• Journal of Society of Preventive Korean Medicine
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• v.11 no.2
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• pp.175-188
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• 2007

The purpose of this study was to confirm the reasons why the medical institutes avoid the traffic accident victims covered by the automobile insurance. For this purpose, a university hospital was sampled to comparatively analyze days of hospitalization, average medical cost per day, ratio of optional medical cost, average cost by injury/age group/department, distribution of MRI photographing, etc., between health insurance and automobile insurance patients. Accordingly, in order to assure automobile patients of a reasonable rights of medical services, it is deemed necessary to arrange a fair system encouraging them reduce the days of their hospitalization as well as a complementary mechanism preventing unnecessary expensive medical services due to the hazard.

• Health Policy and Management
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• v.16 no.2
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• pp.117-134
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• 2006

Korean health care system introduced the reform for separation between prescribing and dispensing of drugs (SPD reform) in the latter part of the year 2000. The objective of this paper is to look at what change this reform has brought about in the financial situation of Korean public health insurance scheme, particularly in terms of insurance benefit outlay. Since the inception of the reform is a development of more than five years ago, its impact on the finance situation would now start to become apparent. Hypothesis is set in this study for each of three components of drug reimbursement in health insurance, i.e. average price level, composition of drugs and their overall volume. In terms of the classification of health care services by mode of production, the impact of the SPD reform is confined mainly to the last two among three drug reimbursement fields including inpatient department, out-patient department and pharmacy. Pure impact of the SPD reform was estimated to be more or less than 1.7 trillion won, 13.1% of the total outlay of the Nation Health Insurance in 2001, and more than 2.0 trillion won, 14.9% of the total outlay of the Nation Health Insurance in 2003. Both dispensing fees for the pharmacists, which had been newly introduced on occasion of the SPD reform, and larger share of expensive drugs in the medicines prescribed by doctors were confirmed to be main drivers of the augmentation of drug reimbursement.

• Health Policy and Management
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• v.19 no.1
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• pp.62-80
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• 2009

The purpose of this study was to examine the factors influencing the attitude toward the increasing role of private health insurance(PHI). In the Korea Welfare Panel Data 2007, a sample of 1,675 (adjusted by weight value: 1,607) respondents on an opinion on promoting PHI was used in the study. With independent variables including socio-demographic characteristics, health status, health-related behavior, and opinions on welfare service, ordered-probit model was used to analyze the attitude toward PHI. Negative opinion on the increasing role of PHI were responded by 54.6%(n=877) of the respondents, whereas 22.2%(n=373) were positive and 23.2%(n=357) were neutral. Old people, the better off, those with worse self-assessed health status, and those having an experience of health examination tend to have the positive attitude toward the increasing role of PHI. Women, those with chronic diseases or disorders and those who do not agree that comprehensive welfare benefits reduce work incentive showed negative attitude toward PHI. When comparing the needs for PHI before and after medical utilization, ex-ante need tends to strengthen the tendency to support private health insurance. This study will contribute to the discussion on the optimal mix of public and private health insurance in Korea by a better recognition of attitude toward PHI and health care system.

• Journal of Preventive Medicine and Public Health
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• v.40 no.2
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• pp.150-154
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• 2007

Objectives : The aim of this study is to identify factors determining the purchase of private health insurance under the mandatory National Health Insurance(NHI) system in Korea. Methods : The data were collected by the National Cancer Center in Korea. It includes cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer. Data were gathered from the hospital Order Communication System (OCS), medical records, and face-to-face interviews, using a structured questionnaire. Clinical, socio-demographic and private health insurance related factors were also gathered. Results : Overall, 43.9% of patients had purchased one or more private health insurance schemes related to cancer, with an average monthly premium of \65,311 and an average benefit amount of \19million. Females, younger aged, high income earners, national health insurers and metropolitan citizens were more likely to purchase private health insurance than their counterparts. Conclusions : About half of Korean people have supple-mentary private health insurance and their benefits are sufficient to cover the out-of-pocket fees required for cancer treatment, but inequality remains in the purchase of private health insurance. Further studies are needed to investigate the impacts of private health insurance on NHI, and the relationship between cancer patients' burden and benefits.

