• Journal of Preventive Medicine and Public Health
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• 제40권3호
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• pp.227-232
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• 2007

Objectives : The purpose of this study was to determine the population-attributable risk (PAR) and estimate the total medical expenditure of the Korean National Health Insurance (KNHI) due to smoking. Methods : We used data from the Korean Cancer Prevention Study of 1,178,138 Koreans aged 30 to 95. These data were available from 1992 to 2003 and covered a long-term follow-up period among the Korean population. Results : The total medical expenditure of KNHI related to smoking increased by 27% from $324.9 million in 1999 to $413.7 million in 2003. By specific diseases, smoking-attributable KNHI medical expenditure was the highest for lung cancer ($74.2 million), followed by stroke ($65.3 million), COPD ($50.1 million), CHO ($49 million) and stomach cancer ($30 million). A total of 1.3 million KNHI patients were suffering from smoking-related diseases in 2003. We predicted rises in total KNHI medical expenditure related to smoking to $675.1 million (63% increase compared with that of 2003) and in the total number of KNHI patients suffering from smoking-related diseases to about 2.6million (an approximate 100% increase compared with those in 2003) in 2015. Conclusions : We found a substantial economic burden related to the high smoking prevalence in South Korea.

• 보건행정학회지
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• 제33권2호
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• pp.166-172
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• 2023

Background: To improve the support low-income individuals' medical expenses, it is necessary to think about ways to enhance the Catastrophic Health Expenditure Support Program. This study proposes expanding support criteria and changing the income standard. Methods: This study conducted simulations using national data from the National Health Insurance Service. Simulations performed for people who have used health services (n=172,764) in 2022 to confirm the Catastrophic Health Expenditure Support Program's size based on changes to the subject selection criteria. Results: As a result of the simulation with expanded criteria, the expected budget was estimated to increase between Korean won (KRW) 13.2 (11.5%) and 138.6 billion (37.4%), and the number of recipients increased between 41,979 (48.9%) and 150,317 (76.1%). The results of the simulation for the change in income criteria (applied to health insurance levels below the 50th percentile) estimated the expected budget to increase between KRW -8.9 (-7.8%) and 55.6 billion (15.0%) and the number of recipients to increase between -8,704 (-10.1%) and 41,693 (21.1%) compared to the current standard. Conclusion: The 2023 Catastrophic Health Expenditure Support Program's criteria were expanded as per the 20th Presidential Office's national agenda to alleviate the burden of medical expenses on the low-income class. In addition, The Catastrophic Health Expenditure Support Program needs to be integrated with other medical expense support policies in the mid- to long-term, and a foundation must be prepared to ensure the consistency of each system.

• 보건행정학회지
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• 제30권4호
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• pp.451-459
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• 2020

Background: Although Korean government have been adopting several policies to expand coverage of National Health Insurance (NHI) program, the coverage rate is still below average across Organization for Economic Cooperation and Development countries. This study was to identify public perception on appropriateness of coinsurance rate and factors associated with coinsurance rate in National Health Insurance. Methods: For this cross-sectional study, 507 participants over aged 20 years were recruited from telephone surveys. Respondents experienced at least one and more visiting medical facilities due to medical problems in last 12 months. Demographic factors, socioeconomic positions, and experiences on medical utilization were measured in order to identify factors associated with perception appropriateness of coinsurance rate. Results: The 49.9% (n=209) of the public responded that the coinsurance rate of NHI program was appropriate. There were no differences in positive perception according to socio-demographic factors and experiences on medical utilization except for gender, residential area, and felt expensive when using medical services. People who felt burden of medical expenditure were more likely to perceive coinsurance rate inappropriate (odds ratio, 2.33; 95% confidence interval, 1.52-3.58) Conclusion: In spite of the relatively low coverage rate of NHI, this study identified that 49.9% of the public perceived the current coinsurance rate was adequate. However, people who felt the burden of medical expenditure were still had a negative perception of the coinsurance rate needed to decrease the coinsurance rate.

