• 서비스연구
• /
• 제11권1호
• /
• pp.31-44
• /
• 2021

국내의 의료보험 제도의 순기능은 높이 평가받지만 불완전한 보장성의 문제로 인해 국민들은 민영의료보험 가입을 통해 보장성을 확보하고자 한다. 이로 인해 최근 민영의료보험의 가입률이 높아지게 되었고, 청구율 또한 높아지게 되었다. 이처럼 민영의료보험을 찾는 사람이 늘어남에 따라 민영의료보험사의 근로자는 직무 부담이 가중되었으며, 특히 보험금 지급을 담당하는 보험심사 근무직의 경우 보험금을 고객과의 소통, 회사의 수익 상출에 기여 등 다양한 이유로 직무스트레스가 나날이 증가하고 있으며 그로 인한 부작용을 경험하고 있다. 이에 본 연구는 보험심사 근무직의 직무스트레스가 정신건강에 미치는 영향에 대해 분석하여 보험심사 근무직의 직무스트레스를 감소시키고 정신건강을 증진하고자 서술적 조사 연구를 실시하였다. 분석 결과, 보험심사 근무직의 직무스트레스는 정신건강에 유의한 정(+)의 영향을 미치는 것으로 나타났다. 세부적으로는 직무스트레스가 역할수행능력·자기신뢰도, 우울, 수면장애·불안, 일반건강·생명력의 정신건강 4가지 요인 모두에 유의한 영향을 미치는 것으로 나타났다. 본 연구를 통해 보험심사 근무직의 직무스트레스가 정신건강에 유의한 정(+)의 영향을 미친다는 사실을 알 수 있었다. 직무스트레스는 근로자로 하여금 직무수행에 대한 열의를 감소시키고 이직률, 퇴사율을 높이는 등 조직적인 측면에서의 부작용을 초래하기도 하지만 개인의 신체 건강을 악화시키고 우울, 불안 등과 같은 질환을 유발하여 정신건강을 피폐하게 만들기도 한다. 따라서 이를 예방하기 위하여 대상자의 특성에 맞는 적절한 직무스트레스 예방법과 대처법을 제공하여 직무스트레스를 감소시키고 정신건강을 증진할 수 있도록 지원하여야 할 것이다.

• Clinical and Experimental Pediatrics
• /
• 제51권4호
• /
• pp.339-342
• /
• 2008

The Korean Health Insurance (KHI) has been introduced since 1977 and it took only 12 years that KHI had accomplished the total coverage of Korean population. The remarkable success of KHI can be compared with other OECD countries which had taken some 30 years to over 100 years to establish the total coverage of the population. Life expectancy at birth and the infant mortality rate in Korea in 2005 both surpassed the average figures of the OECD countries, The main reason for the success of KHI can be delineated with the three characteristics in KHI development; low premiums, low benefits, and low fee-schedule charges. However, these three characteristics of KHI, which had been the key for the rapid development of the system, have become terrible disadvantages for the stable development of KHI. The dissatisfaction and discontent of health care providers are ever increasing. The population is reluctant to pay more premiums though it seems essential for the better care coverage. The health care system has been heavily distorted toward high technology-oriented expensive care. There should be several factors seriously tackled for the secure development of KHI in the future. This paper will review a brief history of KHI development, and I would like to make a suggestion of health insurance for children.

• 대한한의학회지
• /
• 제26권2호
• /
• pp.105-125
• /
• 2005

Objectives: The purpose of this study was to identify resources put into clinical. activities and identify a new RBRVS for oriental medical services in the Korean National Health Insurance. Methods: Based on a survey of physician's time, physical effort & technical skill, mental effort & judgment, and stress that were used for patient treatments, relative input values for the relevant clinical activities were estimated and rearranged in a way to be compared. with the current values in health insurance. Results: We found the actual resource-based relative values for oriental medical services statistically different from the current values, with a narrower variation in value distribution. Conclusions: The findings suggest the C\lrrent RBRVS should be revised to reflect the actual input resources into physicians activities and to avoid a distortion of physicians behavior.

• 대한예방한의학회지
• /
• 제12권3호
• /
• pp.21-34
• /
• 2008

Objectives : This paper analysed the alternative methods of calculating conversion factor for oriental medicine in the National Health Insurance and estimated the conversion factor(reimbursing price level) of the oriental medical services, based on health insurance claims data and macro economic data. Methods : Comparing cost accounting method, SGR model, and index model to estimate conversion factor in the national health insurance, six empirical models were derived depending on the scope of revenue considered in financial indicators. Classifications of data and sources used in the analysis were identified as officially released by the government. Results and Conclusion : Cost accounting analysis and SGR model showed a two digit decrease in the physician fee schedule of oriental medical services in the national health insurance, while index model indicated a positive increase in the fee reimbursed. As expected, SGR model measured an overall trend of health expenditures rather than an individual financial status of medical institutions, and index model properly estimated the level of payments to oriental medical doctors. Upon a declining share of health expenditures on oriental medicine, a global budget system fixed to a flat rate of total budget could be an opportunity as well as a challenge.

• 한국병원경영학회지
• /
• 제13권1호
• /
• pp.1-23
• /
• 2008

In the shortest period of time, we achieved both industrialization and democratization. We also achieved good performance in health care sector. Whole population are covered by health insurance since 1989 and health outcomes, such as infant mortality, life expectance show good level. However, health care system has several problems, rapidly increasing rate of health care expenditure, dissatisfaction of both consumers and suppliers. Current health care system does not reconcile with market competition principle. Causes of these problems originated from 1977 paradigm which was formed to expand health insurance to whole population within short period. Dominant assumption of 1977 paradigm is to assure equitable access of health care by government's command and control. We urgently demand to reform the 1977 paradigm to suitable in 21th century. Our economy entered into a road to advancement. We have concerns how President Lee's administration reform health care system to harmonize with economic development and to achieve advancement in health care sector.

