• Journal of Society of Preventive Korean Medicine
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• v.11 no.1
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• pp.139-151
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• 2007

This paper evaluated the benefits of the National Health Insurance(NHI) and suggested the necessity of extending some oriental medical services into the benefits schedule in the NHI. Comparing the rate of public financing in national health expenditure in OECD countries and measuring out-of-pocket payments in total medical cost showed the level of insurance payments to total medical cost is approximately $50%{\sim}60%$ in Korea, which is quite insufficient to pay household medical expenses, although the NHI covers the whole population. A few of consumers' priority surveys for medical needs suggested herb medicine, muscle treatment, and manufactured herb medicine be included in the list of the NHI benefits, based on efficiency and equity criteria. It was estimated that the NHI can afford to cover these three items of oriental medical services.

• The Journal of Korean Medicine
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• v.28 no.3 s.71
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• pp.244-260
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• 2007

Objectives : The purpose of this study was to provide lawmakers with basic data for the purpose of establishing a policy on health insurance for packed herbal medicine. Methods : To properly execute an insurance system for packed herbal medicine, we surveyed the following questions from May 1st to June 15th, 2006: (1)the way to pay the insurance benefits (2)specific impression (disease) names as related to insurance (3)the range of insurance coverage. We obtained answers from 304 Korea traditional doctors. Results : 89.4% respondents were agreed on execution of health insurance for packed herbal medicine. 93.86% respondents answered that the way to pay insurance benefits and the range of insurance coverage have to be changed properly. Most respondents answered that the coverage should be based on a specific disease being treated, not the current symptoms method which relates to the prescription. The execution of health insurance for packed herbal medicine is expected to increase the number of patients and make the Korean medical system more popular. Conclusion : The findings are expected to make it easier for the general public to get treatment by providing basic data with policy makers that will cover packed herbal medicine in insurance. Also, a proper Korea traditional health insurance program should be set up as soon as possible to widen the choice of medicine for the general public.

• The Korean Society of Law and Medicine
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• v.8 no.1
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• pp.137-177
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• 2007

The medical expenses review system in Korea has developed under fee-for-service system with its own unique structure. The importance of reviewing medical expenses has been emphasized, as the size of medical expenditures moving through the health insurance legal context and its weight in the national economy have increased very rapidly. It is, however, analyzed that the feuds and arguments continue among the stakeholders for the lack of laws supporting the medical expenses review system. The medical expenses review is a series of administrative procedures, deciding whether claims from medical care institutions to the insurer are legal and valid or not. It mainly controls the increase of unnecessarily excessive health insurance claim and prevents fraudulent claim and abuse and checks the less use or unsuitable use of medical resources. It also works a function guarantees medical benefits for the appropriate treatment according to the object of health insurance system as a social insurance scheme. The dispute on legal base of the medical expenses review is about the source of law in the medical expenses review. There are the Health Insurance Act and administrative laws as jus scriptum and the guidelines of review as administrative orders. The medical expenses review should reflect various factors, such as the development of medical healthcare technologies, the health expenditures distribution, the financial situation of the health insurance, and the evaluation on the level of appropriate benefits. It is also likely to adapt to the traits of characters of medicine, and trends and transition, Besides it should judge the legality and the validity of medical benefits expenditures by synthesizing these all factors. And the evaluation system of appropriateness of medical benefits was administrative procedure which was consecutive with reviewing the medical expenses system and it was intended to make up for the result of reviewing the medical expenses in more comprehensive levels.

• Journal of dental hygiene science
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• v.15 no.6
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• pp.768-774
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• 2015

The purpose of this study was to grasp the benefits from pit and fissure sealants and to analyze the factors of influencing the benefit amount by using the raw data of the Korea National Health and Nutrition Examination Survey for 2007~2013 targeting the subjects aged from 6 years in full to 18 years. The analysis was used STATA 11.0. As a result of the analysis, the following conclusions were obtained. It rose up to 1.24 pieces after carrying out the national health insurance coverage from averagely 0.93 piece until the year in 2007~2009 (up to November) when is before enforcing the national health insurance coverage in the pit and fissure sealants. The benefits from pit and fissure sealants depending on general characteristics were surveyed to be higher in the higher income level, in the more subscription to health insurance and private insurance, and in the more toothbrushing frequency per day. The factors that have influence upon the benefits from pit and fissure sealants were shown to include whether or not to have the national health insurance coverage in the pit and fissure sealants, income level, health insurance type and private insurance subscription appearance, and one-day toothbrushing frequency. Synthesizing the results, a rise in the benefits from pit and fissure sealants is shown in 2010 based on December 2009 when the national health insurance coverage in the pit and fissure sealants was implemented, but is showing the tendency of declining again from 2011. To increase the benefits from pit and fissure sealants, it is thought that the schemes will need to be discussed such as reinforcing publicity on the national health insurance coverage in the pit and fissure sealants, expanding a support for low-income bracket, and differentiating the outpatient cost sharing according to socio-economic level.

