• Journal of Chest Surgery
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• 제49권2호
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• pp.85-91
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• 2016

Background: This study was conducted to determine the efficacy of staple line coverage using a polyglycolic acid patch and fibrin glue without pleural abrasion to prevent recurrent postoperative pneumothorax. Methods: A retrospective analysis was carried out of 116 operations performed between January 2011 and April 2013. During this period, staple lines were covered with a polyglycolic acid patch and fibrin glue in 58 cases (group A), while 58 cases underwent thoracoscopic bullectomy only (group B). Results: The median follow-up period was 33 months (range, 22 to 55 months). The duration of chest tube drainage was shorter in group A (group A $2.7{\pm}1.2day$ vs. group B $3.9{\pm}2.3day$, p=0.001). Prolonged postoperative air leakage occurred more frequently in group B than in group A (43% vs. 19%, p=0.005). The postoperative recurrence rate of pneumothorax was significantly lower in group A (8.6%) than in group B (24.1%) (p=0.043). The total cost of treatment during the follow-up period, including the cost for the treatment of postoperative recurrent pneumothorax, was not significantly different between the two groups (p=0.43). Conclusion: Without pleural abrasion, staple line coverage with a medium-sized polyglycolic acid patch and fibrin glue after thoracoscopic bullectomy for primary spontaneous pneumothorax is a useful technique that can reduce the duration of postoperative pleural drainage and the postoperative recurrence rate of pneumothorax.

• 보건행정학회지
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• 제29권2호
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• pp.99-104
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• 2019

On May 1, 2019, the Minister of Health and Welfare announced publicly the first Comprehensive Plan of National Health Insurance (NHI). The Comprehensive Plan which is the 5-year plan including expenditure and revenue aspect of NHI, is desirable in 42 years of introduction of NHI and 30 years of universal coverage of NHI, though the Plan was late and had some conflict process. The Comprehensive Plan was established without evaluation of Moon's Care Plan, did not included to relationship with NHI and other health security systems, and did not have the blue print of NHI. The Plan was not sufficient in content of adequate health care utilization and relationship with service benefit and cash benefit. The Comprehensive Plan should be modified in considering the blue print of NHI and national healthcare system with participating stakeholder in turbulent environment-low fertility, rapid ageing, low economic growth rate, era of non-communicable diseases, unification of the Korean Peninsula, and 4th industrial revolution. Therefore, I suggest to establish the President's Committee of Improving Healthcare System for the blue print of health care and NHI.

• 한방재활의학과학회지
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• 제19권3호
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• pp.101-109
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• 2009

Objectives : This study aimed to investigate the present status of physical therapies provided in the Korean medicine clinics, and to find out the priorities among and the estimated fees of physical therapies for the National Health Insurance plan. Methods : We administered nationwide survey to Korean medicine doctors using the on-line survey system. 16 physical therapies were listed in the Web-based questionnaires, and responders were asked to mark the therapies they used for their patients, and, for each therapy they marked, to fill in the form including the frequencies of service, service fees, target diseases, and priorities for health insurance coverage, etc. Results : Of 488 respondents, 93.7% provide more than one physical therapy for their patients, and each responder uses 5.9 physical therapies on average. 60-90% of physical therapies are being given to patients for free because they are not covered by the National Health Insurance. There is little evidence that the specialties of Korean medicine doctors are related with the use of physical therapies, but, in some therapies, the doctors with longer career years use the physical therapy more frequently. Most physical therapies are applied to the patients with musculoskeletal diseases, cardiovascular diseases, and nervous diseases, etc. Conclusions : Physical therapies are widely used among Korean medicine doctors without proper compensation. This could be the one of the main factors distorting the profit structure of Korean medicine clinics, and it encourages the National Health Insurance to cover physical therapies provided in the Korean medicine clinics.

• 한국산학기술학회논문지
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• 제21권12호
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• pp.798-806
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• 2020

