• 한국임상약학회지
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• 제23권2호
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• pp.89-96
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• 2013

This article aimed to introduce 'risk sharing' schemes for pharmaceuticals between drug manufacturers and healthcare payer. Published literature review was undertaken to summarize risk sharing concepts and collect information on existing scheme examples in other countries focusing on new anticancer drugs. Risk sharing schemes could be categorized into health outcomes-based and non-outcomes (financial) based ones. Outcome-based schemes could be broken down into performance-linked reimbursement and conditional coverage. Performance-linked reimbursement can be further broken into outcomes guarantee and pattern or process of care and conditional coverage included coverage with evidence development and conditional treatment continuation schemes. Non-outcome based schemes included market share and price volume at population level, and utilization caps and manufacturer funded treatment initiation at patient level. We reviewed the fifteen examples for anticancer drugs that risk sharing agreements in response to the inherent uncertainties and increased costs of eleven anticancer drugs. Of them, eight cases were coverage with evidence development schemes. The anticancer drugs except bevacizumab and cetuximab were all listed on the national health insurance formulary in Korea, with reimbursement criteria defined on the basis of approved indications and administrations. Risk sharing approach may be a useful tool to ensure values for drug expenditure, but there are a number of concerns such as high administration costs, lack of transparency and conflicts of interest, especially for performance-based health outcomes reimbursement schemes.

• 한국산학기술학회논문지
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• 제7권2호
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• pp.231-237
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• 2006

2006년 3 월부터 보건복지부에서는 비급여 항목으로 환자의 부담이 컸던 환자식을 급여화하기로 함에 따라 입원환자에 제공하는 병원에서 제공하는 환자식 가격과 관련한 논란이 심화되고 있다. 본 연구는 과학적 방법으로 병원 모집단을 층화 추출한 후 71 개라는 많은 병원 자료를 이용해 급식 유형별 원가와 적정가격을 산정한 우리나라 최초의 연구이다. 활동원가계산과 상대가치 개념을 사용해 급식 유형별 원가를 산출 한 후, 급식 유형별 원가에 영향을 미치는 변수를 알아보았다. 환자식 가격에 영향을 미치는 가장 의미있는 변수는 급식종사인력과 급식 수이므로 보험수가에서는 이들 변수를 고려하여야 한다.

• Physical Therapy Rehabilitation Science
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• 제8권2호
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• pp.67-73
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• 2019

Objective: The purpose of this study was to compare the differences in the length of hospital stay between hemorrhage stroke survivors with health insurance and those with medical care after controlling all factors except for the type of medical insurance by using the propensity score matching (PSM) method. Design: Retrospective cohort study. Methods: Data from the Korean National Centers for Disease Control and Prevention's In-Depth Discharge Injury Survey between the years 2006 and 2012 were used for analysis. A total of 4,538 cases were defined as persons with hemorrhagic stroke (I60-I62) based on the block of categories in the International Classification of Diseases (10th). In order to analyze the inpatient period differences depending on the type of health care, which reflects one's socio-economic level, the chi-square and t-test was conducted. Results: Frequency and percentage were presented, and regression analysis was used to determine the factors affecting the inpatient period. Age, severity of disease, treatment outcome, and post-discharge status were no longer statistically significant after matching. The inpatient period of the persons receiving medical aid benefits was found to be significantly longer than those with national health insurance (p<0.05). Conclusions: The factors influencing the inpatient period of hemorrhagic stroke survivors were treatment outcomes, severity of disease, hospital admission process, and the type of health care. It is necessary for systematic and comprehensive governmental management for persons with hemorrhagic stroke to be transferred to long-term care facilities.

• 보건행정학회지
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• 제22권4호
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• pp.467-496
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• 2012

Public participation in the decision making for scarce health resources is important because health policy requires trust based consensus, which can be achieved by public's understanding and involvement of related policies. In the past, opportunities for interaction between health policy decision makers and lay public were rare in Korea. As political impulses towards public participation in health policy have increased, a few of deliberation methods were attempted. However, there is little research, reporting such cases with a critical examination of relevant theories and previous studies. We first critically review the literature on public participation within theories of democracy, governance, and empowerment. Next, we report a case of a citizen council experiment, which was held to examine public's preferences among different benefit options regarding new drugs and medical technologies. Specifically, in an one-day long citizen council with a total of 28 lay public, twelve questions of whether a drug or a technology should be included in the benefit package of health insurance were asked. Pre- and post-surveys investigated participants' perception of public engagement in health policy. Although it was experimental, the citizen council ensured that lay public could be careful enough to rationally compare the costs and benefits of different options and collectively make decisions. Further, results from pre- and post-survey showed a strong willingness of members to be involved in health care decision making. In the conclusion, we emphasize that better theories and methods need to be developed for more cases of citizen participation in health care policy and management.

