• Korean Journal of Health Education and Promotion
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• v.7 no.2
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• pp.78-88
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• 1990

The subject of this study is to review the practical approaches of Home Care Services. Included is a brief overview of its nature, providers of Home Care Services, recent history of Home Care Services, and the impact of the national movement toward cost containment in health care. The data used in this study are obtained from the Elderly Program of the Medical Services and other data on the Home Care Services in Japan. With the growing elderly population in Japan, it is to be expected that the medical care expenditure for this sector will continue to increase. With the aim of keeping expenditure for medical care within reasonable bounds, it is essential that this increasing expenditure on the elderly be used effectively. With the Health and Medical Services Law for the Aged was enforced, therefore, remuneration for medical treatment of the elderly and what is known as the staff placement standard at hospital for the elderly were rationalized. In addition to rationalization from the point of view of medical care supply, it is necessary to guarantee the appropriate treatment within the community and at home for those elderly who are bedridden but not in need of hospital care. For this it is required that Home Care Services, such as health services like visiting guidance by public health nurse in hospital of Health Center. So that the elderly can feel secure in receiving treatment within the community and at home, allowances for guidance on leaving hospital and for intermittent nursing and guidance thereafter are to be newly introduced. Home care Services in one aspect of comprehensive health care, it is comprised of health services provided to individuals and families in their homes. Its purposes include promoting, maintaining and restoring health, specifically maximazing independent functioning and minimizing the disabling effects of illness, including terminal illness. Services appropriate to the needs of clients and their families are planned, coordinated, and delivered by providers organized for the delivery of home health care through the use of contractual arrangement, employed staff, or a combination of the two.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6985-6989
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• 2013

Background: This study aimed to examine out-of-pocket expenditure for cancer treatments of hospitalized patients and to analyze changing patterns over time. Materials and Methods: This study examined data of all cancer patients receiving inpatient care from two tertiary hospitals from January 2003 to December 2010. Medical expenditures per admission were calculated and classified into those covered and uncovered by the Korean National Health Insurance (NHI) and co-payment. Results: The medical expenditure per admission increased slowly from 3,455 thousand Korean won (KRW) to 4,068 thousand KRW. While expenditures covered by the NHI have increased annually, co-payments have generally decreased. The out-of-pocket expenditure ratio, which means the proportion of uncovered expenditure and co-payment among total medical expenditure dropped sharply from 2005 to 2007 and was maintained at a similar level after 2007. Medical expenditures, NHI coverage, and the out-of-pocket expenditure ratio differed across cancer types. Conclusions: It is necessary to continually monitor the expenditure of uncovered services by the NHI, and to provide policies to reduce this economic burden. In addition, an individual approach considering cancer type-specific characteristics and medical utilization should be provided.

• Health Policy and Management
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• v.24 no.1
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• pp.47-55
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• 2014

Background: Korea is considered to have an integrative health system where both western medicine and Korean (traditional) medicine are officially recognized and provided. Although Korean medicine has been covered by National Health Insurance over 20 years, equity in the utilization of Korean medical care has rarely been examined. Methods: We examined medical care utilization and expenditure of outpatient Korean medicine using panel fixed effects model to remove selection bias. Then we compared it with pooled ordinary least square (OLS) model. This study used Korea Health Panel data, which provides accurate information on out-of-pocket health care payment, including non-covered medical services. Results: Principal findings indicate that the frequency of the utilization of Korean medicine is related with unobservable individual choices different from western medicine, so the panel fixed effect model is appropriate. But pooled OLS model is better fitted for the expenditure of Korean medicine, after controlling for western medical care expenditure. After adjusting for the selection bias, socioeconomic status (income, education) was significantly associated with the expenditure of Korean medicine, but not with the frequency of the utilization of Korean medicine. Conclusion: This study shows that expenditure of Korean medicine utilization is inequitable across socioeconomic groups, which implies that health insurance coverage of Korean medicine is not sufficient.

• Health Policy and Management
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• v.30 no.3
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• pp.399-408
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• 2020

Background: The purpose of this study was to examine the impact of the regional characteristics on the accessibility of emergency care and the impact of emergency medical accessibility on the patients' prognosis and the emergency medical expenditure. Methods: This study used the 13th beta version 1.6 annual data of Korea Health Panel and the statistics from the Korean Statistical Information Service. The sample included 8,119 patients who visited the emergency centers between year 2013 and 2017. The arrival time, which indicated medical access, was used as dependent variable for multi-level analysis. For ordinal logistic regression and multiple regression, the arrival time was used as independent variable while patients' prognosis and emergency medical expenditure were used as dependent variables. Results: The results for the multi-level analysis in both the individual and regional variables showed that as the number of emergency medical institutions per 100 km² area increased, the time required to reach emergency centers significantly decreased. Ordinal logistic regression and multiple regression results showed that as the arrival time increased, the patients' prognosis significantly worsened and the emergency medical expenses significantly increased. Conclusion: In conclusion, the access to emergency care was affected by regional characteristics and affected patient outcomes and emergency medical expenditure.