• 한국콘텐츠학회논문지
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• 제17권6호
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• pp.63-70
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• 2017

우리나라는 전 국민 건강보험 의료체계를 근간으로 하고 있으나, 보장성이 낮아 많은 국민들이 높은 의료비의 재정적 부담 완화를 위해 민간의료보험에 가입하고 있다. 본 연구에서는 민간의료보험의 가입 여부가 개인의 본인부담 진료비 지불에 대한 주관적인 부담 수준에 미치는 영향을 분석하였다. 보건의료정책방향 관련 대국민 실태조사 자료를 활용하여 총 1,564명을 연구 대상자로 선정하였으며, 관련성 파악을 위해 이분형 로지스틱 회귀분석을 실시하였다. 연구 결과, 민간의료보험 가입 여부는 본인부담금의 주관적 부담 수준과 유의한 관련이 있었으며(p<.0001), 민간의료보험 미가입자가 가입자에 비해 주관적 부담 수준이 더 높았다(OR, 1,190; 95% CI, 1,188-1,192). 고연령, 저소득층의 민간의료보험 가입률이 낮음을 감안할 때, 경제적 부담을 대비하는 민간의료보험의 순기능 강화와 형평성 문제 해결을 위한 민간의료보험의 역할 재정립이 필요하다.

• 한국보건간호학회지
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• 제3권2호
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• pp.47-76
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• 1989

The objectives of this study was to analyze the major causes of decreasing utilization rate of health care institutios in pilot-project area of regional medical insurance, Kwang-hwa and Kun-wi country. After the implementation of medical insurance, utilization rate of health institutions turned out' to be lower than it was estimated, when the pilot-project of regional medical insurance was planned. It might be due to changes in inhabitant's behavioral attitude toward medical insurance. So this study was made to find measures for financial stability by increasing utilization rate of health care institutions and to be available for basic demand-supply program of medical care. The hypothesis of this study was as follows; First. there is difference in understanding health care institutions between Kun-wi and Kwang-hwa. Second. respondesnts of inquiry survey have exact knowledge of their past experience of treatment taken prior to enforcement of medical insurance, Questionaire survey was made as to each 700 household among total 11, 884 households in Kun-wi and 20,919 households in Kwang-hwa. In case of Kun-wi, 70% of inquired households (491) gave their answers. In Kwang-hwa, the number was 560 households (80% of inquireds). Dollected data was processed and analyzed by way of using SPSS batch system. To evaluate facto rs distribution aspects of data and to make comparison between two area, percentage and $X^2$ distribution were applied. The results were as follows; L The utilization rate of health care institutions in Kun-wi and Kwang-hwa was lower than it was estimated. when pilot-project of medical insurance was planned. 2. Prior to the implementation of medical insurance. inhabitants in two area chose the medical institutions considering such factors. First was medical care fee cheap. second in habitant's residence, Third was the institutions conveniently easy of access. 3. After the implementation of medical insurance. 26.1% of inqurieds in Kun-wi and 41.6% in Kwang-hwa, changed medical institutions. In case of Kwn-wi, from health care institution (p 0.05), and in case of Kwang-hwa, vice versa, from general medical institutions to health care institutions. 4. Evaluation by factors were made such as follows. Inquired gave high marks to following facts: In case of Kun-wi, general medical institutions were difficult of access and relation between patients: was not friendly, but burden of medical expenditure was light. Effects of treatment and facilities was good. In case of Kwang-hwa, inquired gave high evaluation marks to the follow ing facts; facilities of medical institutions was not good, but the burden of medical expenditure was light. 5. After the implementation of medical insurance, the services was evaluated as good, but inquired hopec for lessening the burden of medical expenditure. 6. In case of exact understanding of cost-sharing, the evaluation rate in Kwang-hwa was higher than that of Kun-wi (p < 0.005). And positive attitude toward necessity of medical insurance was also good in Kwang-hwa (p < 0.05). 7. In case of inquired's attitude toward medical institutions, Kwang-hwa showed positive response (p < 0.05) 8. In the case of comparison between general medical institution and health care institution, two area showed similar positive response; medical manpower, facilities of medical institutions and effest: of treatement was good. 9. In comprehensive evaluation of benefit-service; the general medical institution's positiveness was higher than that of health care institutions in Kun-wi. But in Kwang-hwa vice-versa. 10. If the medical expenditure of general medical institution and health care institutions was equal 77% of inquireds in Kun-wi and 59.1% in Kwang-hwa answered that they chose general medical insurance. Considering results above mentioned, the conclusion of this study was made as follows. 1. In Kwang-hwa county, where the understanding of health care institutions's was good, the utilization's of health care institutions was shown high. Therefore, in case of Kwang-hwa, betterment: should be made to induce increasing utilization rate for negative factors of health care institutions. 2. In case of Kun-wi, where the understanding of health care institutions was on the decrease, measures for changing such negative factors should be taken by way of strengthening public relations. And cases of Kwang-hwa should also be studied. 3. On the side of financial stabilization and establishing health care delivery system, primary health care should be available. Therefore, the major cause of inhabitant's avoiding health care institutions should be known. And measures for activating that institutions have to be taken. So, the facilities of health care institution have to be improved up to the level of clinic. And supportive measures for securing equipment and improving health care services should also be taken. It is necessary that strategy for public relations should be employed with policy considerations and supports.