• Journal of Digestive Cancer Research
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• v.11 no.2
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• pp.104-107
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• 2023

The Ministry of Health and Welfare of Korea has implemented various social security programs to ensure a basic standard of living and raise overall quality of life for all citizens. The Korean social security system provides social insurance, public assistance, and social welfare services. To achieve adequate drug benefits, the Drug Management Department of Health Insurance Review and Assessment Service (HIRA) implement drug management duties including drug listing, upper price limit setting, scope of benefits, and post-factum management. When a manufacturer or an importer wants to apply for National Health Insurance (NHI) coverage of the drug that has obtained safety and efficacy approval, the pharmaceutical benefit assessment committee of HIRA evaluates the drug's clinical efficacy and cost-effectiveness to determine whether or not to include the drug into the benefit package. The benefit standards for a listed drug (ingredient) are set either for the whole permitted range or a part of range with conditions. To increase the coverage rate for new drugs, the listed drugs are regularly reviewed for their value. The status of listed drugs can be adjusted or eliminated from the benefit package if the clinical efficacy turns out to be insignificant. Therefore, through these pharmaceutical management procedures, high-quality drugs are provided at reasonable prices, which save healthcare expenditure by price determination and selective coverage in consideration of economic evaluation.

• Health Policy and Management
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• v.4 no.1
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• pp.77-106
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• 1994

This study attempts to evaluate the beneficial equity and operational efficiency of the three Korean medical insurance programmes and thereby suggest directions for their policy improvement. Concepts of the equity and effciency were reviewed to develop indicators for comparative analysis. For the analysis, statistical and financial accounting data for 1991, issued by the National Federation of Medical Insurance and the Korea Medical Insurance Corporation, on the operational status and performances of the programmes, were collected and rearranged to be suited to the purpose of the study. The analysis reveals that beneficial inequity exists between self-employed and employee programs. and that operational inefficiency is prominent in both programms for self-employeds and for Government employees and private school teachers. In order to improve the beneficial inequity of the self-employed program, it is suggested that policies be formulated and implimented toward increasing the program revenue through increasing subsidies from the Government, and through inter- program finance adiustment. For the operational inefficiency of the two programs, it is judged that, toghether with the administrative support and control from the Government and the insurance society bodies, self- efforts be initiated to improve the internal mangement styles and systems of the insurance societies. Finally, from the viewpoint of the structural efficiency, expansion of the preventive insurance benefits by the insurance soceties is recommended both for beneficial equity and operational efficiency.

• The Journal of the Korean life insurance medical association
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• v.21
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• pp.173-181
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• 2002

• The Journal of the Korean life insurance medical association
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• v.21
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• pp.149-156
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• 2002

• The Journal of the Korean life insurance medical association
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• v.21
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• pp.157-171
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• 2002

• Health Policy and Management
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• v.22 no.1
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• pp.145-162
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• 2012

The purpose of this study is to understand magnitude and its related factors of user's cost-sharing for non-covered services in long-term care facilities. We corrected data for 1,016 subjects, based on the long-term care benefits cost specification. Eighteen subjects were excluded from the data analysis due to missing data on family care-givers characteristics. Finally, 998 subjects were included in the study. The average cost of non-covered services per month was 209,093 won and distributed from 0 to 1,011,490 won. There was a significant difference by the characteristics of family care-givers and long-term care facilities. The monthly average cost for meal materials per person was 199,181 won(0~558,000), average cost of additional charge caused by using private bed was 232,992 won (50,000~600,000), and costs for haircut and cosmetics were 8,599 won. For the rest, there were various programs costs(93,328 won), diaper and its disposal cost(109,628 won), purchase cost for daily necessaries(24,435 won) and etc. The related factors for the magnitude of non-covered services expenditures were education level of family care-givers, occupancy rate and location of LTC facilities, and the costs of using private bed, haircut and cosmetics, and various programs among non-covered services. These findings suggest that present level range of LTC facilities users' cost-sharing is wide and it is urgent to prepare the standard guideline for cost and level in non-covered services.