• Journal of Preventive Medicine and Public Health
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• v.24 no.2 s.34
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• pp.211-220
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• 1991

Finances of health insurance can be explained by factors determining benefit expense and premium collection. This study was conducted to analyze factors contributing to the financial status of rural health Insurance. Nationwide 134 health insurance associations except the six pilot project counties were analyzed and obtained the followings. 1. In univariate analysis, statistically significant variables that explain 1) outpatient benefit expenditures include public health center utilization, proportion of pregnant women. premium and collection rate of premium 2) inpatient benefit expenditures include public health center utilization, Proportion of old age, proportion of pregnant women, premium and collection rate of premium 3) profits include public health center utilization, proportion of old age, proportion of pregnant women and collection rate of premium. 2. In multiple regression analysis, statistically significant determinants in 1) outpatient benefit include premium and public health utilization 2) inpatient benefit include premium 3) profit include public health center utilization, premium and collection rate of premium.

• The Korean Journal of Health Service Management
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• v.6 no.2
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• pp.165-177
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• 2012

This study examined market size of private health insurance premium and individual characteristics associated with the market size change in Korea, using wave 1 (2008) and wave 2 (2009) of Korea Health Panel. The market size was 24.4 trillion Korean won in 2008 and 26.9 trillion in 2009. The increase rate of private health insurance premium among those who were the elderly, single, or the poor was higher than that among their counterpart respectively. Health status and utilization were insignificant in determining the increase rate of private health insurance premium. These findings were more obvious among the uninsured in 2008 than among the insured in 2008. The increase of private health insurance premium in Korea imply the increase of willingness-to-pay for health risk through private sector. The authors suggest policy intervention for accessability to health care for the underprivileged and weak through enlargement of Korean social health insurance benefit.

• Health Policy and Management
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• v.31 no.3
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• pp.364-373
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• 2021

Background: This study aims to examine the regressiveness of national health insurance (NHI) premium burdens for local subscribers. The government has established a restructuring of health insurance contributions in 2017. Therefore, insurance premium reform began in 2018 and the second national health insurance premium reform will be carried out in 2022. We will analyze local subscribers before and after the policy reform of 2018. Methods: This study used data from 'local premium imposition elements' in the health insurance statistics annual reports (2017-2019) on National Health Insurance Service (NHIS). This study was calculated contribution rates according to levels of income and property for local insured by the method of comparing. Simulations of primary and secondary reforms were conducted in the study to determine regressiveness. Results: Insurance premiums for local subscribers were analyzed separately by income and property insurance premiums. In the income premium analysis, the higher the income, the lower the premium rate, and then the fixed rate was maintained from a certain section. The regressiveness of income insurance premiums has been eased in part. On the other hand, the property insurance premium burden was found to be regressive still by income class. Conclusion: Regressiveness analysis showed that a decrease in income contributions was achieved to local insured in the first phase of reform. But in the second phase of reform, more consideration should be given to reductions of property premium portions of local subscribers. Based on the results, the author suggested policy discussions to reorganizing the new systems of NHI contribution of local Insured.

• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.185-209
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• 2014

While the local health insurance and the employment-based insurance were integrated in July 2000, the insured is divided into employment-based insured and the local insured and the relevant premium has been applied to both groups. The health insurance premium having the feature of social solidarity has to be determined depending on income, that is, the ability to pay in accordance with the principles of social insurance. While employment-based insurance premium has been determined depending on the earned income, the local insurance premium for the local insured has been determined by scoring gross income(evaluated income), property and possession of automobiles. A variety of improvement approaches has been implemented including introduction of the employment-based insurance premium ceiling system (2002) and the change of property scoring system for the local insured (2006). However, the health insurance system which was merged in 2000 has been implemented up to now without significant change even though there were lots of socio-demographic change including increase of income level and the population structure such as low birth and aging. In other words, it is required to implement the premium rating system securing the income-based equity. Nevertheless, it was inevitable to apply the diverse rating standards in the early stage because it was very difficult to verify the income of the self-employed. Although the income verification rate was significantly increased from 23% in 1989 to 44% in 2010, the irrational standards including property, automobiles, living standard and activity rate have been still applied to the local insured because it is difficult to secure the validity of insurance premium rating system and it severely lacks of security. This paper investigated whether the current insurance premium rating system for the local insured imposing the premium on the basis of 'gender' and 'age' complies with the basic human rights secured by the current Constitution of the Republic of Korea with respect to the practical and theoretic irrationality of insurance premium rating system and standards for he local insured. In accordance with the analysis results, this paper proposed the approach to improve the system.

• The Journal of the Korea Contents Association
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• v.14 no.8
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• pp.277-286
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• 2014

The purpose of this study was to identify the relationship between the health insurance perception level and health insurance satisfaction for national health insurance subscriber. The collected data were analyzed by $X^2$-test, t-test, ANOVA using the SPSS/WIN (ver.14.0). Research results can be summarized as follows. The relationship between the health insurance perception level and health insurance satisfaction was relatively high. The study showed significantly high levels in the score of health insurance satisfactions according to perception of security level, health insurance premium, positive thinking, and fair in premium charge. Also health insurance satisfaction scores were significantly low levels according to perception of raise health insurance premium and burden on households. This study investigated the relationship between the detail perception and satisfaction for national health insurance. Therefore, we are setting the overall direction of national health insurance perception, and look forward to utilizing the basis data as help to improve the system of health insurance for people.

