• The Korean Society of Law and Medicine
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• v.10 no.2
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• pp.37-82
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• 2009

Korea has gained the much more performances in the fields of pubic health laws and related policies on the basis of the substantial economic achievements. In 1977, the social medical insurance was established for companies with more than 500 employees, and in 1989, Korea successfully achieved the national medical insurance system covering the total population within only 12 years beginning with multiple insurers. There remained some problems, however, to be improved such as both the low level of contribution rates and benefit packages due to the inefficiency in utilizing limited medical resources. In 2000, all insurers were unified into a single insurer (National Health Insurance Corporation), and special independent Health Insurance Review & Assessment Service (HIRA) was also established. From the origin of medical insurance system in 1977, the Korean reimbursement system has been fee-for-service system, and after the establishment of HIRA, it has been providing objective and expert medical cost review services and health quality assessment services.

• Korean Journal of Hospice Care
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• v.5 no.1
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• pp.26-32
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• 2005

Purpose: To know for what the medical expenditure had been used and to seek the way how it can be efficiently redistributed, I investigated total medical expenditure according to the time period to death in the expired patients for recent 2 years. Methods: 21patients were enrolled in this study. Total medical expenditure including benefit charge and non-benefit charge charged to patients in in-patient department(IPD) and out-patient department(OPD) was counted according to the period for one year by death. Results: 94.7% of the total medical expenditure had been payed for admission-related expenditure and 89% during period 3 and 4 for 6months before death, which may be due to the more days of admission during those periods. 70.1% of the total expenditure had been charged on the admission-fee, room charge, diet, and administration of the fluid, medicines, and blood etc. Conclusion: Majority of medical expenditure has been used in the affairs being unable to improve the survival or quality of life of patients and during the periods closer to death. Here, it would be needed heartily to look for the best ways in detail how the idea of hospice can come true through nation-wide and social consensus.

• Health Policy and Management
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• v.5 no.2
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• pp.35-69
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• 1995

The managerial environment of hospitals in Korea characterized by low levels of medical insurance fees is worsening by increasing government regulations as to the utilization of medical services, rising costs of labor, material, and medical equipments, growing patient expectations concerning the quality of services, and escalating competitions among large hospitals in the market. Hospitals should seek for their survival strategies in this harsh environment and they should have information about costs of their products in doing so. However, it has not been available due to the complexity of the production process of hospital services. The objectives of this study were to develop a service-based cost accounting model and to apply the developed model to a study hospital to obtain cost information of hospital services. A model commonly used for the job-order product cost accounting in the manufacturing industry was modified for the use in hospitals in Korea. Actual costs, instead of standard costs, incurred to produce a unit of services during a given period of time were estimated in the model. Data required to implement the model included financial information, statistics for the allocation of supportive cost center costs to final cost centers, statistics for the allocation of final cost center costs to services, and the volume of each services charged to patients during a study period. The model was executed using data of a university teaching hospital located in Seoul for the fiscal year 1992. Data for financial information, allocation statistics fo supportive service costs, and the volume of services, most of them in electronic form, were available to the study. Data for allocation statistics of final cost center costs were collected in the study. There were 15 types of evaluation and management service, 2, 923 types of technical service, and 2, 608 types of drug and material service charged to patients in the study hospital during the fiscal year 1992. Labor costs of each of seven types of pesonnel, material costs of 611 types of drugs and materials, and depreciation costs of 212 types of medical equipments, miscellaneous costs, and indirect costs incurred in producing a unit of each services were estimated. Medical insurance fees for basic services such as evaluation and management of inpatients and outpatients, injection, and filling prescriptions, and for operating procedures were found to be set lower than costs. Infrequent services which use expensive medical equipments showed negative revenuse as well. On the other hand, fees for services not covered by the insurance such as CT, MRI and Sonogram, and for laboratory tests were higher than costs. This study has a significance in making it possible for a hospital to obtain cost information for all types of services which produced income based on all types of expenses incurred during a given period of time. This information can assist the management of a hospital in finding an effective cost reduction strategy, an efficient service-mix strategy under a given fee structure, and an optimum strategy for within-hospital resource allocations.

