• Journal of Technologic Dentistry
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• v.43 no.3
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• pp.124-131
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• 2021

Purpose: This study aimed to investigate the perception of dental implant insurance supply and demand for the elderly living in Hongseong-gun and Chungcheongnam-do, as well as the selection criteria regarding dental clinics for dental implant treatment to collect basic data for improving the oral health of the elderly population. Methods: Participants living in Hongseong-gun, Chungcheongnam-do who were at least 55 years old from November 2020 to March 2021 were included in this study. The chi-square test was performed to examine the age-specific perception of insurance-covered dental implants (p<0.05). Results: The age group that was the most interested in implants was the 70s age group, and the difference between this age group and the other age groups was statistically significant. Those in their 70's, 80's, and 90's or older paid about 600,000 won including dental implants covered by insurance, and there was a significant difference (p<0.05). Those in their 60s, 70s, and 80s estimated the highest value of implants covered by insurance as two and showed a significant difference (p<0.05). The awareness of the dental implant insurance by age showed that all age groups, except for the ≥90 years age group, considered the insurance to be mediocre mostly due to the large co-payment (p<0.05). Conclusion: There were differences by age in the awareness of dental implant insurance, co-payments, number of applications, and insurance coverage. The perceptions on dental implant insurance by age showed that all age groups except for those over 90 years and older, they considered the insurance was just mediocre the most.

• 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.

• Health Policy and Management
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• v.21 no.3
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• pp.381-396
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• 2011

This study is to investigate the factors affecting the regional rate of certification for long-term care insurance benefits. Analyzed data were the 253,935 certified beneficiaries (equivalent to 4.9% of total elderly population) as long-term care degree (LTC degree) 1~3 extracted from the applicants for long-term care in the beginning stage of the system from April 15 2008 to July 1 2009. Although the data were collected from individuals, after restructured into regional data and then analysed in the unit of 225 administrative regions for the Korean Long-term Care Insurance. The rate of certification was operated as the percentage of people of LTC degree 1~3 to the elderly population in each region. The average rate of certification among regions was 4.91%, and ranged from 2.20% to 8.32%. In the analysing regression models, most socio-demographic variables, applicants' disease characteristics, regional service infrastructure, and the certification interviewer's characteristics were included. The most influencing variables were the disease factors of applicants, especially dementia or cerebrovascular disease rather than arthritis, osteoporosis, or fracture patients were strong factors for the regional rate of certification. However, advanced studies adding more explainable factors on the regional variance of certification rate would be necessary to provide political agenda and measures for evidence-based certification process with high reliability and validity for a sustainable LTC system in Korea.

• Health Policy and Management
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• v.7 no.1
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• pp.73-99
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• 1997

This study was carried out by using questionnaires with 126 insurance societies from Sept. 30, 1995 to Oct. 18, 1995. The primary data collected bythe survey have been significantly supplemented by secondary data obtained from sources such as health insurance statistical year books and internal data in the Ministry of Health and Wolfare. Major findings were summarized as follows: Two financial coordinating programs have significantly improved financial status of regional health insurance societies: the catastrophic program for high cost medical care that was initiated in 1991 and the program for hospitalization cost of the aged in 1995. Another finding is that there existed ambiguity and inconsistency of equity index that had been used by stabilization programs and its side effects could not be ignored. Regression analyses were made to identify factors that affect financial transfers. Inde pendent variables in the regression include utilization frequency, dependancy ration, insurance contribution per insured and medical expense per insured. All these variables were statistically significant in the equations of applying distribution rate (distribution/contribution) and transfer rate (transfer/contribution) as dependent variables. Policy suggestions for the catastrophic program for high cost medical care are modifying the definition of catastrophic case and setting the maximum amount of subsidies for each society based on distribution rates. To solve the problems of the financial coordinating program for the aged, we could consider reimbursing more than 50% of the copayment incurred by the aged 65 or more and determining the maximum amount of outpatient copayment at 10,000 Won per day or per visit for the elderly. More fundamental improvement could be made by amending the Welfare Benefit Act to establish and expand medical and welfare facilities for the elderly.

• Korean Journal of Clinical Pharmacy
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• v.25 no.4
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• pp.280-285
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• 2015

Objectives: To suggest direction for improving policies by understanding current management of narcotics or psychotropic drugs and analyzing their distributions and usage. Method: We conducted a comparison analysis between health insurance claims and the amount supplied to health care institutions for narcotics or psychotropic drugs through health insurance claims data and drug distribution supply data from 2010 to 2012 collected from Korea Pharmaceutical Information Service Center (KPIS). Furthermore, we carried out literature investigation and online search to comprehend the current management of narcotics drugs in Korea. Results: The amount supplied to medical institutions for all drugs in 2012 was 19.4 trillion won, which increased from 19.5 trillion in 2011 by 0.54%. For narcotic drugs, the amount supplied was 318.4 billion won in 2011 and increased to 335.1 billion won by 5.3% in 2012, which exceeded the rate of increase for the amount supplied for all drugs. The proportion of amount claimed in the total amount supplied to medical institutions for all drugs was 60.5% in 2012, whereas the proportion of amount claimed for narcotic drugs was 55.6%, which showed that narcotic drugs were used relatively less within health insurance. Furthermore, management of the current domestic distribution supply data focuses on manufacturing and medical institution supply stages. Conclusion: Hereafter, the management of narcotics or psychotropic drugs needs to be improved by reinforcing active monitoring in optimal prescription and usage in patients by collecting and analyzing information on drug usage of patients.