• Health Policy and Management
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• v.18 no.2
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• pp.107-129
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• 2008

The purpose of this paper is to critically examine Korean government's efforts in policy making and implementation regarding the Korea National Health Insurance System in the past and suggest a new paradigm for future policy changes. The structural and political characteristics of the Korea National Health Insurance, where health care services are provided almost exclusively by the private providers and funding for health comes equally from public and private sources, imply persistent difficulties in the operation of the system This may partially explain why the Korean system has continually experienced conflicts among stakeholders whenever there was an attempt to change policy. In this paper, we discuss four cases to illustrate such difficulties and barriers. We propose that in order to address these challenges and reduce policy errors as well as unintended results, it is necessary to restructure policy making process from being oriented toward 'quantitative expansion' to 'qualitative maturity', from a 'linear thinking' to a 'system thinking', from taking a 'top-down' to a 'governance and participatory' decision making process.

• Health Policy and Management
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• v.31 no.3
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• pp.272-279
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• 2021

Background: Korea's health screening program has been faced the need for changes as the population and diseases structure are changing. In addition to Korea, many countries operate state-led health check-up programs to improve the health level of the people, and the operating methods of the program appear in various forms according to each country's health insurance system. This study examines other state-led health screening programs and proposes a direction for the development of Korea's health screening program. Methods: The study was conducted using the literature review method, and the "country" was set as a unit for the case analysis. The operating method of the health screening programs and the financial resources were compared according to the health insurance system. Five countries were selected as Korea, the United States, the United Kingdom, Japan, and Taiwan. Results: The analyzed countries mainly operate the health screening program as a management method for chronic diseases, but there were differences in the operating method, financing, and targeted subjects and examination items. In most countries, a risk assessment was performed prior to the examination (screening), and the subjects who needed the examination were first selected, and a follow-up management service was provided in accordance with the risk each individual exposed. Conclusion: Rather than applying the same screening method to populations with different risk levels, a health screening program will be constructed in consideration of the individual's health level and exposure risk, and the healthcare delivery system will be reorganized so that screening and treatment services can be linked.

• Health Policy and Management
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• v.30 no.2
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• pp.192-198
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• 2020

Background: Korea National Health Insurance Service (NHIS) is operated as a social insurance system in which people pay a portion of their monthly income as insurance premiums and receive benefits when they experience illness or injury. Since 2005, the national health insurance remained surplus accumulating cumulative reserves each year. However, as of 2018, NHIS revenue recorded 62.11 trillion won and spending of 62.29 trillion won. The deterioration of NHIS finances is expected to accelerate with the aging population, income growth, new medical technology development, and enhanced security policies. Methods: To examine the financial health and sustainability of NHIS, we estimated the future revenue and spending until 2030 using the data from Korea Health Insurance Review and Assessment Service statistical yearbook. 2004-2018 average percentage change in NHIS revenue and spending was calculated. We estimated the future NHIS financial status using two methods. In the first method, we calculated the revenue and spending of the future NHIS by applying the 2004-2018 average percentage change to the subsequent years consecutively. In the second method, we estimated the future NHIS financial status after adjusting for the predicted demographic changes such as the aging population and declining birth rate in South Korea. Results: The estimates from this study suggest that the NHIS's cumulative reserves will run out by 2024. Conclusion: In terms of spending on current health insurance, there should be a search for ways of more efficient spending and funding options.

• Health Policy and Management
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• v.17 no.1
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• pp.1-27
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• 2007

This study is designed to estimate an appropriate level of patient's cost-sharing for oriental medical services in the Korean National Health Insurance. The findings of this study can be summarized as follows: 1) The current co-payment system for oriental medical services does not reflect its cost structure in clinical practice due to inconsistency of cost-sharing plan in the NHI. 2) Both oriental medical institutions and their patients, as a result, are at a relative disadvantage in financial burden, compared with other services. 3) The substantial proportion of patients' cost-sharing depends on the amount of co-payment and the range of medical cost that a flat rate is applied to. 4) The extension of the range doesn't make any substantial decrease in patient's cost-sharing. 5) The fixed amount of co-payment is more sensitive than a range to total variations of patient's cost-sharing. Based on the above, the budget impacts of a new co-payment system were estimated for each co-insurance rate, according to given scenarios. The results range from -59 billion Won (-8.5%) to 16 billion Won(2.3%).