• Journal of Preventive Medicine and Public Health
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• v.12 no.1
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• pp.3-12
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• 1979

A survery was carried out in order to know the status of student health service and student medical insurance of universities and colleges in Korea from 1 July to 30 September. 1978. And the following results were obtained; 1. Out of seventy universities and colleges, 54.8% of them had student health service facility such as student health conte. (30.0%) or health room (24.8%). 2. Out of twenty-seven national and public universities and colleges, 44.4% of them had student health service facility and out of forty-three private universities and colleges, 60.5% of them had student health service facilities. 3. Each of 80.0% of 25 universities, 43.3% of 30 colleges and 33.3% of 15 junior colleges had student health service facility. 4. Major roles of student health service were physical examination (92.1%), health counselling (86.8%), primary medical care (78.9%), tuberculosis control (68.4%), insect and rodent control (52.6%), parasite control(47.4%), water source sanitation (44.7%), and dental health care (28.9%). 5. Out of 21 universities and colleges, 66.7% of them had full time doctor and 81.0% of them had full time nurse for student health center. And out of 17 universites and colleges, 5.9% of them had full time doctor and 33.3% of then had full time nurse for student health room. 6. The range of health fee was varied from 100 won to 1,400 won per student per semester and the average was 520 won. 7. Among 55 universities and colleges, 78.6% of them had carried out annual physical examination in 1977 and the rate of physical examination was 57.4%. 8. Out of 70 universities and colleges. 45.7% of them had tuberculosis control program and the prevalence rate was 6.0 per 1,000 students. 9. Student medical insurance program was developed by ten universities and one college among 25 universities and 45 colleges. 10. Student medical insurance benefit was varied according to university and college; the reduction rate of medical fee was 20% to 80% for not only in-patient but also out-patient. 11. The upper limit of pay claim was varied according to the university and college from 5,000 won to no-limitation for out-patient and from 30,000 won to no-limitation for in-patient. 12. The highest utility rate of student medical insurance program was found in university 'F' with the rate of 791 for out-patient and 12 for admitted patient per 1,000 students.

• Korea Journal of Hospital Management
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• v.7 no.1
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• pp.88-104
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• 2002

According to the change of mandatory referral system in July 1, 2000, the effect to the medical utilization of outpatient clinic and medical income in ophthalmology of tertiary care medical institute, S Hospital in Seoul was evaluated for 6 months before(1999. 12$\sim$2000. 5) and after(2000. 12$\sim$2001. 5). The results were as follows: 1. The number of outpatients was reduced by 16.6%. The number of patient with blindness low vision, retina, glaucoma increased and that of patient with accommodation refractive error, cataract decreased. 2. The number of cataract patients was reduced by 36.6%. The major location of patient's address was changed to nearer to the hospital. The number of cataract surgery reduced in 4.1%, the waiting time reduced in 42.2%, however surgery time increased in 20.2% and number of postoperative complications increased in 11.4%. 3. The income of outpatient clinic and cataract surgery reduced. Among items of outpatient clinic income, the most increased was ocular examination and the most reduced was injection and drugs. Among items of cataract surgery income, the most increased was operation fee and the most decreased was doctor's fee. In conclusion, for the patient, due to the lowered density of outpatient population more space was provided to the patients with more severe disease entity such as blindness' low vision, retina and glaucoma. For the hospital, the need for the expansion of ophthalmology was not found, however that for creation of the special clinics dealing with more severe disease entity was found. Due to reduced income and increased need of financial investment for the equipment and manpower for the more severe disease entity, the ophthalmology of tertiary care medical institute is faced with financial disaster. It is strongly suggested that the cost of medical practice of more severe disease entity be raised to achieve the success after change of mandatory referral system in ophthalmology.

• Information Systems Review
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• v.10 no.3
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• pp.289-311
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• 2008

This study is a development of quality scale and a measurement of quality levels for the Hospital Information System(HIS) used in the hospital industry. This study is to provide decision-making guidelines for hospital managers, system analysts, and software designers, and to provide feedback for the users' information needs. The target people of the study were medical doctors, nurses, pharmacists, and clerical staff. The service contexts of usability were diagnosis/treatment, nursing, medicine preparation, and treatment fee receipt/claim. The quality factors were the efficiency, effectiveness, and satisfaction of IS09241-11. This study shows that the current domestic HISs are mostly based on patient diagnosis/treatment and treatment fee accounting, and that other quality scales are necessary according to different job categories, specializations, positions, and service domains. Especially, the low quality of HIS was found in the abnormal service processing, information sharing by outside institutions, and standardization. It may be added that the HIS should be improved and developed in these respects.

