• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.123-164
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• 2014

Under the new system of 'Separation of pharmaceutical prescription and dispensing' in Korea, which was implemented in 2000, physician could not dispense a medicine, and outpatient should have a physician's prescription filled at a drugstore. After pharmacist makes up outpatient's prescription, National Health Insurance Service(NHIS) pay for outpatient's medicine to pharmacist, except an outpatient's own medicine charge. And NHIS only pay for outpatient's prescription fee to physician and, physician doesn't derive profit from dispensing medicine in itself. Nevertheless, if physician writes out a prescription with violation of 'Criteria for the Medical Care Benefits', NHIS clawed back the payment of outpatient's prescription and medicine from the physician or the medical institution which the physician belongs to. In the past, NHIS's confiscation was in accordance with 'the National Health Care Insurance Act, Article 52, Clause 1'. But, since 2006 when the Supreme Court declared that there was no legal basis on the NHIS's confiscation of outpatient's medicine payment, NHIS had put in a claim for illegal prescriptions on the basis 'the Korean Civil law, Article 750(tort)'. So, Many medical institutions filed civil actions against NHIS. The key point of this actions was whether the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits constitute of the law of tort. On this point, the first trial and the second trial took different position. Finally the Supreme Court acknowledged the constitution of the law of tort in 2013. In this paper, the author will review critically the decision of the Supreme Court, and consider the relativeness between the legal effect of Criteria for the Medical Care Benefits and the constitution of the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits as the law of tort.

• Journal of Physiology & Pathology in Korean Medicine
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• v.23 no.1
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• pp.174-179
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• 2009

Arterial pulse palpation is an important diagnostic method in Oriental Medicine, particularly for obtaining information about a patient's health conditions or illness, or for confirming a diagnostic conclusion based on the patient's pulsation. The pulse analyzer is both a leading Oriental Medical equipment and a promising tool with such a strong industrial ripple effect that it was selected as one of the four strategic tools for world Oriental Medical instrument market domination at a recent survey. Although various pulse analyzers had been developed, however, most of these were not widely used for clinical diagnosis, due perhaps to lack of the appliance's reliability caused by its inability to reflect the requirements of the clinicians. Thus, in this thesis, the clinical requirements for the pulse analyzer were identified and analyzed by conducting a questionnaire survey among Oriental Medicine clinicians. By looking into the basic functions of a pulse analyzer, the required measurement time, and the medical insurance fee required were determined and among others, the appliance's specific requirements were determined. Moreover, by investigating on the latest patent trend, the technical elements that are needed for the development of a next-generation pulse analyzer were identified. Through these processes, the flow of the technology that must be developed for the pulse analyzer was determined, and the direction for the development of the specific pulse analyzer hardware, sensor, and diagnostic algorithm was identified and proposed.

• The Journal of Korean Physical Therapy
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• v.5 no.1
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• pp.47-60
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• 1993

This study was conducted to investigate the changes diseases of physical therapy patient. Through the analysis, of total 2,902 cases in one university hospital and one general hospital in Taegu, of which 1,619 cases for 1989 and 1,283 cases for 1981. The physical records were analyzed in terms of sex, age, pattern in PT diseases, fee, and medical department of PT. The international classification of Diseases, 9th revision was used fer the study. Major results are as follows : 1. The ratio of male me female nae 1.51 to 1 in 1989, 1.53 to 1 in 1991. The proportion of the elderly over 60 was $15.6\%$ in 1989, $22.0\%$ in 1989. And the age groups of 50-59 years ranked the first an years. 2. As to the PT patients of medical department, Orthopaedics$(50.3\%)$, Neurosurgery$(28.1\%)$. Neuromedicine$(8.0\%)$. Plastic surgery$(4.4\%)$, and Dentry$(3.2\%)$ in that order in 1989. On the other hand, Orthopaedics$(51.2\%)$, Neurosurgery$(22.1\%)$, Neuromedicine$(9.6\%)$, Plastic surgery$(6.5\%)$, and Internal medicine$(6.5\%)$ in that order in 1991. 3. No significant difference was observed by season of PT patients, but winter (December, January and February) ranked the first all years. 4. No significant difference was observed changes in diseases as for the 56 international classification of diseases of PT patients, Diseases of the musculoskeletal system and connective tissue occupied the largest proportion all years. Fractures increased from $21.4\%$ in 1989, $24.5\%$ in 1991. On the other hand, Diseases of the nervous system remarkably increased from $8.9\%$ in 1989, $19.7\%$ in 1991.