• Journal of Home Health Care Nursing
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• v.7 no.1
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• pp.58-72
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• 2000

This study was an attempt to encourage the development of a rehabilitation delivery system and programs as a substitute service for hospitalization on the case of car accident patients, such as hospital based home health care nursing services. Various substitute services for hospitalization are required to curtail the length of stay for inpatients who were hospitalized with car accident compensation insurance. It focused on developing an estimation an early discharge day for car accident inpatients based on detailed statements of treatment for 111 inpatients who were hospitalized at the General Hospital in 1997. This study had four specific purposes as follows. First. to find out the utilization of medical services. Second, to estimate the time of early discharge and income increasing effect based on early discharge for those patients. Third, to identify the factors affecting total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze the length of stay and medical expenditure for inpatients who were hospitalized due to car accidents, the authors conducted micro- and macro-analysis of medical and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria, such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the test consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, and stable conditions. In addition to identifying variables affecting medical expenditure, and the length of stay and income effect due to early discharge day, the data was analyzed with a multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study were as follows. First. the mean length of stay was 50.3 days. whereas the mean length of stay due to early discharge was 34.3 days at the hospital. The estimation of time of early discharge depended on the length of stay. The longer the length of stay, the longer the length of time of early discharge : for instance a length of stay under 10 days was estimated as correlating to a mean length of stay of 6.6 days and early discharge of 6.5. The mean length of stay was 217.4 days and the time of early discharge was 110.1 respectively. The mean medical expenditure per day was found to be 169.085 Won and the mean medical expenditure per day showed negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to being discharged 16 days early was around 2,244,000 won per bed. However. this sum does not represent the real benefits resulting from early discharge, but rather the income increasing amount without considering medical prime cost in the general hospital. Therefore, further analysis is required on the cost containments and benefits as turn over rate per bed as the medical prime costs. The length of stay was most significant and was positive to the total medical expenditure, as expected. Surgery and patient's residential area was also an important variable in explaining medical expenditure. The level of complications was the most significant variable in explaining the length of stay. There was a high level for need a home health care nursing service which further supports early discharge for accident patients. In addition, when the patient was discharged. they needed follow up care for complications suffered during the car accident. $86.8\%$ of discharged patients responded that they needed home health services after early discharge. From these research findings, the following suggestions have been drawn. Strategies on a health care delivery system must be developed in order to focus on the consumer's needs and being planned for 21 century health policy in Korea. Community based intermediate facilities or home health care should be developed for rehabilitation services as a substitute for hospitalization in order to shorten the length of stay would be. A hospital based home health care nursing service. it would be available immediately to utilize by patients who want rehabilitation services as a substitute for hospitalization with the cooperation of car insurance companies.

• Korea Journal of Hospital Management
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• v.19 no.4
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• pp.57-68
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• 2014

Since the introduction of National Health Insurance(NHI) in 1977, it has grown rapidly and contributed to extend patient's access to the health care services. However, limited coverage for health care services of NHI has been ongoing challenge and private health insurance(PHI) has been rising as an alternative source of enhancing coverage and saving out-of-pocket(OOP) expenditure for patients. In this study, after controlling for socio-demographic, economic, health related variables, we identified the patients' healthcare utilization and subsequent OOP expenditure depending on their PHI enrollment and their enrollment types(fixed benefit, indemnity, fixed benefit plus indemnity). Data were collected from the 2010 Korean Health Panel. The unit of analysis was a member of household(n=13,324). Of the 13,324 cases, 70.7% of patients held PHI, in detail, fixed benefit(47.0%), indemnity(3.6%), fixed benefit plus indemnity(20.1%). Major findings showd that patients who enrolled in PHI used more outpatient services(outpatient visit, number of physician visit, number of examination) and spent more OOP expenditure than non-PHI patients. There were also differences of healthcare utilization and OOP expenditure among the types of PHI. In addition, PHI patients used more inpatient services(inpatient use, number of hospitalization, LOS), but there was no significant difference between PHI and non-PHI patients with regard to the OOP expenditure. Thus, we could not find any distinct relationship between the types of PHI and patients' tertiary hospital use. Policy-makers should need careful political deliberation for monitoring the effect of PHI on health care utilization and subsequent expenditure not only to improve patients' coverage but also to save their OOP expenditures.