• 한국치위생학회지
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• 제17권3호
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• pp.539-551
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• 2017

Objectives: The purpose of this study was to investigate the changes in factors on unmet dental scaling rate before and after the national health insurance. Methods: This study used the $2^{nd}$ data from the Community Health Survey. The study participants numbered 209,341 in 2011 and 219,517 in 2013.The average age was $51{\pm}17$ in 2011 and $52{\pm}17$ in 2013. Data were analyzed by descriptive statistics, chi -squared test and logistic regression using SPSS 23.0. Results: The scaling experienced rate of Korean adults has fallen by 3.5% from 66% to 69.5%. Logistic regression analysis showed that 2.7 times more 'people who were educated at elementary school level or lower' did not use dental scaling compared to higher educated children. Agriculture, forestry and fisheries workers did not use scaling at 2.0 times. Local residents with an income of less than one million won did not use 1.7times scaling. Local residents of 'no private insurance' did not use scaling at 1.5 times. In the case of the predisposing factors, the 20s had less than 1.8 times scaling compared to 50s. In the case of needs factor, local residents who experienced 'bad oral health status' and 'dental calculus' were treated scaling 1.3 times less compared to people with good oral health status and normal periodontal symptoms. Conclusions: In Korea, local residents are less frequently treated scaling due to enabling factors such as accessibility. In addition, predisposing factors such as age and sex, and oral health status and periodontal symptoms were related to not using the dental scaling. Therefore, the universality of health care services should be considered so that people who need periodontal care can use scaling.

• 대한치과기공학회지
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• 제43권3호
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• pp.124-131
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• 2021

Purpose: This study aimed to investigate the perception of dental implant insurance supply and demand for the elderly living in Hongseong-gun and Chungcheongnam-do, as well as the selection criteria regarding dental clinics for dental implant treatment to collect basic data for improving the oral health of the elderly population. Methods: Participants living in Hongseong-gun, Chungcheongnam-do who were at least 55 years old from November 2020 to March 2021 were included in this study. The chi-square test was performed to examine the age-specific perception of insurance-covered dental implants (p<0.05). Results: The age group that was the most interested in implants was the 70s age group, and the difference between this age group and the other age groups was statistically significant. Those in their 70's, 80's, and 90's or older paid about 600,000 won including dental implants covered by insurance, and there was a significant difference (p<0.05). Those in their 60s, 70s, and 80s estimated the highest value of implants covered by insurance as two and showed a significant difference (p<0.05). The awareness of the dental implant insurance by age showed that all age groups, except for the ≥90 years age group, considered the insurance to be mediocre mostly due to the large co-payment (p<0.05). Conclusion: There were differences by age in the awareness of dental implant insurance, co-payments, number of applications, and insurance coverage. The perceptions on dental implant insurance by age showed that all age groups except for those over 90 years and older, they considered the insurance was just mediocre the most.

• 보건행정학회지
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• 제31권3호
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• pp.261-271
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• 2021

Background: In 2018, the government increased the fee for the magnetic resonance imaging (MRI) image deciphering services of the external hospital to discourage the redundant MRI scan and to induce appropriate use of the MRI services. It is important to evaluate the effect of the policy to provide the basis for establishing other MRI-related policies. Methods: The healthcare data of the patients who had brain MRI scans were organized by episode and analyzed using the panel study in order to find out the effect of the MRI-related policy on the substitution effect and the medical expenses. Results: As a result of the increase in the fee of deciphering the MRI image, there has been an uplift in deciphering the MRI scan of the external hospital. It implies that more hospitals chose to use the MRI scan taken by other clinics or hospitals, rather than the MRI scan taken at their own facilities. Conclusion: The research results imply that a policy that facilitates the exchange of the medical image data between the hospitals is needed in order to establish an efficient management system of the healthcare resources. Such improvement is expected to reduce the social cost and contribute to the stability in the finance of national health insurance.