• Health Policy and Management
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• v.8 no.1
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• pp.232-265
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• 1998

Taiwan has experienced rapid economic growth during the past two decades. As a result, the demand for health care in Taiwan has increased rapidly. To meet the rising demand, Taiwan implemented a National Health Insurance (NHI) program on March 1, 1995. This program now covers more than 96 percent of Taiwan's citizens. Implementation of the NHI in 1995 represents fulfillment of a primary social and health policy goals of Taiwan. The goals of the NHI program is to eliminate financial barriers of health care for the citizens, to improve the quality of care. To achieve these goals, the NHI was designed on the following principles: 1. All Taiwan citizens are compul내교 joined the NHI program by law; 2. The NHI program provides comprehensive services; 3. The NHI is run by one single govt' subsidy; 5. The NHI adopt fee-for-services scheme to pay medical expenses and copayment to avoid abouse of medical services. However, the scheme did not bring in the efficient use of health care C. National Health Council, 1986 NARC, Aging in Japan, International Publication Series 1991;2 Kahana EF. Kiyak HA. Attitude and behavior of staff in facilities for the aged, 1984 Naoki I, John CC. Health polic report japan's medical care system, New England Joumal of Medicine 1995; 333(19) National Economic Research Associates, The Health CAre System in Japan, NERA, 1993. National Federation of health Insurance Societies (KEMPOREM), Health Insurance and Health Insurance Societies in Japan, 1995. Owe Ahlund, Aging and housing in sweden, Paper presented at the International Symposium, Long term Care Facility, 1993. Statisitics Jahrbuch, Statistisches Bundesamt, 1992. Stein S. Linn, MIW. and Stein EM. Patient's anticipation of stress in nursing home care, 1985. U. S. Senate Special Committee on Aging, A Report of the special Committee on Aging, Washing D. C, 1992. U.S. Bureau of the Census, 1994.

• Korean Journal of Community Nutrition
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• v.13 no.3
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• pp.396-404
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• 2008

This study aimed to evaluate the amount of patients' satisfaction with hospital foodservices among those who were benefited from national health insurance during their hospitalization. A total of 3,094 inpatients from 191 medical institutions were enrolled in this survey. The survey was carried out from July 23 to September 14, 2007 through the face-to-face interview method. All analyses were made using the SPSS software (version 13.0). The mean age of the participants was 53.3 years, 57.0% were women; 34.7% were high-school graduates. Among the respondents, 30.9% stayed in the hospital for $7{\sim}14$ days long, and 52.0% were hospitalized in multi-patient rooms for six persons. The 87.7% of total population had a general diet, and 9.6% selected the food menu that was notcovered by health insurance. In addition, 38.3% of patients regarded the fee of foodservice as inexpensive. Overall, the satisfaction score with hospital foodservice was 3.63 on a Likert-type scale ranging from 1 (extremely dissatisfied) to 5 (extremely satisfied). However, the limitations were indicated including the lack of providing nutritional information and quality of taste. In conclusion, the quality of hospital foodservice might not deteriorate even after enforcement of national payment of medical insurance. Further efforts are required for the diversification of menus and legislative work for improving quality of food service for a successful hospital foodservice policy.

• Health Policy and Management
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• v.3 no.1
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• pp.53-83
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• 1993

A small number of high cost patients usually spend a larger proportion of scarce health resources. Korea is no exception. Under the national health insurance, 12% of the insured persons have consumed approximately half of the national health insurance expenditures. Therefore, it is necessary to identify the characteristics of the high cost patient group, if we would like to reduce them. This study has defined high cost patients as those who have spent one and half million won and over per 6 months. The study reveals that high cost users are those who have a longer length of stays(LOS), 40days of LOS in the 6 months, have multiple admissions, 2 to 3 admissions per 6 months and are the elderly patients. They have spent 814.126won per on the average, and commonly suffered from malignant neoplasms, circulatory diseases, fracture, diabetes mellitus, etc. Unlike the case of western developed countries, early readmissions are not the major causes of high cost spending in Korea. Undoubtedly, a lengthy admission is the main cause of large spending. Health policies should vigorously be explored to respond appropriately. There are evidences that hospital beds are often misused. As the Korean health care system is lacking in a mechanism of patient evaluation under the fee-for-service remuneration system, an idea of progressive patient care needs to be tested. The Goverment should set up health policy to diversify the role of long-term care facilities and encourage people to establish them. Further studies are needed to identify factors influencing large medical bills necessary for formulating the health policy on cost containment.

