• Health Policy and Management
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• v.15 no.3
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• pp.17-39
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• 2005

Social solidarity, equity in financing, and efficiency in administration have been core issues in the development of Korean health insurance reformation since 1988. This study is to investigate the trend of administrative cost in Korean National Health Insurance from various aspects. For the analysis of administrative cost, the expenditures of each insurance society and the National Health Insurance Corporation are divided into 4 items of (1) insurance benefit, (2) administrative cost, (3) an agency provision accounts, (4) other expenses, and then they are reorganized. The analyses based on 5 types of the health insurance administrative cost showed that efficiency in administration has been improved generally. We, however, should consider qualitative aspects such as customer's satisfaction with health insurance administration, prompt service, control of unjust expenditure (unjust claims), and provision of medical service including health consultation in assessing efficiency of administration. And, in order to connect the administrative costs of health insurance with efficiency, we need to give a fundamentally new definition, which can contain elaborateness of expenditure in details including the structure and evaluation method of administrative costs. It may be necessary to develop new indicators or analyzing methods hereafter.

• The Journal of Korean Physical Therapy
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• v.25 no.2
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• pp.43-48
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• 2013

Purpose: The aim of this study was to demonstrate that non-participation of physical therapists on the political decision-making committee results in invasion of their interests. Methods: To demonstrate the effects, we analyzed the change of medical insurance score decided by the Health Insurance Policy Deliberation Committee between 2001 and 2012 years, focusing on medical examination as the interest of the participation group and physical therapy cost as interest of the non-participation group. Results: Total medical insurance cost increased by 23.72%, on average. Medical examination cost increased by 23.90% and 37.66% in medical examination for new and established patients, respectively. However, physical therapy cost was reduced by 5.01%. The medical examination cost for physical therapy without medical checkup increased by 2.62%. Conclusion: This study shows that the physical therapy cost, related on the interest of the non-participative group in the Health Insurance Policy Deliberation Committee, rather decreased while the total medical insurance cost increased.These findings demonstrate the invasion of the non-participative group on the Health Insurance Policy Deliberation Committee. Thus, aggressive participation in political decision-making committee is necessary in order to protect and increase rights and interests of Korean physical therapists.

• Korea Journal of Hospital Management
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• v.26 no.1
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• pp.71-82
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• 2021

Purpose: The purpose of this study is to estimate incomes and costs of the medical clinics by using secondary data. Methodology: The medical incomes and costs were estimated from 405 clinics operated by sole practitioner providing out-patient services among all clinics subject to the Medical Cost Survey on National Health Insurance Patients in 2017, excluding dental clinics and oriental medical clinics. The incomes and costs of the medical clinics were reflected with incomes and costs of health insurance benefits and were calculated by types of medical services (i.e., basic care, surgery, general treatment, functional test, specimen test and imaging test). The costs were classified as follows: labor costs, equipment costs, material costs and overhead costs. Secondary data was used to estimate the incomes and costs of the medical clinics. For allocation bases for costs for each type of the medical service, the ratio of revenue from health insurance benefits by types of medical services was applied. However, labor costs were calculated with the activity ratio by types of medical services and occupations, using clinical expert panel data. Finding: The percentage of health insurance income for all medical income was 73.1%. The health insurance cost per clinic was 401,864 thousand won. Labor cost accounted for the largest portion of the health insurance income was 191,229 thousand won (47.6%), followed by management cost was 170,018 thousand won (42.3%), materials cost was 35,434 thousand won (8.8%), and equipment costs was 5,183 thousand won (1.3%). Practical Implications: This study suggests a method of estimating incomes and costs of medical clinic services by using secondary data. It could efficiently provide incomes and costs to assess an appropriate level of the health insurance fee to the clinics.

• Health Policy and Management
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• v.33 no.3
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• pp.325-337
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• 2023

Background: While there are many studies estimating the effects of private health insurance on various types of health care utilization, few have examined how such effects change in conjunction with important policy reforms in national health insurance (NHI). This study examined how the effect of private health insurance (supplemental and fixed cash benefit) on high-cost outpatient imaging test utilization changed following the expansion of magnetic resonance imaging (MRI) coverage in 2018, which is a key example of the NHI benefit expansion policy in recent years. Methods: Data from the 2017 and 2019 Korea Health Panel Survey, which contained information about healthcare utilization before and after the expansion of MRI coverage in 2018, were used. The incremental effect of private health insurance on high-cost outpatient imaging test utilization for each period were quantified and compared, with special attention given to the type of private health insurance. Results: While people with supplemental private health insurance were more likely to use high-cost outpatient imaging tests than those without, both before and after the expansion of MRI coverage, the incremental effect increased from 1.6% points in 2017 to 2.5% points in 2019. Conclusion: Benefit expansion in NHI does not necessarily reduce disparities in the use of health care between private health insurance subscribers and non-subscribers. The results of our study also suggest that the path through which private health insurance affects healthcare utilization may not be limited to the price mechanism alone but can be more complex.

