• Health Policy and Management
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• v.27 no.2
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• pp.128-138
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• 2017

Background: The purpose of this study is to analyze the effects of differential coinsurance policy on prescription drug coverage of outpatients by types of medical institutions. Methods: In this study, we used a sample cohort database of the National Health Insurance Service and frequency analysis and marginal logistic regression model using generalized estimating equation were used for statistical analysis. Results: The summary on the major research is followed. First, about 16% of patients who used only tertiary or general hospital due to 52 ambulatory care sensitive conditions before policy implementation moved to hospitals and clinics. However, about 57% of them still use tertiary or general hospital. Second, the factors influencing the utilization of hospitals and clinics after the implementation of the policy were gender, age, and income level. As a result, the policy is effective to reduce the medical use of outpatient mental patients in tertiary or general hospital, but the effect is not significant. Conclusion: Therefore, in order to achieve the purpose of the policy for establishing the health care delivery system, it is necessary to adjust the co-payment so as to feel the burden on the co-payment when the outpatient for 52 ambulatory care sensitive conditions is used at the tertiary or general hospital.

• Journal of Society of Preventive Korean Medicine
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• v.24 no.2
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• pp.31-41
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• 2020

Background : The introduction of policies expanding the coverage of uninsured Korean Medicine (KM) services have requires an understanding of the following components of the service : current financial expenses, degree of financial burden on the patient, and financial effect of the coverage expansion. Objectives : This study aims to determine the annual trend of outpatients' characteristics and the category of out-of-pocket spending in KM. Methods : This study uses data from the Korea Health Panel to analyze use of KM in the Korean population. Using the user characteristics and behavior drawn from the Korea Health Panel data, out-of-pocket spending trends of KM were analyzed by year. The diagnosis and prescription of out-of-pocket spending were also analyzed. Results : The proportion of patients receiving uninsured medical treatment and the number of uninsured medical treatment in outpatient clinics have increased. However, the average out-of-pocket spending per person and out-of-pocket spending per visit are consistent or have decreased. Meaningful trends are the increase of R00-R99 (unclassified symptoms) and the decrease of K00-K93 (digestive system disease) and J00-J99 (respiratory system disease). Conclusions : Expansion of KM medical service and insurance is influenced by uninsured medical treatment of KM. Hence, research to increase medical treatment categories for out-of-pocket spending or explore diseases where KM diagnosis has been proven effective should be further developed.

• Health Policy and Management
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• v.20 no.4
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• pp.58-73
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• 2010

Background : Cancer is a disease that not only places a significant burden on patients clinically but also requires significant expense for diagnosis and treatment. Although the cancer coverage of health insurance has recently been expended, the need for financial assistance among cancer patients and their families is still expected to be significant. In this study, cancer patients' need for financial assistance in Korea was examined and its influence factors were analyzed. Methods : Target study subjects were those who are over 18 years of age and were diagnosed with cancer more than four months prior at the National Cancer Center and 9 Regional Cancer Centers in Korea during the period from July to August of 2008. Quarter sampling was conducted according to the ratio of the type of each cancer. A face to face interview survey was conducted. A total of 2,661 cancer patients finished the survey. Medical charts were reviewed in order to obtain the cancer type and SEER stage of cancer patients. An ordered logistic regression model was used to examine the level of need for financial assistance according to the demographical, clinical, and socio-economic variables of cancer patients. Result : The percentage of cancer patients who needed financial assistance was 69.0%, and 36.9% needed significant financial assistance. The need for financial assistance was perceived to be greater in males, younger age group, low income group, low education group, medical aid recipients, those who were diagnosed recently, those with a low level of quality of life measured through EQ5D, and those with decreased income after cancer diagnosis. Conclusion : In spite of the current policy to increase health insurance coverage, the majority of cancer patients and their families in Korea still need financial assistance due to cancer. In particular, there were more vulnerable groups, such as the low income, or low education group. In the future, policies that focus on the disadvantaged, which strengthen social security, should be considered for achievement of a substantially better quality of life for cancer patients and their families.

• Journal of dental hygiene science
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• v.15 no.1
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• pp.46-53
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• 2015

The purpose of this study is to identify the awareness of oral health workforce and the attitude concerning the health insurance benefit on topical fluoride application. The subjects are 173 dentists and 288 dental hygienists. The data were collected using a self-administered questionnaire and analyzed using SPSS 12.0 statistical program. The findings of the study were as follows: Agree's (including strongly agree) ratios regarding to the health insurance benefit of topical fluoride application was 92.5% for dentists and 90.8% for dental hygienists. Appropriate age of health insurance benefit about the topical fluoride application was elementary, middle and high school students (8~19 years). This response ratio was high 45.7% for dentists and 43.2% for dental hygienists. Appropriate copayment (mean value) of health insurance about topical fluoride application coverage showed that NaF, $SnF_2$ solution and acidulated phosphate fluoride gel were 25,782 Korean Won (KRW) for dentist and 14,282 KRW for dental hygienist. Fluoride varnish copayment was 31,705 KRW for dentist and 17,979 KRW for dental hygienist. Fluoride iontophoresis copayment was 40,156 KRW for dentist, and 21,210 KRW for dental hygienist. The frequency of health insurance benefits about topical fluoride application was high in 'unlimited (37.5%)' for the dentists and 'two times (31.3%)' for dental hygienists. In conclusion, topical fluoride application should be included as one of the health insurance benefit items for oral health.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.23 no.1
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• pp.260-269
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• 2010

