• Korea Journal of Hospital Management
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• v.23 no.1
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• pp.28-40
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• 2018

Purpose: The purpose is to understand the perception of medical providers at tertiary hospitals in Seoul on the importance-performance of the reform on a doctor-designation system, and to provide the policy suggestion of the perception on such a system. Methodology: To achieve the purpose, this study utilized structured survey tools to conduct a questionnaire survey of nursing, administrative and medical technology professionals at six tertiary hospitals in Seoul. An importance-performance analysis was utilized for an analysis that showed the perception of the reform on a doctor-designation system. Findings: First, it was identified that those medical providers had the highest perception of the importance about the performance of the reform on a doctor-designation system. Second, according to the result of action grid of an importance-performance analysis (IPA), it can be identified that in the 2nd stage of 'Concentrate here' included are the items as to design and effect of medical care quality and subsidies & patient infection and safety and control fees, effect of income security of the method for compensating for loss established by the government and offering sufficient information on general medical services and doctor-designation medical services. In the 1st stage of 'Keep up the Good Work', and the 2nd stage of 'Concentrate here' included is the item as to the performance of patients of the reform on a doctor designation system. Practical Implications: There could be identified the effect of the reform bill on the perception of medical providers. It is expected that a better environment would be provided for patients to use a hospital and for medical providers to offer medical services, if the goverment makes efforts to improve methods for compensating for loss and continuous monitoring of the performance of patients.

• Health Policy and Management
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• v.12 no.4
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• pp.91-113
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• 2002

We report and analyze the Korean physicians' recent general strike over the implementation of the Separation of Prescribing and Dispensing Practice (SPDP) in which more than 18,000 private clinics and 280 hospitals participated. Utilizing game-theoretic models of bargaining we explain why the Korean physicians were so successful in organizing intense collective action against the government and securing very favorable policy outcomes. In particular, we highlight the role of distributional conflict among social actors in shaping the details of institutional reform. The introduction of the SPDP was a necessary first step in the overall reform of health care system in Korea. However, the SPDP was perceived to be a serious threat to the economic viability of their profession by the vast majority of Korean physicians who had long been relied on the profits from selling medicines to compensate for the loss of income due to the low service fee under the previous health care system. The strong political coalition among heterogeneous physicians enabled them to organize an intense form of collective action, the general strike. Thus, physicians were successful not only in dragging the government to a bargaining table, but also winning in the bargaining and securing an outcome vastly favorable to them. On the other hand, the lack of an overall reform plan in the health care policy area, especially the finance of the National Health Insurance and the need for maintaining an image as a successful reform initiator, motivated the government to reach a quick resolution with the striking physicians.

• Health Policy and Management
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• v.24 no.4
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• pp.322-329
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• 2014

Background: As most of people in Korea are covered by National Health Insurance (NHI), the disease information collected in NHI provides high availability for health policy. Nevertheless, the validity of disease codes in NHI data has been controversial till now. So we tried to evaluate the validity of them by comparing the NHI claims data with Korean National Hospital Discharge In-depth Injury Survey (KNHDIIS) data. Methods: We compared the NHI patients sample data (2009) with the KNHDIIS data (2009). We selected the inpatient data of KNHDIIS and NHI patients sample. The weighted number of patients from NHI patients sample was 5,551,210 and the number of patients from KNHDIIS was 5,559,874. We classified the disease codes into principal diagnoses and other diagnoses, and we compared as one, two, three unit level. Also we calculated the agreement rate of each of them. Results: In the comparison of principal diagnoses, NHI claims data had more C code than KNHDIIS data did, whereas KNHDIIS data had more Z code than NHI claims data did. In the comparison of other diagnoses, NHI claims data had 2, 3 more codes than KNHDIIS data did. The overall agreement rate at three unit level was 76.5% in principal diagnoses and 46.8% in other diagnoses. Conclusion: Considering the large difference between the two data, the validity of disease codes in NHI Claims data seems to be low. To increase the validity of them, the definite detail coding indicator, the reinforcement of coding education, and the reform of system are needed.