• The Korean Journal of Applied Statistics
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• v.28 no.6
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• pp.1063-1073
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• 2015

In the long-term care insurance (LTCI) system, National Health Insurance Service (NHIS) provide counseling services for beneficiaries and their family caregivers, which help them use LTC services appropriately. The purpose of this study was to develop a Target Selection Model for the Counseling Services based on needs of beneficiaries and their family caregivers. To develope models, we used data set of total 2,000 beneficiaries and family caregivers who have used the long-term care services in their home in March 2013 and completed questionnaires. The Target Selection Model was established through various data-mining models such as logistic regression, gradient boosting, Lasso, decision-tree model, Ensemble, and Neural network. Lasso model was selected as the final model because of the stability, high performance and availability. Our results might improve the satisfaction and the efficiency for the NHIS counseling services.

• Korean Journal of Clinical Pharmacy
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• v.21 no.4
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• pp.319-331
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• 2011

Purpose: The purpose of this study is to evaluate current criteria for insurance coverage by Health Insurance Review & Assessment Service (HIRA) on the systemic therapy used in the treatment of advanced or metastatic renal cell carcinoma (RCC), by reviewing all available clinical evidences including a variety of clinical practice guidelines. Methods: We searched clinical databases and collected data from published phase 1 through 3 randomized clinical trials on all systemic therapies used in RCC, including novel targeted therapies. Additionally, current clinical practice guidelines on the management of kidney cancer or RCC were reviewed. Based on the collected data we evaluated the appropriateness of the HIRA criteria for insurance coverage on the systemic therapy of RCC whether they are evidence-based and up to date. Results: On the basis of the collected data we concluded that there was a need for a revision in HIRA criteria for systemic therapy of RCC. Despite recent emerging therapeutic advances and changes in therapeutic strategies of management of RCC, some of anticancer regimens were inappropriately listed even though they were not proven to provide efficacy or safety superior to those of other therapies. We thus proposed an updated recommendation based on current clinical evidences. Conclusion: Systemic therapy of RCC is being rapidly changed with the advancement of understanding of the molecular biology of cancer. Consequently newly developed targeted therapies are becoming the standard therapy in the management of medically or surgically unresectable advanced or metastatic RCC. To provide effective and safe therapy to patients with RCC, the criteria for insurance coverage should be made carefully taking into consideration of most up-to-date and high-quality clinical evidences, and should be continuously reviewed so as to reflect evidence-based clinical practice.

• Journal of dental hygiene science
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• v.20 no.1
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• pp.1-8
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• 2020

Given that the demand for dental care for elderly individuals is expected to increase according to demographic changes, long-term roadmaps for the current health insurance system should be actively planned. The study aimed to investigate the health insurance system in Korea, compared to that of Japan, and suggest directions for the work of dental hygienists to provide basic data on efficient improvements in the health insurance system. Based on the collected data, the website was used to collect additional related data from Korea and Japan. The most common cause of death in Korea was malignant neoplasms, and most patients were hospitalized for diseases and disorders of the musculoskeletal system and connective tissue. Dental care covered by Korean medical insurance for individuals aged 65 years or older was treatment oriented, such as dentures and implants, while in Japan, treatment-intensive items, such as visiting a dental hygienist for guidance and provision of home-care professional oral hygiene treatment, were covered. The percentages of remaining teeth in Korea and the percentage of remaining 20 teeth were 68.9% in those aged 65 to 74 years and 51.2% in those aged 75 to 84 years in Japan. A strategy for promoting oral health among elderly individuals should be established, and a multilateral intervention approach is required to prevent oral problems from leading to deterioration of whole-body health. The role of dental hygienists in providing comprehensive assessment to elderly individuals is important. In order to provide systemic oral care, it is necessary to introduce oral care systems according to the national policy.

• Health Policy and Management
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• v.28 no.4
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• pp.402-410
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• 2018

Background: Monitoring appropriate medication categories can provide early warning of certain disease outbreaks. This study aimed to present a methodology for selecting and monitoring medications relevant to the surveillance of acute respiratory tract infections, such as influenza. Methods: To estimate correlations between acute febrile respiratory tract infection and some medication categories, the cross-correlation coefficient (CCC) was used and established. Two databases were used: real-time prescription trend of antivirals, anti-inflammatory drugs, antibiotics using Drug Utilization Review Program between 2012 and 2015 and physicians' number of encounters with acute febrile respiratory tract infections such as influenza outbreaks using the national level health insurance claims data. The seasonality was also evaluated using the CCC. Results: After selecting six candidate diseases that require extensive monitoring, influenza with highly specific medical treatment according to the health insurance claims data and its medications were chosen as final candidates based on a data-driven approach. Antiviral medications and influenza were significantly correlated. Conclusion: An annual correlation was observed between influenza and antiviral medications, anti-inflammatory drugs. Suitable models should be established for syndromic surveillance of influenza.

• Journal of Korean Physical Therapy Science
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• v.15 no.2
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• pp.61-69
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• 2008

Background: This article reviewed the current status of home-based physical therapy infrastructure in long term care insurance and then solved the problem. Method: We used two forms of data that were acquired from ⅰ) the Ministry of Health & Welfare and the Family and National Health Insurance Corporation, ⅱ) a home-visiting health care program, and ⅲ) evaluation data from the Korea Health Industry Development Institute. The home-based physical therapy program was then analyzed. Results: The role and concept of home-based physical therapy was not clearly established. There were few home-based physical therapy programs in the community. The manpower of home-based physical therapists in the home-visiting health care program was very low. The role between home-visiting nurses (caregivers) and home-based physical therapists was mixed. Research and promotion regarding home-based physical therapy was poor. Conclusion: To establish a system of legal, long-term care insurance, we must increase the manpower of home-based physical therapists and the amount of research pertaining to the demand for home-based physical therapy.