• Health Policy and Management
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• v.33 no.4
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• pp.379-388
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• 2023

This study aims to propose the implementation of innovative payment models in Korea in order to promote the financial sustainability of the national health insurance system by reviewing the current status of the payment system in Korea and examining other countries' experiences with various innovative payment models. Korea primarily uses a fee-for-service payment system and additionally uses various payment systems such as case payment, per diem, and pay-for-performance. However, each payment system has its limitations. Many OECD (Organization for Economic Cooperation and Development) countries have pointed out the limitations of existing payment systems and have been attempting various innovative payment models (e.g., add-on payment, bundled payment, and population-based payment). Therefore, it is essential for Korea to consider innovative payment models, such as a mixed payment model that takes into account the strengths and weaknesses of each payment system, and to design and pilot these models. This process requires stakeholders to work together to build a social consensus on the implementation of innovative payment systems and to refine legal and systematic aspects, develop an integrated health information system, and establish dedicated organizations and committees. These efforts towards innovative payment models will contribute to developing a sustainable health insurance system that ensures the public's health and well-being in Korea.

• Health Policy and Management
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• v.30 no.2
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• pp.164-177
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• 2020

This study aims to compare the experience of selected countries in operating separate payment system for new healthcare technology and to find implications for price setting in Korea. We analyzed the related reports, papers, laws, regulations, and related agencies' online materials from five selected countries including the United States, Japan, Taiwan, Germany, and France. Each country has its own additional payment system for new technologies: transitional pass-through payment and new technology ambulatory payment classification for outpatient care and new technology add-on payment for inpatient care (USA), an extra payment for materials with new functions or new treatment (C1, C2; Japan), an additional payment system for new special treatment materials (Taiwan), a short-term extra funding for new diagnosis and treatment (NUB; Germany), and list of additional payments for new medical devices (France). The technology should be proven safe and effective in order to get approval for an additional payment. The price is determined by considering the actual cost of providing the technology and the cost of existing similar technologies listed in the benefits package. The revision cycle of the additional payment is 1 to 4 years. The cost or usage is monitored during that period and then integrated into the existing fee schedule or removed from the list. We conclude that it is important to set the explicit criteria to select services eligible for additional payment, to collect and analyze data to assess eligibility and to set the payment, to monitor the usage or cost, and to make follow-up measures in price setting for new health technologies in Korea.

• Health Policy and Management
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• v.27 no.2
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• pp.139-148
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• 2017

Background: The purpose of this study is to investigate family caregivers' opinions about out-of-pocket payment for long-term care (LTC) facilities, and find the differences in the opinions for family caregivers of all different levels of income. Methods: We used the data of the study on out-of-pocket payment in national long-term care insurance, including 1,552 family caregivers with the elderly in long-term care facilities. Results: The average out-of-pocket payment per month was 511,635 Korean won and distributed from 230,750 to 1,365,570 Korean won. The amount of out-of-pocket payment might be affected by not co-payment but the cost of non-covered service. There were differences in them for family caregivers of all different levels of income. Opinions were surveyed about 5 issues. By levels of income, there were differences in their opinions about 3 issues, the financial burden on LTC, the necessity of reducing out-of-pocket payments, and to be willing to pay more for a high quality service. But there were not different opinions about the interruption of LTC service and staying with LTC facilities. Conclusion: These findings suggest that the range of out-of-pocket payment for LTC facility is wide and it can be a burden to lower income group. It should be to prepare the policies to ease the financial burden and support the appropriate LTC use.

• Health Policy and Management
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• v.30 no.2
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• pp.178-184
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• 2020

Background: Korea set up a new diagnosis-related group as a demonstration project in 2009. The new diagnosis-related group was reformed in 2016. The main purpose of the study is to identify the effect of reform on coverage of national health insurance. Methods: This study collected inpatient data from a hospital that contains medical information and cost from 2015 July to 2016 June. The dependent variable was the coverage of national health insurance. The dependent variable was divided by total, internal medicine partition, surgical partition, and psychiatric partition. To analyze the effect of the reform, this study conducted an interrupted time series analysis. The final sample included 23,695. Results: The health insurance coverage of internal medicine has the highest, followed by surgery and psychiatry. The health insurance coverage of bundle payment is higher than that of unbundled payment. The proportion of bundled payment and non-benefit decreased and the proportion of unbundled payment increased. The coverage of national health insurance significantly increased after policy reform in internal medicine partition (p-value=0.0356). Conclusion: The results of the study imply that policy reform enhanced the coverage of national health insurance in internal medicine. The government needs to monitor side effects such as an increase of unbundled payment.