• The Korean Society of Law and Medicine
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• v.20 no.1
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• pp.243-279
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• 2019

During the main ruling in 2018, it is difficult to find a new judiciary, which is understood to be due to a certain degree of jurisprudence established and focusing mainly on contentious disputes within the framework of damages. The cases in which the court's judgment is reversed helped to understand the reason and the judiciary, and it was confirmed that the dispute in the medical lawsuit became more and more intense. Decisions on responsibility restrictions and medical records were also noticeable, with a significant increase in the number of verdicts relating to the doubt about medical records. This is considered to be part of the increasing number of cases in which the parties raise questions about medical records, and several cases were categorized and introduced at this opportunity. We also introduce the case of forced discharge of long-term hospitalized patients and medical fee bill, because it was judicial interest after the Supreme Court ruling that the cost of treatment for the after-effects of medical malpractice can not be claimed to the patient.

• The Korean Society of Law and Medicine
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• v.17 no.1
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• pp.299-346
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• 2016

There were also various decisions made in medical area in 2015. In the case that an inmate in a sanatorium was injured due to the reason which can be attributable to the sanatorium and the social welfare foundation that operates the sanatorium request treatment of the patient, the court set the standard of fixation of a party in medical contract. In the case that the family of the patient who was declared brain dead required withdrawal of meaningless life sustaining treatment but the hospital rejected and continued the treatment, the court made a decision regarding chargeable fee for such treatment. When it comes to the eye brightening operation which received measure of suspension from the Ministry of Health and Welfare for the first time in February, 2011, because of uncertainty of its safety, the court did not accept the illegality of such operation itself, however, ordered compensation of the whole damage based on the violation of liability for explanation, which is the omission of explanation about the fact that the cost-effectiveness is not sure as it is still in clinical test stage. There were numerous cases that courts actively acknowledged malpractices; in the cases of paresis syndrome after back surgery, quite a few malpractices during the surgery were acknowledged by the court and in the case of nosocomial infection, hospital's negligence to cause such nosocomial infection was acknowledged by the court. There was a decision which acknowledged malpractice by distinguishing the duty of installation of emergency equipment according to the Emergency Medical Service Act and duty of emergency measure in emergency situations, and a decision which acknowledged negligence of a hospital if the hospital did not take appropriate measures, although it was a very rare disease. In connection with the scope of compensation for damage, there were decisions which comply with substantive truth such as; a court applied different labor ability loss rate as the labor ability loss rate decreased after result of reappraisal of physical ability in appeal compared to the one in the first trial, and a court acknowledged lower labor ability loss rate than the result of appraisal of physical ability considering the condition of a patient, etc. In the event of any damage caused by malpractice, in regard to whether there is a limitation on liability in fee charge after such medical malpractice, the court rejected the hospital's claim for setoff saying that if the hospital only continued treatments to cure the patient or prevent aggravation of disease, the hospital cannot charge Medical bills to the patient. In regard to the provision of the Medical Law that prohibit medical advertisement which was not reviewed preliminarily and punish the violation of such, a decision of unconstitutionality was made as it is a precensorship by an administrative agency as the deliberative bodies such as Korean Medical Association, etc. cannot be denied to be considered as administrative bodies. When it comes to the issue whether PRP treatment, which is commonly performed clinically, should be considered as legally determined uninsured treatment, the court made it clear that legally determined uninsured treatment should not be decided by theoretical possibility or actual implementation but should be acknowledged its medical safety and effectiveness and included in medical care or legally determined uninsured treatment. Moreover, court acknowledged the illegality of investigation method or process in the administrative litigation regarding evaluation of suitability of sanatorium, however, denied the compensation liability or restitution of unjust enrichment of the Health Insurance Review & Assessment Service and the National Health Insurance Corporation as the evaluation agents did not cause such violation intentionally or negligently. We hope there will be more decisions which are closer to substantive truth through clear legal principles in respect of variously arisen issues in the future.