• The Korea Journal of Herbology
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• v.27 no.2
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• pp.1-16
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• 2012

Objective : To investigate the current status of prescription drugs in Oriental medical institutes and to draw up a future plan for the revitalization of Oriental medical health insurance, this survey has been performed. Method : The survey has been made with 321 doctors working at Oriental medical institutes in Daegu and Kyungbuk areas for a period of 3 month from June 1, 2010 until September 1, 2010. Result : 1. When it comes to the current status of the use of herbal drugs in Oriental Health insurance, most of doctors surveyed prescribe insurance drugs, and they prescribe insurance drugs to patients, who are less than 20% of total patients visiting their clinics. 2. The awareness of Herbal Health Care Drugs is investigated. When it comes to the understanding of the difference between insurance drugs(powder type drugs) and granular type drugs, doctors admit that they differ only in one aspect, whether or not their being covered by health insurance. Based on the survey results on the understanding of insurance coverage of granular type drugs, doctors, even though they long for granular type drugs to be accepted as insurance drugs, are worrying whether the number of outpatients might dwindle due to increased insurance co-payments. They also point out that the biggest obstacles in the expansion of the granular type drugs as insurance drugs are the lack of understanding of the government and the objection of the Health Insurance Review and Assesment service (HIRA) for fear of increased insurance claims. 3. Upon investigation on Oriental medicine doctors' understandings of herbal pharmaceutical industry, it is found that doctors' responses on pharmaceutical industry are not all positive ones('new product development and neglect of R&D infrastructure' and 'smallness of industry'). When it is investigated what area needs the greatest improvement in herbal pharmaceutical industry, 'securing sufficient capital, good manufacturing, and strengthening quality control', is the highest. 4. When it is asked what are the most needed in order to improve herbal health insurance medicine, responses such as 'the increase in the accessibility to and the utilization of Oriental medical clinics through the diversification of the means of prescriptions', 'the improvement of insurance benefits(cap adjustments)', 'increase the proportion of high quality medicinal plants', 'the ceiling of co-payments(deductible) at 20,000 won or more', 'expansion of the choices of formulations', 'formulational expansions of tablets and pills', and finally 'admittance and expansion of granular type drug as insurance drug' are the highest. 5. Upon investigating the general characteristics of the current status of the usage of Oriental health care herbal drugs, the followings are observed. First, the frequency of use of health insurance drugs by the doctors who use health insurance with general characteristics shows similar differences in case of total monthly sales amount (p<0.001), average number of daily patients (p<0.05). Secondly, as to the willingness of the expanded usage of insurance drugs, similar differences are observed in case of total monthly sales amount (p<0.05). 6. Upon investigating the general characteristics of the perception of Herbal health care drugs, the followings are observed. First, inspecting general characteristics and insurance claims due to increased co-payments(deductible amount) reveals similar differences in case of working period (p<0.01) and in case of total monthly sales amount (p <0.01). Secondly, inspecting general characteristics and the obstacles that hinder granular type drugs from being accepted as health care insurance drugs shows similar differences in case of working period (p<0.05). 7. Upon investigating the general characteristics of the understanding of Oriental Herbal pharmaceutical companies, the followings are observed. First, opinions on the general characteristics of pharmaceutical companies, when examined with variance analysis, shows similar differences in case of total monthly sales amount (p<0.05). Secondly, when opinions are examined on general characteristics and the problems of herbal pharmaceutical companies, similar differences are found in case of working period (p<0.01) and in case of total monthly sales amount (p<0.001). Lastly, opinions on the general characteristics and reforms of pharmaceutical companies, similar differences are observed in case of working period (p<0.001). 8. Upon investigating the general characteristics of the improvement of insurance Herbal drugs, the followings are observed. First, regarding general characteristics and insurance benefits, similar differences are observed in case of working period (p<0.05), in case of total monthly sales amount (p<0.05), and in case of average number of daily patients (p<0.01). Secondly, opinions on the general characteristics and the needs for the improvement of Herbal insurance drugs are examined in 5 different aspects, which are the approval of granular type drugs as insurance drugs, the expanded practices of the number of prescription insurance drugs, the needs of a variety of formulations, the needs of TFT of which numbers of Oriental medical doctors are members for the revision of the existing system, and the needs of adjusting the current ceiling of the fixed amount and the fixed rate. When processed by the analysis of variance, the results show similar differences in case of average number of daily patients (p<0.01). Conclusion : From the results of this study the first measures to take are, to reform overall insurance benefit system, including insurance co-payment system(fixed rate cap adjustment), to expand the number of the herbal drugs to be prescribed matching with insurance benefit accordingly, and to revitalize herbal medicine insurance system through the change of various formulations. In addition, it is recommended to improve the effectiveness of herbal medicine by making plans to enhance the efficacy of herbal medicine and by enabling small pharmaceutical companies to outgrow themselves.