• The Korean Society of Law and Medicine
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• v.8 no.2
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• pp.9-35
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• 2007

The Health care program in Korea has now been systemized after 30 years of declaring the inauguration of the national health insurance system by the current government. The national health care covering all Korean citizens was achieved after 12 years of implementing the national health insurance and the health care program since 1977. Hundreds of multiple operational agencies managing the insured individually had undergone the amalgamation process from 1998 to 2000, and had been restructured as one agency, the National Health Insurance Corporation. In 2003, the community/area based financial management was also merged together with the employment based financial management. The National health care system of Korea offer various merits, compared with that of other countries, such as health care provision covering all Koreans, low insurance premium, accessibility of medical services/facilities etc. However, there are still some weak features which need to be addressed for improvement; below expectation insurance cover system, mistrust on the medical services, low medical charges resulted from excessive restrictions, and unstable financial status of the national health insurance etc. Therefore, the National health care system should continue to evolve to re-establish itself as more effective national health care system by further strengthening its merits, and by improving its weaknesses; with adopting the positive system to optimize the costs of prescribed medicines/drugs, applying simpler insurance coverage system to calculate the optimum medical charges, promoting private medical insurances, and increasing insurance premium etc.

• The Korean Society of Law and Medicine
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• v.20 no.1
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• pp.203-242
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• 2019

Since 2006, local governments in Korea have been providing premiums for social insurance, such as the National Health Insurance System, for the health care of local residents. The purpose of this study is to analyze the content of self-governing legislation that defines these policies. The method of conducting the research was based on the articles of the ordinance related to the 'public health insurance premium' of the self-governing statutes published on the website of the National Law Information Center. As of May 2019, 201 municipalities have enacted ordinances to support public health insurance premiums. In the case of state local governments, 8 out of 17 were found, and in the case of basic local governments, 193 out of 226. The constitution of the ordinance consisted of purpose, time of enactment, type of social insurance premium, object of social insurance premium, amount of social insurance premium support, method and process of social insurance premium support, time of social insurance premium support. This study analyzed contents of these articles. Finally, this study presented issues that could be controversial from the policy and legal viewpoints and suggestions for improvement.

• Health Policy and Management
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• v.32 no.3
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• pp.258-271
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• 2022

The rapidly aging trend of Korea is a major factor that threatens the sustainability of the long-term care insurance system. Therefore, looking at how Japan and Germany mitigated the financial burden when they managed similar long-term care insurance systems will provide important implications for improving the Korean system in the future. The study was conducted using the literature review method, and the "country" was set as a unit for the case analysis. The three countries selected are Korea, Japan, and Germany. Recently in Korea, the insurance premium rates of all subjects have been rapidly rising, which can exacerbate the issue of intergenerational equity. On the other hand, Japan has responded to the aggravating finances for long-term care insurance due to aging by raising coinsurance for selected groups like the wealthy elderly. Germany is selectively raising the insurance premium rates by additionally increasing the premium rate for childless recipients. A more preventive and quality-oriented care service plan can be promoted by referring to the recent changes in Japan and Germany. In addition, a more effective and selective increase in payment burden in Japan and Germany could be considered in response to a recent equity issue in Korea.

• Journal of Preventive Medicine and Public Health
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• v.25 no.4 s.40
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• pp.399-412
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• 1992

This study was designed to investigate factors relating to fiscal deficit for regional health insurance. The financial statements for the fiscal year 1990 of nationwide 254 regional medical insurance societies were analyzed. Important findings are summarized below: 1. There were differences in the main reason fur the financial deficit among regions when deficit and surplus societies were compared by regions. The total revenue per enrollee, especially revenue from the premium contribution of a deficit society was significantly smaller than that of a surplus society in large cities and counties. On the other hand, the total expenditure per enrollee of a deficit society was larger than that of a surplus society in small cities. 2. Both low premium rate at the beginning of health insurance program and less effort to increase the premium rate were main factors for the smaller revenue from the contribution of a deficit society in large cities and counties. 3. Larger expenditures per covered person of a deficit society in small cities were explained with larger medical expenditures especially for out-patients services rather than larger administrative expenses. 4. A regression analysis showed that utilization rates in out-patient services were significantly associated with income and numbers of total medical care institution per capita within a region where a health insurance society located. Also expenses paid by insurer per visit were associated with the proportion of utilization for tertiary care hospitals as well as the proportion of utilization of public health centers.

• The Korean Journal of Health Service Management
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• v.9 no.1
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• pp.57-66
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• 2015

This study was performed to provide efficient fund managing plans for hospitals by looking into the management of medical fees for accident insurance. Car insurance, industrial accident insurance and seamen's insurance at a general hospital which is located in Busan during 29 months from January 1, 2009 to May 31, 2011 were assessed. The research data is the total number of 6,293 cases, including 2,251 car insurance cases, 2,350 industrial accident insurance cases, and 1,692 seamen's insurance cases. There were some significant differences found, as car insurance and seamen's insurance, including accident insurance, are types of insurance for which employers or traffic accidents offenders shall be the final premium payer. In addition, medical examination fees or premium payers are applied under their respective related laws. The findings suggest that it is necessary for managers of hospitals to prepare differentiated management schemes based on the characteristics of each insurer and schemes to ensure proper recovery strategies of uncollected medical account receivables.