• 보건행정학회지
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• 제28권4호
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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.

• 대한물리치료과학회지
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• 제15권2호
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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.

• 한국병원경영학회지
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• 제12권1호
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• pp.31-50
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• 2007

This study was carried out to analyze the present condition of high-price medical technologies in South Korea and to compare it with OECD countries. This study included 10 high-price medical equipments and used medical equipment registry data of Health Insurance Review Agency. The major findings of this study are as follows; Firstly, The number and growth of high-price medical equipments in South Korea is much higher than those in other OECD countries. There are many of high-price medical equipments even in clinics. Secondly, the percentage of old poor-quality medical equipments is very high, especially in clinics. This is because of high-price of medical equipments. The results of this study implicated that there is high possibility of inappropriate use of high-price medical technologies. This may result in the increase of health expenditure; therefore, there should be a kind of regulation policy to control amount and quality of medical equipment.

• 보건행정학회지
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• 제15권3호
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• pp.79-93
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• 2005

The purpose of the study is to identify Ambulatory Care Sensitive Conditions (ACSC) and their potential health insurance applicability in Korea, using the correlation and regression analysis with the empirical data provided by Korean Health Insurance Review Agency(KHIRA). Here, ACSC would be thought of as conditions that when timely and effectively treated in the outpatient medical services can help reduce the risk of hospitalizations. As for ACSC, reducing accessibility for outpatient visit results in increasing hospitalization. In this respect, the ACSC concept is popularly adopted as one of the performance indicators of the national health system. As one of main results, fortifying the accessibility to necessary health care in a way of sharing appropriately the role with private health insurance can lead to the efficiency of national health care delivery systems in view of total health care expense, in particular in a case of ACSC children. Lastly, we would like to strongly suggest that the disease treatment data set reported to KHIRA needs to be opened to private insurance companies only for illness experience investigation.

• Journal of the Korean Data and Information Science Society
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• 제21권2호
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• pp.201-209
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• 2010

최근 10년간 허혈성심질환 사망은 급격히 증가하였기에 이에 대한 효과적인 예방대책이 매우 중요한 실정이다. 이에 본 연구에서는 1996년 국민건강보험공단 건강검진 수검자 2,268,018명을 약 10년간 추적하여 허혈성심질환의 주요 위험요인별 상대위험도를 콕스비례위험모형을 통해 파악하고자 하였다. 그 결과 남자에서는 체질량지수, 혈압, 흡연, 여자에서는 고혈압, 주관적 건강감 및 감마-글루타밀전이효소가 허혈성심질환과 유의한 관련성이 있었다.

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

• 동서간호학연구지
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• 제16권2호
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• pp.172-178
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• 2010

Purpose: We examined the relationship between the health-related issues of elderly women and bone density and identified specific factors that affect the prevalence of osteoporosis to provide basic data for developing a health care program on osteoporosis prevention. Methods: This study is a secondary data analysis of 118,903 66-yr-old women who received a health examination conducted by the National Health Insurance Corporation in 2008. Multiple logistic regression analysis was used to identify factors affecting the prevalence of osteoporosis. Results: The prevalence of osteoporosis was 46.8%, whereas the prevalence of osteopenia was 38.4% among elderly women in this study. Statistically significant differences were observed between the osteoporosis and non-osteoporosis group in terms of smoking (p<.001), exercise (p<.001), obesity (p<.001), waist circumference (p<.001), depression (p<.001), falling experience (p<.05), and the cognitive function risk (p<.05). Based on the multiple logistic regression results, the risk for osteoporosis was high in those who were under-weight, smoked, or were depressed. In contrast, moderate or high level obesity showed a negative relationship with osteoporosis. Conclusion: The prevalence of osteopenia and osteoporosis was 85.2%. Therefore, there is a need to develop health care programs pertaining to osteoporosis intervention and prevention for elderly women. Because smoking, non-exercise, and obesity are main osteoporosis risk factors, it is highly recommended that some sound practical life programs and psychological support programs be considered for this population.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.178-187
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• 2012

Purpose: In Korea, the nation's medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system. Methods: From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital's emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient's insurance, and the entire bill when the patient was discharged. Results: Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge. Conclusion: We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system.

• Journal of Preventive Medicine and Public Health
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• 제33권2호
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• pp.150-156
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• 2000

Objective : To analyze the factors affecting the participation rate in the health screening program of medical insurance. Method : We investigated the factors associated with the participation rate in the health screening program in Korea. Data were collected at the aggregate level from 145 employee health insurance societies and 227 self-employed health insurance societies from 1995 to 1997 Data were also collected at the individual level from four health insurance societies. This study hypothesized that the participation rate of the health screening program was related to 1) the characteristics of its members and the size of the health insurance society; 2) the specifications of the health screening program; 3) the venue of the health screening institution and the interests of individuals in the health screening program; and 4) the activities of the health insurance society. We used bivariate and multiple regression models to examine the factors on the participation rate of the health screening program. Results : First, in the case of dependents of on employee health insurance society, the ratio of dependents 40 years old and over, the average monthly contribution per household, the interest and satisfaction level of individuals in health screening, and the level of refunds for over-payment were all associated with the participation rate in the health screening program, accounting for 54.4% of the participation rate. Second, in case of those insured by the self-employed health insurance society, the interest and satisfaction level of individuals in health screening, the level of refunds for over-payment, and the performance level of on-the-spot health screening were statistically significant, accounting for 40.1% of the participation rate. Conclusion : The factors concerning the participation rate in the health screening program of medical insurance, in both a health insurance society and for individuals, were closely related to the age and gender of individuals and household contributions.

• 응용통계연구
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• 제22권6호
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• pp.1229-1237
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• 2009

노인장기요양보험에서 가장 중요한 이슈는 급여대상자의 희망, 건강 및 기능상태에 따라 어떤 급여를 제공할 것인가 이다. 이를 해결하고자 노인장기요양보험의 보험자인 국민건강보험 공단은 급여대상자에게 '표준장기요양이용계획서'를 제공하고 있다. 본 연구에서는 표준장기요양이용계획 작성의 효율화 방안을 마련하고자 노인장기요양보험 3차 시범사업 표준이용계획 자료를 활용하여 노인장기요양급여 권고모형을 개발하였다. 모형개발에는 데이터마이닝의 의사결정나무모형, 로지스틱회귀모형, 앙상블 모형의 배깅과 부스팅 기법을 사용하였고, 이 중 실무자가 이해하기 쉬운 의사결정나무를 채택하여 권고모형을 설명 하였다. 본 연구는 노인장기요양보험 제도의 이용계획 수립의 객관성 및 과학성을 확보하고 이용계획 업무를 효율화하는 데에 기여할 것으로 기대된다.