• Journal of the Korean Dietetic Association
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• v.16 no.4
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• pp.378-396
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• 2010

The objectives of this study were to explore hospital foodservice management and to investigate conditions related to health insurance coverage of inpatient meals. A questionnaire was distributed to the nutrition departments of 44 hospitals in Seoul on July 2009. The average kitchen area was 0.5 $m^2$, and centralized distribution systems were in place. Partition walls from contamination zones, separate work tables to prevent cross-contamination, exclusive areas for preparing tube feeding, and split carts with refrigerated and convection heat settings were largely used in tertiary hospitals. Most dietitians did meal rounds (93.2%) and surveyed for patient satisfaction (86.4%). The major theme of QI (Quality Improvement) was menu management (31.8%). The health insurance fees for meals were (won)4,938.9 for a general diet, (won)5,199.8 for a therapeutic diet, (won)4,067.0 for tube feeding, (won)9,950.0 for sterilized diet, and (won)18,383.4 for diets not covered by health insurance. The prices for general and therapeutic diets were significantly lower in hospitals compared to tertiary or general hospitals (P<0.001). The cost composed of 48.3% food, 44.0% labor and 7.7% overhead for general diets and 47.9%, 44.5% and 7.6% for therapeutic diets. In the case of health insurance coverage for patient meals, the number of items applied to general diets averaged 2.8 out of 4 and for therapeutic diets it averaged 1.9 out of 3. To reform the health insurance coverage system for patient meals, it is urgent that the qualified level of patient meals is presented from a national viewpoint, and monitoring should be performed consistently by developing the evaluation tools.

• Journal of East-West Nursing Research
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• v.26 no.1
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• pp.28-38
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• 2020

Purpose: The aim of this study was to provide information on the extent and variations of elderly residents' nursing care needs, and provision of nursing care across long term care facilities. Methods: A nationwide survey was conducted on nurse managers from 1,041 long term care facilities, by e-mail or fax, from August 16 to September 30 in 2017. A self-reported questionnaire consisting of 5 domains was used to collect data. Results: Facilities with more than 30 residents were more likely to need skilled nursing services and to obtain the nursing staff such as a registered nurse and a nurse's aide. Awareness and satisfaction of hospital-based home nursing care was high in all facilities. In addition, there are some differences in nurse managers' perceptions of the level of healthcare resources and required action by facility size. Nurse managers of senior congregate housings were more likely to have considerable difficulty in dealing with healthcare needs of residents and recognizing the healthcare resource shortage. A majority of nurse managers agreed on the need to employ a registered nurse. Conclusion: This study confirmed that it is essential to increase nurse staffing level and to reform the long term care insurance for enhancing the accessibility of healthcare services, especially for the residents in small long term care facilities. There is also a need to provide diverse education and training opportunities for nursing staff working in long term care facilities.

• Korean Medical Education Review
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• v.24 no.1
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• pp.10-17
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• 2022