• 보건행정학회지
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• 제31권4호
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• pp.423-436
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• 2021

This article summarizes the structure of China's current social health insurance system and reviews the development status of China's private health insurance (PHI). China's medical security system is mainly composed of two parts: basic medical insurance (BMI) and PHI. Among them, the BMI provides reimbursement of basic medical expenses for the insured persons according to different proportions. PHI is a necessary supplement to the BMI and provides assistance to the insured persons in the event of illness or accident. By having PHI, people can obtain medical protection outside the coverage of BMI. In the development of PHI in China, the total medical cost is high and the insurance market size is large, but the proportion of PHI expenditure is low and the personal burden is high. Through this Chinese case, it will be helpful for mutual development between Korean PHI and national health insurance, for Korean insurance companies to enter the Chinese market, and for removing the medical burden on the people.

• 한국콘텐츠학회논문지
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• 제19권5호
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• pp.331-341
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• 2019

본 연구는 외환위기 이후 소득계층별 보건의료비 지출이 가구소득 불평등에 미치는 영향과 그 변화를 확인하기 위하여 1996년부터 2016년도 가계소득조사를 활용하여 지니계수를 시계열적으로 산출하였다. 도출된 결과와 함의는 다음과 같다. 첫째, 외환위기 이후 가구 총소득 불평등은 연도별로 다소 변화는 있지만 지속적으로 심화되어 왔다. 둘째, 소득계층별 보건의료비 지출은 고소득층이 더 많이 지출하는 다소 불평등한 수준을 지속적으로 유지하고 있다. 셋째, 가구소득 불평등에 대한 보건의료비 지출의 영향을 평가하기 위하여 보건의료비 지출을 제외한 가구소득에 대한 지니계수를 산출한 결과, 총소득 지니계수 보다 그 값이 커져서 가구의 보건의료비 지출로 인하여 소득불평등이 심화되는 것으로 나타났다. 보건의료비 지출로 인한 가구소득 불평등 심화현상은 외환위기 이후 지속적으로 증가하는 경향을 보였다. 국민의료비 부담을 감소시키기 위한 목적으로 건강보험보장성 강화 등 노력이 지속적으로 이루어지고 있지만 소득불평등 해소에는 기여하지 못하는 것이다. 향후 저소득층의 의료비 지출 감소를 위한 보다 저소득층을 위한 선택적인 의료비 지원제도의 마련이 필요할 것이다.