• 대한한의학회지
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• 제44권2호
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• pp.10-19
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• 2023

Objectives: This study aimed to find out the characteristics of patients with facial palsy based on the National Health Insurance(NHI) statistical yearbook and provide the information pertaining to supplement Coverage of NHI. Methods: Based on the data of NHI between 2004 to 2021 for facial palsy(G51) obtained from the Ministry of Health and Welfare, the analyses were carried out according to the distribution of gender and the number of patients, visits, reimbursed days, and medical expenses by using the SAS 9.4. Results: The crude rate of facial palsy was reported as 361.71(2021) comparable with 419.60(2004) and 534.11(2009). The rate of men increased from 293.96(2004) to 302.27(2021) but the rate of women decreased from 450.88(2014) to 420.80(2021). The number of patients maintained around 190,000, however, it declined for patients treated Korean medicine(KM) after 2010. As the medical expenses were elevated, especially Western medicine(WM), that of WM exceeded KM's since 2018. The expenses of women were higher than men's in KM. By contrast, there was no difference with gender in WM. For reimbursed days per visits, it has been increased in WM but there was no difference in KM. Conclusion: Although the rate of patients with facial palsy in KM was high with no difference in the whole number of patients and reimbursed days per visits in KM annually, the number of patients in KM decreased but medical expenses elevated. According to this, it is necessary for reinforcing Coverage of NHI to research other factors related to KM.

• 보건행정학회지
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• 제27권3호
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• pp.199-210
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• 2017

Background: This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2015 constructed according to the SHA2011, which is a new manual of System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analysing health accounts of OECD member countries. Particularly, financing public-private mix is parsed in depth using SHA data of both HF as financing schemes as well as FS (financing source) as their revenue types. Methods: Data sources such as Health Insurance Review and Assessment Service's publications of both motor insurance and drugs are newly used to construct the 2015 National Health Accounts. In the case of private financing, an estimation of total expenditures for revenues by provider groups is made from the Economic Census data; and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. Results: CHE was 115.2 trillion won in 2015, which accounts for 7.4 percent of Korea's gross domestic product. It was a big increase of 9.3 trillion won, 8.8 percent, from the previous year. Government and compulsory schemes's share (or public share) of 56.4% of the CHE in 2015 was much lower than the OECD average of 72.6%. 'Transfers from government domestic revenue' share of total revenue of HF was 17.8% in Korea, lower than the other contribution-based countries. When it comes to 'compulsory contributory health financing schemes,' 'Transfers from government domestic revenue' share of 14.9% was again much lower compared to Japan (44.7%) and Belgium (34.8%) as contribution-based countries. Conclusion: Considering relatively lower public financing share in the inpatient care as well as overall low public financing share of total CHE, priorities in health insurance coverage need to be repositioned among inpatient care, outpatient care and drugs.

• 보건행정학회지
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• 제20권4호
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• pp.126-138
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• 2010

Objectives : The purpose of this study is to evaluate the effects of assistive products usage on activity of daily living for the beneficiary older adults people in Korean long-term care insurance system. The study subjects were divided to assistive products users and non-users among the beneficiary older adults based on Korean long-term care insurance system to compare function improvement of the activity of daily living. Methods : In national wide 12 community elderly care center enrolled the National Health Insurance Corporation, The numbers of 281 beneficiary older adults(long-term care Grade I: 66, Grade II: 58, Grade III: 157) participated in this study. This survey assessment tool for activity of daily living was used the long-term care assessment instrument of the physical functions in the law of Korean long-term care insurance. The function items of Activity of daily living were included in clothing, washing, tooth brushing, bathing, eating, posture converting, stand sitting, move sitting, out of room, using toilet, controlling of stool, controlling of urine, washing hair. According to independence to complete dependence functioning level, remarks pointed 1 to 3 points. The data were analyzed by chi-square, two-way anova using SPSS V. 12.0. Results : The results appeared that the mean score of the functions in activity of daily living of assistive products users was a 27.60, and that of non-users was a 30.66. Assistive products were not effected in Grade I and II recipients, but that effected in Grade III recipients. Conclusion : Preparing for activation of assistive products based Korean long-term care insurance system, the result application as follows is possible. The usage of assistive products could improve the function of daily living activity in older adults. Related to Grade III beneficiary elderly people were improved function in activity of daily living by using assistive products, it is necessary to extend coverage the non-eligible elderly people in Korean long-term care insurance system.