• Health Policy and Management
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• v.33 no.3
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• pp.325-337
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• 2023

Background: While there are many studies estimating the effects of private health insurance on various types of health care utilization, few have examined how such effects change in conjunction with important policy reforms in national health insurance (NHI). This study examined how the effect of private health insurance (supplemental and fixed cash benefit) on high-cost outpatient imaging test utilization changed following the expansion of magnetic resonance imaging (MRI) coverage in 2018, which is a key example of the NHI benefit expansion policy in recent years. Methods: Data from the 2017 and 2019 Korea Health Panel Survey, which contained information about healthcare utilization before and after the expansion of MRI coverage in 2018, were used. The incremental effect of private health insurance on high-cost outpatient imaging test utilization for each period were quantified and compared, with special attention given to the type of private health insurance. Results: While people with supplemental private health insurance were more likely to use high-cost outpatient imaging tests than those without, both before and after the expansion of MRI coverage, the incremental effect increased from 1.6% points in 2017 to 2.5% points in 2019. Conclusion: Benefit expansion in NHI does not necessarily reduce disparities in the use of health care between private health insurance subscribers and non-subscribers. The results of our study also suggest that the path through which private health insurance affects healthcare utilization may not be limited to the price mechanism alone but can be more complex.

• The Journal of the Convergence on Culture Technology
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• v.10 no.3
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• pp.667-673
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• 2024

This study aims to diagnose the issues arising from the relationship between the out-of-pocket maximum in health insurance and private indemnity health insurance and propose policy tasks for institutional improvement. Through literature research, the study analyzed the damage to consumers caused by the non-payment of refunds exceeding the out-of-pocket maximum and the changing role of indemnity insurance due to the strengthening of health insurance coverage. The results confirmed that unilateral interpretation of insurance clauses and incomplete sales practices infringe upon consumer rights, and that insurance premiums do not decrease despite the reduction in coverage of indemnity insurance. Therefore, the study emphasized the urgency of institutional improvements such as rationalization of product structure, transparency of risk rate calculation, and reinforcement of consumer information provision, as well as the need for social consensus on the rational division of roles between health insurance and private insurance. This study is significant in that it provides policy implications for the developmental reorganization of the healthcare system.

• Health Policy and Management
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• v.31 no.3
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• pp.261-271
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• 2021

Background: In 2018, the government increased the fee for the magnetic resonance imaging (MRI) image deciphering services of the external hospital to discourage the redundant MRI scan and to induce appropriate use of the MRI services. It is important to evaluate the effect of the policy to provide the basis for establishing other MRI-related policies. Methods: The healthcare data of the patients who had brain MRI scans were organized by episode and analyzed using the panel study in order to find out the effect of the MRI-related policy on the substitution effect and the medical expenses. Results: As a result of the increase in the fee of deciphering the MRI image, there has been an uplift in deciphering the MRI scan of the external hospital. It implies that more hospitals chose to use the MRI scan taken by other clinics or hospitals, rather than the MRI scan taken at their own facilities. Conclusion: The research results imply that a policy that facilitates the exchange of the medical image data between the hospitals is needed in order to establish an efficient management system of the healthcare resources. Such improvement is expected to reduce the social cost and contribute to the stability in the finance of national health insurance.

• Health Policy and Management
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• v.33 no.3
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• pp.264-272
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• 2023

Background: Private health insurance supplements the coverage of national health insurance in Korea. In this situation, the subject of the study is to identify the healthcare utilization of people with physical and mental illnesses according to private health insurance. Methods: This study used data from the Korea Health Panel Survey 2018. The study population consisted of 813 individuals with physical and mental illnesses (PMI). Multiple logistic regression analysis and binominal logistic regression analysis were conducted about the utilization of emergency, inpatient, and outpatient medical services of people with PMI depending on enrollment in private health insurance (PHI). Results: The results of this study indicated that individuals with PHI utilized emergency and outpatient medical services less frequently compared to those without PHI. Conversely, having PHI was associated with a higher utilization of inpatient medical services compared to not having PHI. Binomial logistic regression analysis revealed that individuals with PMI who had PHI exhibited a higher frequency of visits to emergency and outpatient medical services compared to those without PHI. However, the significance of this trend was not observed in the case of emergency medical services. On the other hand, individuals with PMI who had PHI showed a lower frequency of visits to inpatient medical services compared to those without PHI. Conclusion: In conclusion, there was a significant relationship between having PHI and the utilization of medical services in people with PMI. There is a need for a follow-up study considering the type of mental illnesses, length of stay, and health outcome of people with PMI depending on having PHI.