치면열구전색법은 건전한 구치부의 교합면의 좁고 깊은 소와나 열구를 전색 하여 교합면에 발생되는 치아우식증을 예방하기 위한 술식이다. 치면열구전색의 급여화 기준 확대 및 국가구강보건사업 결정에 필요한 기초자료를 제공하고자 본 연구를 시행하였다. 본 연구는 국민영양조사 원시자료 제 5기, 6기, 7기 자료를 토대로 만 6~18세 이하 소아청소년을 총 4,366명을 대상으로 치면열구전색 수혜량과 수혜률을 조사하였다. 2012년 치면열구전색 수혜률에서는 나이, 동. 읍면, 월 평균 가구소득에서 차이가 있었고. 일반적 특성이 수혜에 미치는 요인에서는 2014년 월평균 가구소득 2017년 나이, 월평균 가구소득에서 수혜률 차이가 나타났다(P<0.05). 연도별 일반적 특성이 수혜에 미치는 요인에서 2012년에서 동. 읍면, 월 평균 가구소득 2014년은 월 평균 가구소득, 2017년은 나이와 월 평균 가구소득이 영향을 미치는 요인으로 나타났다(P<0.05). 치아우식증에 효과적인 치면열구전색의 수혜량과 수혜률 증가를 위해서는 지속적인 사업의 홍보와, 본인부담금 감소 및 대상 치아 및 연령 확대, 소외지역 및 취약계층에 대한 지원 확대 방안에 대해서 다각적으로 논의해야 할 것으로 요구되어진다.

• 농촌의학ㆍ지역보건
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• 제16권2호
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• pp.179-194
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• 1991

Despite its universal coverage of health insurance, the rural health insurance program(RHIP) stands at the crossroads in Korea. The RHIP has weaknesses in stability of financing, problems of inequities in the provision of health services and has suffered from high cost of running the program. The author has analyzed these problems from the perspective of health insurance policy and presented several options for improvement. First of all, this study urged the importance of a firm Governmental commitment of RHIP with the 50% subsidization of contributions as the Government had promised, instead of the current 40%. This can be justified from the 20% subsidization by the Government for the contributions of private school teachers and their dependents, who belong to richer segments of the population. Second, various cost containment measures ought to be sought curbing the rising demand for medical through strengthening health education and increasing individual responsibility, and tightening the claim review process. Third, this study requires the Government to run a demonstration project on the introduction of case payment system for primary health care. Fourth introducing an income-related cost sharing scheme is another possibility. Reforming the cost sharing formula for large medical expenditures is recommendable for a beginning. This measure can take the form of tax credit for medical expenditures of the poor. Fifth, the degree of financial adjustment among health insurance plans should be levelled up for enhancing stability of RHIP and social solidarity. Sixth, health policy should be redirected toward development of rural health resources and higher priority should be put on relieving difficulties in access to care. Seventh. the insurance plan owned-hospital needs to be developed or provision of health services in the medically underserved areas, and the need of such facilities is particularly acute for geriatric care, rehabilitation and renal dialysis, etc. Eighth, more generous insurance benefits are required of the elderly who are suffering the most : elimination of the maximum 180 days of benefit period and provision of glasses and artificial dentures, etc. Ninth. the economies of scale principle is working for the operating expenses of regional self-employed insurance plan. Thus, measures should be instituted to pursue an optimum size of health insurance plans. Lastly, excessive dependence on exclusion items is an evil so that some radical remedies are urgently required to cut them.

• 치위생과학회지
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• 제15권3호
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• pp.287-294
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• 2015

연구 대상자의 건강보험 치석제거 수진에 영향을 미치는 요인을 알아 보기 위하여, 2014년 2월 10일부터 2014년 2월 28일까지 수도권(서울, 경기 인천)에 거주하는 만 20세 이상 60세 미만의 성인 238명을 대상으로 설문조사하여 다음과 같은 결론을 얻었다. 건강보험 치석제거에 대한 인식을 조사한 결과 제도에 대한 개선점은 연간횟수가, 건강보험 치석제거에 대한 인지도는 보통이다가 그리고 건강보험 치석제거 제도에 대한 지지도는 그렇다가 가장 많은 분포를 차지하였다. 건강보험 치석제거를 받지 않은 이유로는 시간이 없어서가 가장 많았다. 건강보험 치석제거 수진 의향은 여자가, 정기적 구강검진을 받는 경우, 구강보건교육 경험 이 있는 경우, 건강보험 치석제거 경험이 있는 경우에 유의미하게 높았다. 로지스틱 다중회귀분석결과, 건강보험 치석제거 수진에 영향을 미치는 요인은 소득 (OR, 3.55; p<0.05), 건강보험 치석제거 경험 (OR, 3.06; p<0.05), 정기적 구강검진 (OR, 2.63; p<0.05) 순으로 나타났다. 이상의 결과로 볼 때, 건강보험 치석제거의 수진율을 높이기 위해서는 건강보험 치석제거에 대한 홍보 및 구강보건교육을 통하여 새로운 제도의 인지도를 높이고, 정기적인 구강검진으로 건강보험 치석제거의 중요성을 강조할 필요가 있다.