• Health Policy and Management
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• v.29 no.2
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• pp.206-219
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• 2019

This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2018 constructed according to the SHA2011, which is a manual for System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analyzing health accounts of OECD member countries. Particularly, scale and trends of the total CHE financing as well as public-private mix are parsed in depth. In the case of private financing, estimation of total expenditures for (revenues by) provider groups (HP) is made from both survey on the benefit coverage rate of National Health Insurance (by National Health Insurance Service) and Economic Census and Service Industry Census (by National Statistical Office); and other pieces of information from Korean Health Panel Study, etc. are supplementarily used to allocate those totals into functional classifications. CHE was 144.4 trillion won in 2018, which accounts for 8.1% of Korea's gross domestic product (GDP). It was a big increase of 12.8 trillion won, or 9.7%, from the previous year. GDP share of Korean CHE has already been close to the average of OECD member countries. Government and compulsory schemes' share (or public share), 59.8% of the CHE in 2018, is much lower than the OECD average of 73.6%. 'Transfers from government domestic revenue' share of total revenue of health financing was 16.9% in Korea, lower than the other social insurance countries. When it comes to 'compulsory contributory health financing schemes,' 'transfers from government domestic revenue' share of 13.5% was again much lower compared to Japan (43.0%) and Belgium (30.1%) with social insurance scheme.

• Journal of Korean society of Dental Hygiene
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• v.9 no.1
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• pp.169-180
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• 2009

This study grasped recognition on a system of long-term care insurance for the elderly targeting dental professionals who are working at dental hospitals and clinics where are located in Daejeon Metropolitan City. It developed and utilized materials available for educating the care staff in a system of long-term care insurance for the elderly and the dental professionals who participate in the oral hygiene service. It carried out the effective duty performance for the elderly in a situation of long-term care protection. Thus, the purpose of this study was to contribute to the early settlement in a system of long-term care insurance for the elderly. The following conclusions were obtained as a result of having carried out self-administered questionnaire research targeting 238 people from August 1 to August 30 in 2008. 1. In the general characteristics of the research subject, the present working place was indicated to be 22.7% for dental hospital, 71.8% for dental clinic, and 5.5% for others. As for the main duty field, the medical treatment & cooperative duty was indicated to be the highest with 61.8%, and was statistically significant(p=0.000). 2. The necessity for a system of long-term care insurance for the elderly was indicated to be 77.7% for 'necessary' and 1.7% for 'unnecessary,' and was statistically significant(p=0.016). 3. In the item of dividing the service of long-term care insurance for the elderly, the dental hygienists showed higher recognition than non-dental hygienists, and indicated significant difference(p=0.010). 4. As for recognition on a system of long-term care insurance for the elderly in dental professionals who responded as saying of 'knowing name and contents' about a system of long-term care insurance for the elderly, the recognition level was high in recognition of subjects' age(p=0.000), division in services(p=0.012), contents in at-home care service(p=0.000), execution in oral-hygiene service(p=0.004), procedure of using the long-term care insurance for the elderly(p=0.016), item of judging grade of long-term care insurance for the elderly(p=0.013), medical charge by service according to judging grade of long-term care insurance for the elderly(p=0.015), burden of cost for a system of long-term care insurance for the elderly(p=0.011), qualification of care staff(p=0.002), and contents of oral-hygiene service(p=0.027), and showed significant difference. 5. The service of long-term care insurance for the elderly and the oral-hygiene service indicated the statistically significant correlation. Accordingly, all of dental professionals need to make a desperate effort to improve dental professionals' knowledge on a system of long-term care insurance for the elderly enough to be required a system of long-term care insurance for the elderly. The more systematic and standardized professional education and materials are thought to be needed to be developed aiming at the success in oral-hygiene service within a system of long-term care insurance for the elderly, by strengthening professionalism in dentists and dental hygienists.