• 보건행정학회지
• /
• 제32권3호
• /
• pp.323-329
• /
• 2022

Background: This study aimed to identify the characteristics of the referral and return of patients to clinics in the endocrinology and cardiology departments at the National Health Insurance Service Ilsan Hospital to evaluate the "referral and return of patients to clinics" program and reduce the rate of returning patients. Methods: From May 2018 to December 2020, we identified the number of visits to referral hospitals and hospital usage status at Ilsan Hospital after returning to clinics. We also identified the patients who returned to Ilsan Hospital within 6 months, defined as "failure to transport," among those recommended to be transported to clinics of the Medical Cooperation Center. Additionally, we evaluated the characteristics of the "failure to transport" patients. Results: Among the returning patients, the rate of visiting Ilsan Hospital within 6 months was higher in cardiology than in endocrinology (25.1% vs. 16.7%). Older age, more severe disease, and more number of visits to the department were associated with a high rate of failure to transport. The rate of failure to return was low in cases diagnosed with hyperlipidemia/lipoprotein metabolism disorder. With respect to diabetes, the rate of failure to transport differed according to each type of diagnosis of diabetes. Conclusion: The success rate of the "referral and return of patient to clinics" program differed based on each patient's characteristics, department of visit, and diagnosis. Individualizing according to the visit department and diagnosis is required to ensure successful transfers, and infrastructure expansion and institutional arrangements must be facilitated.

• 가정∙방문간호학회지
• /
• 제24권2호
• /
• pp.181-188
• /
• 2017

Purpose: The aim of this study was to compare between performance and requirements of visiting nursing care in long-term care insurance using the OMAHA system. Methods: The subjects were 72 nurses who had worked in a visiting nursing care center in long-term care insurance. Data were collected from December 5, 2016 to January 31, 2017 using self-recorded questionnaires. The collected data were analyzed using descriptive statistics and paired t-tests. Results: Four dimensions of the OMAHA system showed statistically significant differences between performance and requirements of visiting nursing care in long-term care insurance. The requirements of visiting nursing care were higher than was performance on all 40 items of the OMAHA system. The greatest difference was in environmental domain and then the psychosocial domain. Conclusion: Based on the results, we found that the environmental and psychosocial domains were the largest gap areas. Therefore, with the reality of elderly people living alone and the increase in elderly couples, active intervention connected with the community is needed in residential areas. Further, we suggest that the OMAHA system can be utilized as an integrated conceptual framework for developing and enhancing visiting nursing care in long-term care insurance.

• 보건행정학회지
• /
• 제32권3호
• /
• pp.245-246
• /
• 2022

Concerns about a global economic recession are rising following the coronavirus disease 2019 (COVID-19) pandemic. Accordingly, government entities, which are committed to overcome two barriers to severe inflation and economic recession, are showing high interest in spending management so as not to undermine fiscal soundness. Since the health care sector especially accounts for a large proportion of fiscal expenditure, it should be managed in a manner that the expense is appropriately spent. The National Health Insurance System and Healthcare System have secured international competitiveness and reliability by effectively responding to the COVID-19 pandemic. Likewise, considerable efforts should be made to reorganize the welfare and healthcare systems so that they can be sustainable during the post-COVID-19 era and the recession.

• 보건행정학회지
• /
• 제18권4호
• /
• pp.185-206
• /
• 2008

The National Health Insurance (NHI) has been the main body of health care system in Korea for the last 30 years since the NHI was founded. However, the inefficient management and strong regulations of the NHI have hindered the development of health care industry. The establishment of the MB government, whose interest lies on economic growth rather than equity, is expected to help the health care services gain a momentum. The essential measures that can step up public health care services overall are the following: the introduction of competition within NHI, the activation of private health care insurance, and the allowance of for-profit hospital. The private-public mix with market mechanism would level up the health care service for the public.

• 한국병원경영학회지
• /
• 제26권1호
• /
• pp.55-70
• /
• 2021

Purpose: The purpose of this study was to examine the influencing factors of the patient leaning phenomenon in tertiary hospitals. Based on the results of this study, we intended to find implications for improving the problems of the delivery system imbalance in tertiary hospitals caused by patient leaning phenomenon. Methodology/Approach: Qualitative studies were conducted, using focus group interviews and in-depth interviews. The focus group interviews were conducted for 12 users of tertiary hospitals by 2 groups. And in-depth interviews were conducted for 6 tertiary hospital managers. This was considered to be the most effective approach to gather diverse and in-depth information about the influencing factor of patient leaning phenomenon in tertiary hospitals. Findings: In focus group interviews, the reason for choosing tertiary hospitals was the reliability of the hospital(physician, reputation, etc.). And the effect of the policy to strengthen coverage of National Health Insurance and private medical insurance was relatively small. In other words, we found that the individual's desire to receive medical services suitable for one's health status and disease condition was the biggest factor, rather than the cost and policy factors. Practical Implications: We suggested that the appropriate medical care provision should be strengthened according to the role and function of medical institutions. In addition, the education system needs to be reorganized to activate the referral program, expand community medical capabilities, and foster quality primary medical care.