South Korea is not a wasteland of publicly funded health care-instead, it has a good medical social security system known as the national health insurance (NHI). The NHI of Korea has three unique features; (1) low premiums, low insurance fees, and low coverage; (2) obligatory designation of medical institutions; (3) and allowance of non-benefit services. These features have made hospitals and doctors interested in profit-seeking. However, the commercialization of medical institutions has taken place in both private- and public-established sectors. A basic problem of commercialization is the co-existence of the obligatory designation of medical institutions and non-benefit services. The problem became worse in the Kim Dae-Jung government because it officially permitted non-benefit services. Since 2000, the Korean government has consistently pursued benefit extension policies, but the coverage rates of the NHI have stagnated. In addition, premiums and current medical expenses have markedly increased because policy-makers have emphasized accessibility to the NHI, while ignoring important principles of medical social security such as a needs-based approach and patient-referral system. In order to resolve the commercialization problem, the obligatory designation of medical institutions to the NHI should be changed to a contract system, and non-benefit services should be prohibited at NHI institutions. We must re-establish the patient-referral system via a needs-based approach. We also need to build a primary healthcare system and public health policies. We should make a long-term plan for healthcare reform.

• Health Policy and Management
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• v.31 no.4
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• pp.387-398
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• 2021

Moon Jae-in Care can be seen as a 2.0 version of Roh Moo-Hyun Care. Just as Roh Care failed to achieve its coverage rate goal and 30% share of public beds, Moon Care also failed to achieve its expected goal. The reason is that it followed Roh Care's failed strategy. Failure to control non-covered services has led to a long way to achieve a 70% coverage rate and induced the expansion of voluntary indemnity insurance, resulting in increased public burden. The universal coverage of non-covered services caused an immediate backlash from doctors. And Moon government also failed to control the private insurance market. The expansion of publicly owned beds has not become realized and has not obtained public support. Above all, it failed to overcome the resistance of doctors and failed to obtain consent from budget power groups in the cabinet for public investment. It was also insufficient to win the support of civic groups. Communication with interested groups failed and the role of private health care providers was neglected. The next government should also continue to strengthen health care coverage, but it should prioritize preventing medical poor and create a consensus with both medical providers and consumers for the control of non-covered services. Ahead of the super-aged society, the establishment of linkage between medical services and long-term care and visiting health care or welfare services is an important task. All public and private provisions and resources should be utilized in the view of a comprehensive public health perspective, and public investment should be input in sectors where public medical institutions can perform more effective functions. The next government, which will be launched in 2022, should design a new paradigm for health care in the face of a period of transformation, such as the coming super-aged society in 2026 and the Fourth Industrial Revolution, and recognize that the capabilities of the health care system represent the nation's overall capacity.

• Health Policy and Management
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• v.23 no.4
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• pp.303-313
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• 2013

During last 65 years, Korea has achieved very rapid economic growth and social reformation including healthcare system. Many foreigners have praised that Korea healthcare system is very good in the respect of ease accessibility to healthcare under the lowest cost among the industrialized countries. Whole population are covered by the National Health Insurance. Also utilizations of healthcare among different income classes are even. However Korea healthcare system faced with several challenges, in terms of the an aging population and a rise in chronic disease problem, new threats of communicable disease due to globalization, the rapid increase of healthcare expenditure and high financial burden of patients even though they are insured. To cope with these challenges, we need reconsider the healthcare system as followings; to set up ideology of healthcare as normative public goods, to rebuild paradigm of healthcare for 21 century, to reform public health for strengthening health promotion, to develop new method for healthcare management including quality improvement and consumer responsiveness, to build new governance for health and to view new perspective on healthcare as a kind of industry.

• The Journal of the Korea Contents Association
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• v.18 no.1
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• pp.504-516
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• 2018

Many countries have tried to reform financing systems toward UHC and paid attention to the function of strategic purchasing. This study was performed to examine theoretical foundations and the function of strategic purchasing. And we examined the functions of strategic purchasing in Korea based on the framework proposed by Preker(2005). For this purpose, we reviewed literature related to purchasing. we defined the strategic purchasing as strategic activities to provide health care services people need within a given budget, which is carried out by certain organizations, purchasing organizations. These activities include selecting appropriate providers, designing and operating the payment system, setting the price, and determining the target populations and their needs etc. The relationships among government, purchasers and healthcare providers can be explained by the principal-agent theory. In addition to Preker's framework, we emphasized the importance of the infrastructure such as decision making support systems, information systems, health care resource management systems, or expenditure monitoring systems. The National Health Insurance Service and the Health Insurance Review & Assessment Service play major roles in performing strategic purchasing.