• 대한영상의학회지
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• 제81권5호
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• pp.1024-1037
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• 2020

상대가치란 소모된 자원의 양을 기준으로 의료행위의 가치를 상대적으로 비교한 점수로 의사업무량, 진료비용, 위험도로 구성된다. 2차 상대가치 개정 당시 영상검사 수가는 높은 원가 보존율을 이유로 인하되었다. 영상검사 수가는 상대가치 체계에서 진료비용이 대부분을 차지하고 있으며, 의사업무량은 상대적으로 저평가되어 있다. 문재인케어라고 불리는 새로운 건강보험 보장성 강화 대책은 비급여의 급여화, 본인부담금 상한제 확대, 재난적 의료비 지원을 골자로 국민의 의료비 부담을 줄이는 것이 목표이며 향후 건강보험 재정에 부담이 늘어날 것으로 우려된다. MRI와 초음파 검사 급여 확대는 문재인케어에서 큰 비중을 차지하고 있으며 영상의학과는 문재인케어 적용 과정에서 저평가된 영상검사에서의 의사의 노동을 적절히 평가받을 수 있도록 노력해야 한다.

• 대한예방한의학회지
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• 제14권2호
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• pp.57-66
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• 2010

Backgrounds : Since December 1, 2009, National Health Insurance began to reimburse for three physical therapies of Korean medicine. The extension of insurance coverage is demanded by Korean medicine societies. Objectives : This study aimed to measure the resource-based relative value scale (RBRVS) scores for thirty four physical therapies of Korean medicine and to estimate the insurer's expenditure for them in National Health Insurance. Methods : To measure the physician's work and the practice expense, the 'magnitude estimation method (MEM)' and the 'fully distributed cost - attributable cost method (FDC-ACM)' were applied respectively. We collected the frequency data of physical therapies from Korean medicine hospitals and clinics to estimate the total expenditure. Results : The resource-based relative value scale scores of physical therapies were measured from 23.44 to 160.66. Total insurer's expenditure was calculated to be 95.5 billion won as of 2009. Conclusions : Based on the result that showed minor increase of total expenditure, most physical therapies of Korean medicine need to be reimbursed in the National Health Insurance.

• 보건행정학회지
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• 제33권3호
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• pp.264-272
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• 2023

Background: Private health insurance supplements the coverage of national health insurance in Korea. In this situation, the subject of the study is to identify the healthcare utilization of people with physical and mental illnesses according to private health insurance. Methods: This study used data from the Korea Health Panel Survey 2018. The study population consisted of 813 individuals with physical and mental illnesses (PMI). Multiple logistic regression analysis and binominal logistic regression analysis were conducted about the utilization of emergency, inpatient, and outpatient medical services of people with PMI depending on enrollment in private health insurance (PHI). Results: The results of this study indicated that individuals with PHI utilized emergency and outpatient medical services less frequently compared to those without PHI. Conversely, having PHI was associated with a higher utilization of inpatient medical services compared to not having PHI. Binomial logistic regression analysis revealed that individuals with PMI who had PHI exhibited a higher frequency of visits to emergency and outpatient medical services compared to those without PHI. However, the significance of this trend was not observed in the case of emergency medical services. On the other hand, individuals with PMI who had PHI showed a lower frequency of visits to inpatient medical services compared to those without PHI. Conclusion: In conclusion, there was a significant relationship between having PHI and the utilization of medical services in people with PMI. There is a need for a follow-up study considering the type of mental illnesses, length of stay, and health outcome of people with PMI depending on having PHI.

• 사상체질의학회지
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• 제23권1호
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• pp.1-7
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• 2011

Reforming the insurance scheme for herbal drugs in the National Health Insurance is a long-cherished desire for Korean Medicine doctors. Because most Korean Medicine doctors distrust the quality of existing insured herbal drugs, which are powdered mixes of each herbal extract, the use and the expenditure of insured herbal drugs have been decreased in the last ten years. To address this, it has been demanded to insure the composite type of herbal preparation, which is the extracted powder of the whole prescription, to the benefit coverage for herbal drugs. Many stake holders, however, have so far been unable to reach an agreement on this. In this situation, Sasang Constitutional prescriptions are expected to make a breach of insuring the composite herbal preparations, because some of them were approved as prescription drugs in 1999. In this review, I discussed the problems of insured herbal drugs, the necessity of insuring the composite herbal preparations and Sasang Constitutional prescriptions, and the tasks of Sasang Constitutional Society to insure them.