• Journal of the Korea Convergence Society
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• v.9 no.2
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• pp.125-136
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• 2018

The purpose of the study is to investigate dental health insurance coverage the awareness and dental health insurance coverage extension to scaling in service consumers. There were significant differences according to education level, age on the appropriateness of the age of yearly scaling benefit, and to married, regions, self-oral health of the frequency of yearly scaling benefit, who their teeth brushed frequence a day on the appropriateness of the fee of yearly scaling benefit. It implies that should be added to the coverage list national health insurance every age group after increasing periodontal disease. It is to be more extension as to age, frequency and fee health insurance coverage of scaling, the effort to improve dental health insurance coverage policy must be continue for oral health in the future.

• Journal of Korean Neurosurgical Society
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• v.60 no.1
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• pp.47-53
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• 2017

Objectives : The Korean Resource Based Relative Value Scale (K-RBRVS) was introduced in 2001 as an alternative of the previous medical fee schedule. Unfortunately, most neurosurgeons are unfamiliar with the details of the K-RBRVS and how it affects the reimbursement rates for the surgical procedures we perform. We summarize the K-RBRVS in brief, and discuss on how the relative value (RV) of the spinal neurosurgical procedures have changed since the introduction in 2001. Methods : We analyzed the change of spinal procedure RVs since 2001, and compared it with the change of values in the brain neurosurgical procedures. RVs of 88 neurospinal procedures on the list of K-RBRVS were analyzed, while 24 procedures added during annual revisions were excluded. Results : During the past 15 years, RVs for spinal procedures have increased 62.8%, which is not so different with the cumulative increase of consumer prices during this time period or the increase rate of 92.3% for brain surgeries. When comparing the change of RVs in more complex procedures between spinal and brain neurosurgery, the increase rate was 125.3% and 133%, respectively. Conclusion : More effort of the society of spinal surgeons seems to be needed to get adequate reimbursement, as there have been some discrimination compared to brain surgeons in the increase of RVs. And considering the relative underestimation of spinal neurosurgeons' labor, more objective measures of neurospinal surgeons' work and productivity should be developed for impartial reimbursement.

• Journal of the Korean Home Economics Association
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• v.35 no.2
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• pp.217-234
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• 1997

This study attempts to analyze some determinants of consumers' medical service quality and their complaining behavior. The results can be summerized as follows: 1. The determinants of consumers' perceived medical service quality could be categorized as five factors; i.e. nursery, hospital environment, medical doctors, other staffs service fee. Among them nursery sector consists of 32% variance. 2. According to the discriminant analysis, those determinants are of great value to distinguish between satisfied/unsatisfied group. The hit ratio was 85.4% which is relatively high score. 3. The type of complaining behavior could be grouped into no action, private and public complaining behavior. Most of respondents belonged to no action group and a few showed private complaining behavior. Any respondents who were willing to show public complaining behavior could not be found out. 4. These variables which influence complaining behavior were preconception toward hospital, barrier to complaining process and expected complaining behavior. Among them the first one was most influential variable. 5. In order to distinguish between complaining/non complaining behavior group, discriminant analysis was done. The result showed the above three variables had a significantly discriminatory power, the hit ratio reaching above 70%. In summary, we can see that consumers' evaluation on the whole medical service depends on the external factor such as staffs' attitude or hospital facilities due to the lack of their ability to evaluate highly specialized service like doctor's treatment.

• Korea Journal of Hospital Management
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• v.19 no.2
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• pp.1-11
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• 2014

The purpose of this study is to investigate awareness on medical insurance on the caregivers cost for hospital administrative staff and to provide the basic data for realization of legislation. The subjects were caregivers living in Busan, the survey was conducted from February 18 to March 9, 2013, 283 except for 17 copies of non-response and error response among a total of 300 questionnaires were analyzed. As a result, To improve the quality of care services, there were 51.8% of refresher training needs in refresher training items, 72.7% in favor of premiums increases in health insurance details, as for health insurance coverage subjects, patients' income were 32.0%, copayment for caregivers cost was 20.0%, which was 42.3%. Refresher training item, premiums increases, health insurance applied subjects, variables for copayment for care fee were related to medical insurance on the caregivers cost. On legislation on the medical insurance, systematic and standardized criteria should be provided to provide standardized curriculum for caregivers, to relieve patients and guardians of economic burden for caregivers cost and offer the stability of the cost.