• Health Policy and Management
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• v.33 no.4
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• pp.400-410
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• 2023

Background: As the government has recently been discussing the expansion of the disaster health expenses support project, we would like to confirm the characteristics of beneficiaries of the support project, particularly those of high-cost beneficiaries. Methods: Using the database of catastrophic health expenditure support project from 2019-2020, this study aims to confirm the characteristics of high-cost beneficiaries focusing on the overlap of the relieved out-of-pocket systems, known as the out-of-pocket ceiling system and the system for rare incurable diseases. Logistic regression analysis is used to examine this issue. Results: In order to analyze the factors influencing high-cost beneficiaries, five models were created and analyzed, including the status of duplicated beneficiaries for relieved out-of-pocket systems, sociodemographic and economic factors, and individual health status as sequential independent variables. All five models were statistically significant, of which economic factors had the greatest impact on the model's predictions. The main results indicated that those who benefited from multiple systems in duplicate were more likely to be high-cost beneficiaries, and there is a higher probability of incurring high health expenses among the underage. In addition, within the beneficiaries of catastrophic health expenditure support project, it was observed that higher health insurance premium percentiles are associated with a higher proportion of high-cost beneficiaries. Conclusion: This study examined the characteristics of high-cost beneficiaries by encompassing reimbursement and non-reimbursement. According to this study, it is expected to be used as basic data for setting priorities and improving the current criteria of catastrophic health expenditure support project, aiming to sequentially expand the program.

• Health Policy and Management
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• v.9 no.4
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• pp.1-14
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• 1999

The purpose of this study was to estimate the magnitude of patient's actual cost-sharing for hospital services in the National Health Insurance which has been estimated with only a few hospitals or limited number of patients. Also we aimed at analysis of factors influencing the magnitude. Sources of analyzed data were two databases. 1997 medical benefits record of the National Federation of Medical Insurance and 1997 Statistics for Hospital Management from the Korea Institute of Health Services Management(KIHM). We merged two databases and related records for 224 hospitals. based on the identification details of each hospital. The average percent of patients' cost-sharing was 51.7% of total hospital revenues from the insurance. with 40.3% of revenue in inpatient and 67.4% in outpatient. respectively. The contributing hospital factors to the magnitude of cost-sharing were size of hospitals. teaching status. location. number of employed physicians. etc. Larger and university hospital. urban location. and with more physicians were positively correlated with higher level of cost-sharing. Additionally, the higher the expenses of inpatient's treatment was, the higher the size of patient's cost-sharing was. These findings suggest that present level of patients' cost-sharing is quitely high and it is urgent to reduce the patient's cost-sharing to the reasonable level. It would be necessary to extend the coverage of insurance benefits and to develop policies focusing on larger hospitals and inpatient services.

• Health Policy and Management
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• v.22 no.1
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• pp.145-162
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• 2012

The purpose of this study is to understand magnitude and its related factors of user's cost-sharing for non-covered services in long-term care facilities. We corrected data for 1,016 subjects, based on the long-term care benefits cost specification. Eighteen subjects were excluded from the data analysis due to missing data on family care-givers characteristics. Finally, 998 subjects were included in the study. The average cost of non-covered services per month was 209,093 won and distributed from 0 to 1,011,490 won. There was a significant difference by the characteristics of family care-givers and long-term care facilities. The monthly average cost for meal materials per person was 199,181 won(0~558,000), average cost of additional charge caused by using private bed was 232,992 won (50,000~600,000), and costs for haircut and cosmetics were 8,599 won. For the rest, there were various programs costs(93,328 won), diaper and its disposal cost(109,628 won), purchase cost for daily necessaries(24,435 won) and etc. The related factors for the magnitude of non-covered services expenditures were education level of family care-givers, occupancy rate and location of LTC facilities, and the costs of using private bed, haircut and cosmetics, and various programs among non-covered services. These findings suggest that present level range of LTC facilities users' cost-sharing is wide and it is urgent to prepare the standard guideline for cost and level in non-covered services.