• Journal of Preventive Medicine and Public Health
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• 제45권5호
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• pp.291-300
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• 2012

Objectives: We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data. Methods: A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective. Results: Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556). Conclusions: The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.

• 한국병원경영학회지
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• 제29권2호
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• pp.37-47
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• 2024

Purpose: This study aimed to determine the effect of adjusted out-of-pocket maximum rules in the 'differential co-payment ceiling', which means having a higher burden of co-payment, that expanded to the entire ceiling level in long-stay admission patients in long-term care hospitals(LTCH). Methodology: We used health insurance claim data between January 1, 2022, and December 31, 2022 received from the National Health Insurance Service. The study populations were inpatients in long-term care hospitals more than 1 days during the study period. We performed the difference in characteristics of the LTCH patient of the differential and general ceiling by the chi-square test. We estimated the change of the population, cost, and co-payments per person under the assumption of restructuring. Finding: Based on adjusted out-of-pocket maximum rules in 2023, it was expected that the number of benefits decreases at the high-income level while increasing at the low-income level. The burden of health expenditure after reimbursement of co-payment ceiling, is expected to increase by 65.1% in the highest medical necessity, whereas the low medical necessity would decreases compared to 2022. Practical Implications: The results demonstrate that the current out-of-pocket maximum rules do not reflect the needs of medical necessity. This study suggested the need to reflect the medical necessity in LTCH on the out-of-pocket maximum rules in the future.

• 한국사회복지학
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• 제56권3호
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• pp.5-35
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• 2004

본 연구는 의료비 지출이 가입자에게 미치는 경제적 영향을 의료비지출자의 종사상 지위변화와 가구내 소득 소비실태 변화를 중심으로 살펴보았다. 또한 의료비지출에 미치는 요인과 이와 같은 의료비가 종사상 지위변화 및 소득변화에 영향을 미쳤는지 분석하였다. 분석자료는 '한국노동패널'의 4차 연도 부가조사인 '건강과 은퇴' 응답자 가운데 의료비 지출자 4,215명의 자료를 5차 연도와 병합하였다. 분석결과 의료비지출자의 근로소득대비 의료비는 평균 5.5%로 나타났으나, 저지출 집단과 고지출 집단과의 격차가 크게 발생하였다. 또한 상대적 저소득그룹의 의료비 부담이 가구근로소득의 1/3을 차지하여 저소득계층은 의료적으로 취약할 뿐만 아니라 의료비부담이 과중함을 알 수 있었다. 한편 의료비 고지출 집단은 사적이전소득이 높아, 의료비가 발생할 경우 가족 및 친지로부터 의료비 등의 지원이 있는 것으로 보인다. 그러나 의료비가 발생할 경우 금융소득 및 부동산을 처분하여 의료비를 충당하는지에 대해서는 통계적으로 유의한 결과가 나타나지 않았다. 또한 의료비 지출자 가운데 종사상 지위는 14.4%만이 변화하였으며, 의료비 지출의 평균이상 여부가 종사상 지위변화의 주요 요인이 되었다. 즉, 의료비 저지출 집단은 건강이 상대적으로 나쁘지 않음을 의미하여 의료비의 비중이 낮을 뿐 아니라, 이와 같은 요인이 종사상 지위변화에 미치는 영향은 미미한 것으로 보인다. 그러나 의료비지출이 높은 그룹은 건강이 악화되어 종사상 지위까지 변화시킨 것으로 보인다. 나아가 이와 같은 종사상 지위변화는 총소득 변화에 부(-)적인 영향을 미쳐, 종사상 지위가 변화된 경우 총소득이 감소하여 가구내 경제상황이 더 악화된 것으로 보인다. 따라서 우리나라 건강보험은 질병으로 인하여 발생하는 비용과 함께, 경제활동 축소 및 중지에 따라 발생하는 소득손실을 보장하는데 미흡한 것으로 판단된다.