• Health Policy and Management
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• v.27 no.3
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• pp.211-218
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• 2017

Background: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. Methods: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. Results: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. Conclusion: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.

• The Journal of the Korea Contents Association
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• v.10 no.8
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• pp.349-359
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• 2010

The purpose of this study is to design the On-line Insurance Sales Support System using Case-Based Reasoning(CBR). In on-line insurance subscription process, this system provides the personalized insurance payment cases and insurance statistics for customers to entice an insurance subscription. By measuring, specifically, similarities between the user profile and insurance payment cases, it suggests the best insurance payment case which has the highest similarity and reflects the latest in the insurance payment cases. In addition, it serves the insurance statistical information that matches with the attributes of the finally-selected case. These functions can be useful in on-line insurance sales.

• International Commerce and Information Review
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• v.8 no.3
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• pp.99-119
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• 2006

The recent trend in the payment terms of international trade shows the gradual shift toward more diversified payment methods (from L/C to not L/C) in order to cope with the increasingly dynamic international transactions in a more flexible manner. The reasons behind this recent shift are as follows : first, the global trade market is breaking away from the traditional L/C methods based on letters of credit toward a not L/C methods. nother reason for the changing trade payment methods is the increasing volume of intra transactions between headquarters and their foreign subsidiaries based on collection payment methods. Having mentioned the above problems that impede the Korean export insurance system, some suggestions can be put forward through a comparative analysis with foreign export insurance system. First, inducing private investments is one way of strengthening financial health of the KEIC. The KEIC also needs to diversify its insurance coverage adapting to the changing international trade environments.

• Journal of Society of Preventive Korean Medicine
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• v.10 no.2
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• pp.95-120
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• 2006

The purpose of this paper is to investigate the structure of cost-sharing for oriental medical services in the national health insurance. Out-of-pocket payment in ambulatory oriental medical care is a co-payment of KRW3,000 up to total expenses of KRW15,000, and co-insurance rate of 30% thereafetr. The empirical analysis based on medial claims data shows that the frequency of medical claims for outpatient care are mostly concentrated just below a total expenses of KRW15,000, and it decreases beyond a total expense of KRW15,000, while it rebounds between KRW17,000${\sim}$20,000. This means the current co-payment(KRW3,000) in oriental medical services should be applied up to a total payment of KRW17,000${\sim}$20,000, or the level of co-payment should be adjusted upward to KRW45,000 in order to be consistent in cost-sharing, between co-payment and co-insurance.

• Journal of Preventive Medicine and Public Health
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• v.53 no.4
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• pp.285-288
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• 2020

The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service. However, this system has several drawbacks. In this study, we aimed to provide examples of the problems that can occur in relation to HIRA assessments in Korea through actual clinical cases.

• Journal of Society of Preventive Korean Medicine
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• v.14 no.1
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• pp.77-96
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• 2010

Objectives : This paper recommends a global budget based payment system for reimbursing oriental medical services in the national health insurance. Methods : We analyzed previous research outcomes related to oriental medical services and payment system We reviewed the experiences of other countries' global budget system in terms of their strength and weakness. In addition, we developed a reimbursement method for oriental medical services based on global budget. Results : Our reviews focused on global budget system of Germany, the Netherlands, the United Kingdom, Canada, France, and Taiwan. The estimation of global budget in the national health insurance was described in two scenarios. First scenario was to allocate oriental medical services in scale after signing a contract for global budget. In this case, 4.16% of the national health insurance expenditure was allocated for the oriental medical services. Second scenario was to estimate the global budget in a historical context. As a result, the first scenario in total budget was higher than the second, and we proposed a retrospective adjustment method for the gap between the budget and the actual expenditure Conclusions : The payment system for oriental medical services is recommended to shift from fee-for-service to global budget.