• Journal of Preventive Medicine and Public Health
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• 제43권6호
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• pp.455-458
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• 2010

The Affordable Care Act (ACA) was signed into law on March 23, 2010 and will fundamentally alter health care in the United States for years to come. The US is currently one of the only industrialized countries without universal health insurance. The new law expands existing public insurance for the poor. It also provides financial credits to low income individuals and some small businesses to purchase health insurance. By government estimates, the law will bring insurance to 30 million people. The law also provides for a significant new investment in prevention and wellness. It appropriates an unprecedented $15 billion in a prevention and public health fund, to be disbursed over 10 years, as well as creates a national prevention council to oversee the government's prevention efforts. This paper discusses 3 major prevention provisions in the legislation: 1) the waiving of cost-sharing for clinical preventive services, 2) new funding for community preventive services, and 3) new funding for workplace wellness programs. The paper examines the scientific evidence behind these provisions as well as provides examples of some model programs. Taken together, these provisions represent a significant advancement for prevention in the US health care system, including a shift towards healthier environments. However, in this turbulent economic and political environment, there is a real threat that much of the law, including the prevention provisions, will not receive adequate funding.

• 대한예방한의학회지
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• 제10권2호
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• pp.147-158
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• 2006

The purpose of this paper is to review the empirical study results of conversion factors(unit prices) for relative values of health care services in the national health insurance system and establish optimal classification of health care institutions for feasible contract of conversion factors between National Health Insurance Corporation(NHIC) and provider groups, based on legal backgrounds and types of health care service delivery system. some empirical research evidences shows the validity of applying multiple conversion factors to annual contract for reimbursement in the national health insurance. Policy recommendations suggest that clinic, hospital, general hospital, tertiary hospital, dental clinic, oriental medical clinic, pharmacy, and public health centers would be a basic category of provider groups for a meaningful price contract between the NHIC and providers.

• 대한한의학회지
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• 제30권4호
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• pp.64-78
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• 2009

Objectives: To research Korean oriental medical doctors' use of uninsured herbal extracts and how to bring about the insurance coverage of such herbal extracts. Methods: We surveyed Korean oriental doctors about the following issues from October 17th to November 15th, 2008: (1) Korean oriental medical doctors' knowledge about herbal extract insurance and the circumstances of oriental medicine in Korea, (2) their opinion on the coverage of currently uninsured herbal extracts and the dispensing of herbal extracts from pharmacies rather than from their clinics, (3) their use of herbal extracts, and (4) how to bring about insurance coverage of uninsured herbal extracts. Results: Over 70% of the respondents said that herbal medicine prescriptions have been reduced recently and that the existence of herbal medicine is in danger. In addition, 63.64% respondents agreed with expanding insurance coverage to include currently uninsured herbal extracts in spite of the fact that patients might have to obtain herbal extracts from pharmacies rather than from Korean oriental medical clinics. The average patient number per month of uninsured herbal extracts was 13.64 people, the average dosage was 5.64g, the average cost per day was 3,859 won, and the average prescription period was 2.65 days. Korean oriental medical doctors asked an average of 12,486 won for the medical examination-prescription fee and 3,292 won in fees for prescriptions obtained outside the hospital. If insurance coverage expands to include these herbal extracts, their usage is expected to increase 2.31 times. Conclusions: This study shows Korean oriental medical doctors' use of herbal extracts and their opinions about execution of herbal extracts' insurance. A periodic study such as this one will hopefully aid in establishing polices for uninsured herbal extracts' insurance.

• 척추신경추나의학회지
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• 제7권2호
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• pp.1-14
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• 2012

Objectives : The aim of this study was to prepare the validity and relevance for National Health Insurance of Chuna manual therapy through measurement of resource-based relative value scale(RBRVS) scores. Methods : To prepare for National Health Insurance, we studied it about standardized classification of the practice and definition, and speciality by difficulty and safety of Chuna manual therapy. Results : Classification of the practice could be classified to 7 of Chuna manual therapy and 24 traditional manual therapy, it also categorized as one of 3 kinds(basic, simple, special). The RBRVS scores of Chuna manual therapy were measured to 283.28, 566.57 and 1133.14. Conclusions : This study could be used to basis data for National Health Insurance of Chuna manual therapy, but further studies must be needed more objective investigation and data to calculate RBRVS scores.

• 보건교육건강증진학회지
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• 제20권1호
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• pp.41-60
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• 2003

This study, performed to analyze the factors associated with health and cancer screening using preventive programs form health insurance among the women of a community, through a survey of about 923 women in Euijungbu-city. The subjects of the study were selected by a proportional cluster sampling method. The self-reported questionnaire was intended to fine factors associated with health screening and cancer screening. The results of this study were as follows: 1. In the case of health screening using health insurance, 14.1% of the subjects turned out to have been screened once or more in their respective life-time. Reasons given for non-participation in the screening were : 'lacking screening information', a belief that' it's not useful' and a belief that they' weren't sick'. 2. The factors associated with health screening behavior were age, educational level, number of doctor visits, BMI and health promotion behavior(p<0.01, p<0.05). Also, the factors associated with health screening behavior were cue to action and health status, and the predictors on health screening behavior were age and health promotion behavior(p<0.01, p<0.05). 3. In the case of cancer screening through the health insurance, 7.4% of the subjects turned out to have been screened once or more respectively in their life-times. Reasons given for non-participation in the screening were : 'lacking screening information', a belief they 'weren't sick' and that it's not useful'. 4. The factors associated with cancer screening behavior were age, educational level, income, alcholol intake, exercise, number of doctor visits and BMI(p<0.01, p<0.05). Aditional factors associated with cancer screening behavior were cue to action, health belief score and health status. Predictors for cancer screening behavior were: age, health belief score, screening attitude and health status(p<0.01, p<0.05). As indicated by the above results, a lack of information was an important factor for a lack of participation in screening. Age and cue to action were also important factors in promoting the cancer screening rate. Therefore, a dissemination of information about cancer screening contributes to the promotion of a screening rate, and cooperation between health insurance and local health cancer facilitates to be public the community-based cancer screening program.