• Journal of Families and Better Life
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• v.10 no.2
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• pp.19-36
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• 1992

The purpose of this paper is to analyze empirically the tendency of household consumption expenditure according to the change of social and economical condition, and the factor which influences consumption expenditure of urban household. The data used in analysis are time-series. The data are statistic form Urban Household Economy Survey published by the Economic Planning Board, dating form the first quarter of 1970 to the fourth quarter of 1989. The income of household and consumption expenditure materials were deflated as consumer price index to exclude the influence of prices and the influence of household composition are considered to deflated as the size of the household under assumption of homogeneity. The consumption expenditure items were categorized to 12 relatively large range items. The time-series data were analyzed by using the Two Stage Least Squares and the Ordinary Least Squares. The following is the result of analysis. 1) Rather than the income increase of previous years. the average income increase for two years influences more significantly on consumption expenditure of household. In the case of influence on consumption expenditure for each item by increase in disposable income, such categories as furniture and utensils. clothing and footwear, housing, medical care, culture and recreation, and transportation and communication have significant influence. 2) Among consumption expenditure categories, the increasing factors were furniture and utensils, and clothing and footwear. And the decreasing factors were housing, medical care, culture and recreation ,and transportation and communication. The relative prices, however, had significant influence on categories such as housing, furniture and utensils, medical care , culture and recreation, and transportation and communication and all of them were the decreation factors. 3) Among with changes of social and economical conditions, miscellaneous showed the highest increase in marginal propensity to consume and foods was the lowest. Also culture and recreation and housing brought up a great change of the income elasticity of demand.

• The Journal of the Korea Contents Association
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• v.15 no.12
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• pp.560-571
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• 2015

This study aims to examine primary determinant for medical expenditure depending on different age and income brackets. The age and income brackets are simultaneously taken into account for a forming of structural models, and GARCH methodology is utilized in analyzing the model. Empirical evidence reveals that no matter how general medical care system is appropriately operated, medical expenditure is vulnerable in taking care of potential socially-disadvantaged class and the group of catastrophic medical expenditure as long as the age and income brackets concern, simultaneously. It signifies that more elaborately designed medical-related policy seems to be established to improve its effectiveness. On the contrary, ageing society is comparatively well-treated by public health law and act on long-term care insurance for the aged.

• Journal of Yeungnam Medical Science
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• v.10 no.1
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• pp.91-102
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• 1993

This study was carried out to assess medical care expenditure of residents in urban poor area. The study population included 377 family members of 85 households in the poor area of Daemyung 8-Dong, Nam-Gu, Taegu and 442 family members of 96 households in a control area. The data was collected through self-administered questionnaires completed by housewives. The survey was conducted from March 1 to May 31, 1992. The mean age was 31.1 years in the poor area and 37.1 years in the control area. The average number of households per house was 4.5 in the poor area and 4.5 in the control area. The frequency of medical care utilization per household in a one month period was 4.6 in the poor area and 4.3 in the control area. The average number of days of utilization was 12.9 in the poor area and 12.5 in the control area. The average monthly income of a househlod in the poor area was 848,600 Won compared to the control area's 1,752,300 Won. The average monthly consumption expenditure of a household in the poor area was 568,800 Won and that in the control area 1,238,400 Won. The average medical care monthly expenditure per household was 34,500 Won in the poor area and 58,400 Won in the control area. The proportion of the medical care expenditure to monthly income and to monthly consumption expenditure was 4.1% and 6.1% respectively in the poor area, and 3.3% and 4.7%, respectively in the control area. The premium of medical insurance was 1.5% in both areas. The proportion of cost for drug was 57.4%, for medical appliance was 1.2%, and for medical treatment was 41.1% in the poor area and in the control area 52.4%, 1.9%, 45.7%, respectively. The highest proportion of medical care expenditures in the poor area was herb clinic utilization (36.9%), while hospital and clinic(37.8%) was the highest proportion in the control area. Mean medical care expenditure per visit was 7,400 Won in the poor area and 12,600 Won in the control area. Mean medical care expinditure per day was 2.800 Won in the poor area and 6,300 Won in the control area.

• Journal of Home Health Care Nursing
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• v.6
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• pp.5-18
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• 1999

This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.