by 12% in year 2015 compared to year 2014. But the oriental medical service expenses in automobile insurance increased by 36% during the same period. In this paper the reason for the rapid increase of expenses for oriental medical service was analyzed using the method of decomposing medical expenses. As a result of analyzing 34,351,120 cases that were examined and completed during the period of 2014~2015, the number of oriental medicine patients increased by 27% and the medical expense per patient increased by 7%. The result of analysis showed that there was no significant change in service period per patient but medical expense per day increased by 7%. The increase in the number of patients receiving only oriental medical services was 32%. Increase in the number of patients receiving medical treatment and oriental medical services was 24% and the number of patients receiving medical treatment only decreased by 4%. There was significant increase in non standardized cost of oriental physical therapy which was one reason of the increase of the expenses. However, the most influential factor of the increase in the expenses of oriental medical services was the increase of the number of patients.

• Journal of the Korea Convergence Society
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• v.8 no.12
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• pp.149-157
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• 2017

Unnecessary readmissions could be the result of the inadequate and unnecessary treatments. Adequate quality indicators for readmission are important because they can identify inadequate spending by inpatients as well as quality screening. This study attempted to estimate the cost incurred by unnecessary readmissions. The Health Insurance Claims Data of 18 years or older who were admitted in the tertiary hospitals in 2014 were analyzed. Admissions and readmissions were sorted and readmissions were classified into planned and unplanned readmissions. We adopted 28 days as a criteria for the classification of the readmission. Proportion of the patients were higher in readmissions among cancer, accompanied diseases, and special rehabilitation patients. Cost of the readmissions were 50% of the total cost of the admission among the patients of same diseases, same departments, and same hospitals. Almost 1,000billion Won were used by the unnecessary readmissions. We need to reduce the readmissions in regions, departments, and diseases studying the pattern of the readmissions. National level efforts are required to improve quality of care and reduce cost by the unnecessary readmissions.

• The Journal of the Korea Contents Association
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• v.12 no.4
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• pp.380-389
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• 2012

This study aims to argue fundamental issues on factors associated with revenues of hand injury patients to effectively manage hospitals specialized in hand injuries. The study employes 2,461 patients who entered S hospital from 2008 to 2010 with hand injuries. The followings are the results of the study. First, there is significant difference among occurrence of hand injuries with regard to demographics of patients. That is, it is likely to have longer average length of stay(ALOS) of male over female, of the elderly over infants and toddlers, and vice versa on average daily patient revenues. Also, compared to patients with traffic and labor insurance, patients with health insurance is likely to stay longer at lower daily cost. Fifth, demographics and incidence of hand injuries were significantly associated with average length of stay(ALOS) and average daily patient revenues. That is, male over female, age over 60 over any other age categories, patients with traffic and labor insurances over one with health insurance, cases with laceration, avulsion and bone transplantation over any other types of hand injury patients were factors significantly related to ALOS and average daily patient revenues. In sum, it is needed to focus on education and campaign to raise attentions on preventing various hand injuries. Also, managers at hospitals specialized in hand injuries should pay attention on issues such as reducing ALOS to run the organization effectively.

• The Science & Technology
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• v.30 no.8 s.339
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• pp.10-11
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• 1997

우리나라 의료보험이 실시된지 20년이 되었지만 그동안 개선이나 보안이 안돼 국민과 의료기관의 불평과 불만이 쌓여 뿌리를 내리지 못하고 있다. 양질의 의료서비스로 의료보험을 개선하기 위해선 1)합리적 의료보험수가 조정 2)수가의 현실화 3)진료비 심사기구 독립 4)사회보험성의 의보제 도입 등이 절실하다.

• Korea Journal of Hospital Management
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• v.22 no.4
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• pp.33-49
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• 2017

Background: Health care utilizations and costs of the patients with degenerative lumbar spine disease in Korea increased dramatically. We analyzed whether hospital market competition is associated with charges and length of stay for patients with degenerative lumbar spine disease. Methods: We used Medical claims data of 2002 and 2010 from the nationwide representative sample of National Health Insurance Service of Korea. The study subjects were inpatients with degenerative lumbar spine disease (N=24,768) in 2002 and 2010. We employed a multilevel linear mixed model that included patient- and hospital-level variables in hierarchical data. Results: Higher hospital competition was associated with lower charges (${\beta}=57.5$, p<.0001 in 2002; ${\beta}=353.7$, p<.0001 in 2010) and shorter length of stay (${\beta}=0.3$, p<.0001 in 2002; ${\beta}=0.9$, p<.0001 in 2010) in both 2002 and 2010. Compared to 2002, the magnitude of such association became greater in 2010. However, subgroup analyses show that the influence of competition on charges and length of stay differed by hospital size. Conclusions: This study showed that hospital market structure (e.g., hospital competition) affects hospital efficiency (i.e., hospital charges and length of stay). It is necessary to continue to monitor how changing market structure influences hospital outcomes, including more detailed outcomes such as patient satisfaction.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.11
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• pp.6746-6755
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• 2014

This study examined the effect of long-term care utilization on the health care utilization of Medicaid elderly. The subjects were 5,834 long-term care insurance with the level 1 Medicaid elders, who received either service or non-service. This study examined the impact of long-term care service on the probability of health care utilization and the costs of health care utilization. The total medical cost and inpatient day between 2009-2007 were significant factors affecting long-term care utilization (${\beta}=.29$, p< .001, ${\beta}=.33$, p< .001 ) and this variable explained 22.6% of the total medical cost and 22.4% of the inpatient day. The results showed that non-service in long-term care was associated with an increase in health care utilization. The current long-term care insurance system should place higher priority and more resource allocation on long-term care utilization to increase the efficiency of the insurance system.