• The Journal of the Korea Contents Association
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• v.16 no.8
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• pp.366-375
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• 2016

This study evaluates the degree of the inequality of medical care expenditure and private health insurance benefits and the relation with household income inequality in korea health care system. This study used the 2014 korea Health Panel survey, and study method is Gini coefficient. The main results are as follow. First, average household income in 1st income quartile is 6,290,000won and 10st income quartile is 101,930,000won. And Gini coefficient of Korea household income is 0.3756. In other words, family income inequality is quite serious. Second, the Gini coefficient of the public institution supported medical care expenditure, such as health insurance and public assistance, is 0.0761, and the Gini coefficient of the expenditure of transportation fee and medical materials etc that don't supported is 0878. The inequality in medical care expenditure in public health care system and without public support aren't serious all. Third, Gini coefficient in excluding household medical care expenditure from household income slightly increased. That is, the medical care expenditure of our country household is the factor of aggravating the inequality of household income. Fourth, Gini coefficient of private health insurance benefits is 0.0927. Therefore, the ineqality in private insurance benefits is low. In addition, the Gini coefficient of the sum of private insurance benefits and household income is 0.3672. it decrease from Gini coefficient(0.3756) of household's. Private health insurance perform the functions somewhat weaken household income inequality. However, it is very little improvement.

• Health Policy and Management
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• v.7 no.1
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• pp.100-124
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• 1997

In order to suggest the strategies for participation in the PPS(Prospective Payment System), analyses were performed based on variations in utilization pattern and changes in revenues of hospitals in 10 selected KDRGs. The data was collected from the claims data of a tertiary hospital in Kyunggido from September 1, 1995 to August 31, 1996. The studies consisted of 1, 718 inpatients diagnosed for lens procedures, tonsilectomy &/or adenoidectomy, appendectomy with complicated principal diagnosis, Cesarean section, or vaginal delivery without any complications. The resources used in each KDRG were measured including average length of stay, total charges, number of orders, intensity of medical services, frequencies of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders. Then, the changes in hopital revenues due to the composition of medical fee schedules under the PPS were estimated as follows: 1) The variations in average lenght of stay, total charges, number of orders, the intensity of medical services, the frequency of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders among the 10 KDRGs were comparatively small. 2) The average lenght of stay was the longest(6.0 days) for appendectomy with complicated principal diagnosis, while it was the shortest(2.1 days) for two vaginal deliveries. Statistically differences existed in the average length of stay among physicians and among the dates of admission in several KDRGs. 3) The total charges were the highest for lens procedures(1, 716, 000 won), while the lowest charges were for two vaginal deliveries(558, 000 won). Statistically differences in the total charges were found among physicians in several KDRGs: however, there were no differences with the dates of admission. 4) The number of orders was the greatest(155) for appendectomy with complicated principal diagnosis, while it was the smallest(75) for the two vaginal deliveries. Statistical differences in the number of orders did not exist among physicians in the KDRGs. 5) Significant differences were found in the intensity of medical services, and in the frequency of medical services among physicians in the KDRGs. 6) The rate of non-reimbursable charges for each KDRG was not related to the rate of non-reimbursable orders. The rate of non-reimbursable orders was the highest(36.0%) for lens procedures, while the lowest rate(11.6%) was for appendectomy with complicated principal diagnosis. The rate of non-reimbursable charges was the highest(39.4-39.7%) for vaginal deliveries, while the lowest rate(13.1%) was for tonsillectomy &/or adenoidectomy(<17 ages). 7) If the physician's practicing style were not change under the PPS, the hospital revenuses could be increased by 10%, and the portion of patient payment could be decreased by 1.4-22.4%. However, the non-reimbursable charges for showed little change between two reimbursement systems. Based upon the above findings, this hospital could be eligible for participation in the PPS(Prospective Payment Systm). However, the process of diagnosis and treatment should be standardized, inentifying methods to reduce cost and to assure quality of medical care. Furthermore, consideration should be given to finding ways to increase patient volume.