• Journal of Korean Academy of Nursing Administration
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• v.11 no.4
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• pp.449-467
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• 2005

Purpose: This study aims to offer the fundamental data in order to cost the nursing service on the basis of the NIC and a close examination of the interventions that are contained in the health insurance cost list under the system of the current health insurance. Methods: The data is handled with the SPSS 10.0 program. The participants' general peculiarity is calculated in terms of the real number and the percentage, and the performing frequency of the nursing interventions is calculated in terms of the mean and the standard deviation. the correlation between the participants' general peculiarity and the performing frequency of the nursing interventions is analysed with t-test or one way ANOVA of SPSS. Results: In the performing frequency of the nursing interventions, the domain of "the physiological: basic" was the highest as 2.69${\pm}$1.21, the domain of "the behavioral" was the lowest as 2.11${\pm}$1.12. There were 50 core interventions in the medical unit, 48 in the surgical unit, 24 in the MICU and 33 in the SICU. The health insurance cost items contained commonly in the core interventions of each unit were 12, and the health insurance cost items except 12 items contained commonly in the core interventions of each unit were appeared 14 items in the medical unit, 6 in the surgical unit, 7 in the MICU and 2 in the SICU. The core interventions contained commonly in four units of the medical unit, the surgical unit, the MICU & the SICU are 18. And among these, the core interventions contained in the health insurance cost items are 10; pain management, hyperglycemia management, analgegic administration, medication administration: intravenous, oxygen therapy, pressure ulcer prevention, fluid management, fluide monitoring, intravenous(IV) insertion, intravenous(IV) therapy. As the result of the comparison & analysis between the core interventions of the NIC and the health insurance cost items, the core interventions contained in the health insurance cost list are 21(29 as the health insurance cost items). Conclusion: In the performing frequency of the nursing interventions, the domain of "the physiological: basic" is being performed most frequently, and in the performing frequency of the core interventions, the interventions of the domain of "the physiological: complex" is being performed most frequently. On the basis of these results, the writer hopes that the attempts to interlink the nursing interventions into the nursing cost by using of standard terms and the efforts to cost the nursing services would also be made in the future constantly.

• Journal of Technologic Dentistry
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• v.38 no.4
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• pp.327-342
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• 2016

Purpose: The purpose of this study was to investigate the cognition of denture fabrication activities and its cost in National Health Insurance for elderly denture. Methods: A self-administered questionnaire was completed by 41 dental laboratories' owner who was research subjects of HIRA(Health Insurance Review & Assessment Service)'s policy research for elderly denture in 2011. The questionnaire consisted of general characteristics of the subjects, dental technicians' knowledge of national health insurance coverage of elderly denture, job-related changes after national health insurance coverage of elderly denture including validity of denture fabrication activity classification and the cost for each service. Each question was measured by Likert 5 point scale or frequency. The collected data were analyzed by SPSS 16.0. Results: Most of the research subjects had been fabricating national health insurance coverage denture(92.7%), also had ample knowledge of national health insurance coverage denture for elderly. Job-related changes after national health insurance coverage of elderly denture revealed marginal differences in the quality. The validity of fabrication activity classification of resin based complete denture was $3.71{\pm}1.023$ by Likert 5 point scale. Conclusion: The goal of national health insurance for elderly denture is to promote elderly's health and well-being. To fabricate denture is a very important part of the denture treatment. For this reason, denture fabrication activity classification and the cost analysis plan should be duly reflected in the policy of national health insurance for elderly denture.

• Korea Journal of Hospital Management
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• v.19 no.2
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• pp.1-11
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• 2014

The purpose of this study is to investigate awareness on medical insurance on the caregivers cost for hospital administrative staff and to provide the basic data for realization of legislation. The subjects were caregivers living in Busan, the survey was conducted from February 18 to March 9, 2013, 283 except for 17 copies of non-response and error response among a total of 300 questionnaires were analyzed. As a result, To improve the quality of care services, there were 51.8% of refresher training needs in refresher training items, 72.7% in favor of premiums increases in health insurance details, as for health insurance coverage subjects, patients' income were 32.0%, copayment for caregivers cost was 20.0%, which was 42.3%. Refresher training item, premiums increases, health insurance applied subjects, variables for copayment for care fee were related to medical insurance on the caregivers cost. On legislation on the medical insurance, systematic and standardized criteria should be provided to provide standardized curriculum for caregivers, to relieve patients and guardians of economic burden for caregivers cost and offer the stability of the cost.