• Health Policy and Management
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• v.28 no.3
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• pp.263-271
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• 2018

Health technology assessment (HTA) is defined as multidisciplinary policy analysis to look into the medical, economic, social, and ethical implications of the development, distribution, and use of health technology. Following the recent changes in the social environment, there are increasing needs to improve Korea's healthcare environment by, inter alia, assessing health technologies in an organized, timely manner in accordance with the government's strategies to ensure that citizens' medical expenses are kept at a stable level. Dedicated to HTA and research, the National Evidence-based Healthcare Collaborating Agency (NECA) analyzes and provides grounds on the clinical safety, efficacy, and economic feasibility of health technologies. HTA offers the most suitable grounds for decision making not only by healthcare professionals but also by policy makers and citizens as seen in a case in 2009 where research revealed that glucosamine lacked preventive and treatment effects for osteoarthritis and glucosamine was subsequently excluded from the National Health Insurance's benefit list to stop the insurance scheme from suffering financial losses and citizens from paying unnecessary medical expenses. For the development of HTA in Korea, the NECA will continue exerting itself to accomplish its mission of providing policy support by health technology reassessment, promoting the establishment and use of big data and HTA platforms for public interest, and developing a new value-based HTA system.

• Journal of Korean Public Health Nursing
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• v.29 no.1
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• pp.53-66
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• 2015

Purpose: This study was considered in order to identify the factors affecting healthcare utilization by Asian immigrants in the United States. Methods: From February to April 2011, a descriptive survey study was conducted in a convenience sample of 250 Korean and Asian Indian immigrants aged between 40 and 64 in the Triangle area of North Carolina. An author-developed instrument was used to assess predisposing, enabling, and need factors according to Anderson's Behavioral Model of Health Services. Utilization Data analysis was performed by $X^2$-test, t-test, and binary logistic regression. Results: Participants' healthcare services experiences were significantly different when they had a longer stay in the U.S., had been employed, had higher income, were Asian Indians, had better English-speaking skills, better health status, more knowledge of health system and health insurance, had higher satisfaction with the healthcare system, and when they were taking prescribed medications and having health insurance. The strongest association with experience of healthcare services was having health insurance with an adjusted odds ratio (OR) of 15.37 (95% CI 4.95-47.71, p<.001) and self-reported English proficiency (OR=1.99, 95% CI 1.00-3.96, p=.05). Conclusion: Intervention strategies to increase accessibility to healthcare services should focus on these significant predictors.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.2
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• pp.395-400
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• 2015

Both Japan and Korea provide population-based screening programs. However, screening rates are much higher in Korea than in Japan. To clarify the possible factors explaining the differences between these two countries, we analyzed the current status of the cancer screening and background healthcare systems. Population-based cancer screening in Korea is coordinated well with social health insurance under a unified insurer system. In Japan, there are over 3,000 insurers and coordinating a comprehensive strategy for cancer screening promotion has been very difficult. The public healthcare system also has influence over cancer screening. In Korea, public healthcare does not cover a wide range of services. Almost free cancer screening and subsidization for medical cost for cancers detected in population-screening provides high incentive to participation. In Japan, on the other hand, a larger coverage of medical services, low co-payment, and a lenient medical audit enables people to have cancer screening under public health insurance as well as the broad range of cancer screening. The implementation of evidence-based cancer screening programs may be largely dependent on the background healthcare system. It is important to understand the impacts of each healthcare system as a whole and to match the characteristics of a particular health system when designing an efficient cancer screening system.

• Health Policy and Management
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• v.24 no.2
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• pp.109-119
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• 2014

In accordance with the government's plan to expand the national health insurance (NHI) coverage for severe diseases such as cancer, heart disease, cerebrovascular disease, and rare and incurable disease, the diagnostic ultrasound services have been covered by NHI from October 1, 2013. The quality is very important factor in providing diagnostic services because they influence on the diagnosis, treatment, and outcome of diseases. In particular, equipments and health care providers plays an important role in providing qualitative services. The purpose of this paper is to examine the major feature of ultrasound services covered by health security system and to review quality assurance policies in other countries such as Australia, Japan, the USA, and Canada. In addition, we assessed the implication of those policies. We especially put emphasis on the types and qualifications of healthcare professionals and measures to manage equipments. All countries have reviewed on policies to promote the quality such as educational requirements of professionals or restrictions on the duration of equipment usage. Various measures should be implemented to assure the qualitative ultrasound service.

• Quality Improvement in Health Care
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• v.22 no.1
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• pp.11-26
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• 2016

The Organization for Economic Cooperation and Development, which has continuously evaluated the performance of healthcare systems, has recently invested much effort into hospital performance measurement. The purpose of this paper is to introduce the hospital performance measurement programs operated by international organizations or at the national level based on the OECD's hospital performance project. Health Insurance Review & Assessment service (HIRA)'s quality assessment was analyzed based on the analytical framework of the OECD's hospital performance project. The hospital performance measurement programs of WHO, Canada, Australia, United States and United Kingdom are briefly explored, in view of the conceptual framework, key performance dimensions and indicators that are currently in use. The OECD suggested seven key dimensions of hospital performance: timeliness, efficiency, continuity, effectiveness and appropriateness, staff orientation, patient orientation and safety. The analysis of the quality assessment program of HIRA, which operates 36 diseases and procedures and 347 indicators, shows that the numbers of indicators are relatively small in the areas of safety, patient centeredness and efficiency. Continuity of care and staff orientation are not fully developed also, but the situations are similar in other countries. In conclusion, hospital performance measurement using stable and comprehensive data should be developed to improve overall system performance, and discussions on a conceptual framework that can lay out directions and key performance domains need to take into place.

• 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.