• Journal of Chest Surgery
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• 제49권sup1호
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• pp.20-27
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• 2016

Background: This study analyzed the association between the volume of heart surgeries and treatment outcomes for hospitals in the last five years. Methods: Hospitals that perform heart surgeries were chosen throughout Korea as subjects using from the Health Insurance Review and Assessment Service. The treatment outcome of the heart surgeries was defined as the mortality within 30 postoperative days, while the annual volume of the surgeries was categorized. Logistic regression was used as the statistical analysis method, and the impacts of the variables on the heart surgery treatment outcomes were then analyzed. Results: The chance of death of patients who received surgery in a hospital that performed 50 or more surgeries annually was noticeably lower than patients receiving operations from hospitals that performed fewer than 50 surgeries annually, indicating that the chance of death decreases as the annual volume of heart surgeries in the hospital increases. In particular, the mortality rate in hospitals that performed more than 200 surgeries annually was less than half of that in hospitals that performed 49 or fewer surgeries annually. Conclusion: These results indicate that accumulation of a certain level of heart surgery experience is critical in improving or maintaining the quality of heart surgeries. In order to improve the treatment outcomes of small hospitals, a support policy must be implemented that allows for cooperation with experienced professionals.

• 대한예방한의학회지
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• 제24권2호
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• pp.83-94
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• 2020

Backgrounds : To reduce the patients' economic burden of herbal decoctions use, in 2012, Korean government decided to implement the pilot project of herbal decoctions coverage in the National Health Insurance. Objectives : This study aimed to analyze the policy decision-making process for the pilot insurance project in 2012. Methods : Official documents, research papers, statistical reports, and news articles, etc. on the coverage of herbal decoctions were searched and collected. We used the Kingdon's Policy Stream Model to analyze how the policy of pilot project of herbal decoctions coverage was decided, and who were the main activists for the decision-making process. Results : Components to be included in the 'Problem stream' were the decline in the profits of Korean Medicine institutions, the contraction of the herbal decoctions use, and the fiscal surplus of National Health Insurance. In the 'Policy stream', there were several model studies for herbal decoctions coverage, and examples of herbal benefits in other social insurances. In the 'Political stream', there were the legislative initiatives by member of the National Assembly and the promotion of insurance coverage by the Association of Korean Medicine(AKOM), etc. Policy window for herbal decoctions coverage was opened by the combination of these three streams with the efforts of policy activists, such as the executives of AKOM, and policy researchers. Conclusions : The policy decision process for health insurance coverage of herbal decoctions was analyzed using Kingdon's model, and the analysis shows that the combination of political streams and entrepreneurs' competencies can be an important driving force in policy decision making.

• 의료법학
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• 제8권2호
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• pp.69-118
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• 2007

In providing general medical treatments, the medical service contract between the patient and the doctor is the mutually responsible onerous contract. However, the nature of the mutually assumed contract standings of the patient and the doctor has been changing since the implementation of the national health insurance program. For instance, besides the cases of beyond excessive medical charges and medical negligence, if the doctor charged for his/her medical treatments violating the post-treatment/nursing cover criteria, the overpaid medical charge, regardless of being collected with the patient's consent, has to be refunded back to the patient. Medically needed aspects, treatment results, and unfair benefits favoring the patient are not at all taken into consideration in the health insurance scheme. This makes it easier for patients to get refunds for their share of the medical payments by involving the Health Insurance Review & Assessment Service or the National Health Insurance Corporation, without engaging in civil law suits (for reimbursement claim) against doctors. In other words, the doctor's responsibility to provide medical treatments and the patient's responsibility to pay for the medical treatment provided within the contractual realm are being demolished by the administrational arbitration of the National Health Insurance system. The basic rights of medical service providers, and the patient's right to choose are as important constitutional rights, as the National Health Insurance program, which is essential in the social welfare system. Furthermore, the development of the medical fields should not be prevented by the National Health Insurance system. If the medical treatment services can be divided into necessary treatments, general treatments, and high quality treatments, the National Health Insurance is supposed to guarantee the necessary and general treatments to provide medical treatments equally to all the insured with limited financial resources. However, for the high quality treatments, it is recommended that they should not be interfered by the National Health Insurance system, and that they should be left to the private contract between the patient and the doctor.

• Tuberculosis and Respiratory Diseases
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• 제63권2호
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• pp.188-193
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• 2007

악성 흉수의 원인은 폐암, 유방암, 및 악성 림프종, 백혈병이 그 대부분을 차지하며 내분비 종양에 의한 악성 흉수는 매우 드물며 특히 유두상 갑상선 암에 의한 흉수는 거의 없다. 저자들은 유두상 갑상선 암이 폐 전이를 거치지 않고 유방 전이를 거쳐 흉막 전이 일으킨 것으로 보이는 1예를 경험하였기에 보고하는 바이다. 아울러 원인이 명확하지 않은 악성 흉수의 원인 감별에 유두상 갑상선 암도 고려 대상으로 할 필요가 있다고 생각한다.

• Journal of Preventive Medicine and Public Health
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• 제40권4호
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• pp.329-335
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• 2007

Objectives : To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. Methods : The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. Results : Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. Conclusions : We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.