Background : Bojungikgitang(BJT) and Banhabaekchulchonmatang(BBT) are known to treat the tinnitus patients, which were registered Korean National Health Insurance coverage lists. Objective : Few studies have evaluated economic benefits of both herbal medicines. This research is to investigate the cost-effectiveness of Bojungikgitang(BJT) and Banhabaekchulchonmatang(BBT) in chronic tinnitus patients over nineteen years old. Method : We built the decision tree model of chronic tinnitus and executed the deterministic analysis and threshold sensitivity analysis based on randomized clinical trial. Effectiveness was measured in quality-adjusted life-years(QALYs), and costs were in 2009 KRW(South Korean Currency). The perspective is societal, time horizon is 10 weeks, and Korean willingness to pay threshold is assumed to 20,000,000KRW. Results : In the base case analysis, BJT treatment resulted is better outcomes as low cost, so BJT is dominant medicine and BBT is dominated. But both cost per QALYs (BJT is 3,120,339KWN per QALY, BBT is 3,505,780KWN per QALY) are lower than the threshold, that could be covered by Korean National Health Insurance(KNHI). Conclusion : This study results showed that BJT was more cost-effective than BBT treating tinnitus patients for 10 weeks, and the cost per QALYs of both alternatives were lower than Korean national threshold.

• 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.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.2
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• pp.395-400
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• 2015

Both Japan and Korea provide population-based screening programs. However, screening rates are much higher in Korea than in Japan. To clarify the possible factors explaining the differences between these two countries, we analyzed the current status of the cancer screening and background healthcare systems. Population-based cancer screening in Korea is coordinated well with social health insurance under a unified insurer system. In Japan, there are over 3,000 insurers and coordinating a comprehensive strategy for cancer screening promotion has been very difficult. The public healthcare system also has influence over cancer screening. In Korea, public healthcare does not cover a wide range of services. Almost free cancer screening and subsidization for medical cost for cancers detected in population-screening provides high incentive to participation. In Japan, on the other hand, a larger coverage of medical services, low co-payment, and a lenient medical audit enables people to have cancer screening under public health insurance as well as the broad range of cancer screening. The implementation of evidence-based cancer screening programs may be largely dependent on the background healthcare system. It is important to understand the impacts of each healthcare system as a whole and to match the characteristics of a particular health system when designing an efficient cancer screening system.

• Perspectives in Nursing Science
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• v.14 no.1
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• pp.37-44
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• 2017

Purpose: This study aimed to provide information on the developmental process and current status of Advanced Practice Nurses (APN) and to suggest ways for activating APN roles in Korea. Methods: We reviewed literatures to explore domestic and international trends related to the roles, practice settings, scope of practice, regulatory policies, and political environment of APN. Results: Interest in the APN role has been gaining ground worldwide. While the roles of APN in the USA, Taiwan and Japan have been changed in terms of legislation and institutional regulations, the role of APN in 12 fields except for APN in home care has not been legislated since qualification was specified in Korean Medical Law. Many problems were found in vitalizing APN roles: absence of legal regulations on the scope of practice or health insurance coverage for APN, increase the number of medical support staffs who are not qualified, and a disagreement regarding the qualification field and practical field. Conclusion: This study presents snapshots and vitalizing strategies of practice, and regulation for APN to develop their unique roles in Korea. The tasks and duties of APN should be identified specifically to fulfill their roles. In terms of national health insurance policy APN's Nursing care should be reimbursed just as nursing care of APN in home care.

• Journal of Society of Preventive Korean Medicine
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• v.23 no.2
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• pp.43-51
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• 2019

Objectives : This study aimed to analyze price variance by year, region and company of raw herbal medicines to draw payment system for herbal medicine insurances in the National Health Insurance. Methods : To analyse price variance, we used 2015-2017 data of 'Quality test results of imported herbal medicines' provided by Korea Pharmaceutical Traders Association and 'Price data of 56 raw herbal medicines' that was surveyed by the Association of Korean Medicine. We analysed gap of highest price and lowest price those were compared with average price and coefficient of variation(CV) of prices by year, region and company of raw herbal medicines. Results : In analysing 3 years data, the highest price was 23.2% higher, and the lowest price was 19.1% lower than the average price. As of 2018, the average price of domestic produced herbal medicines was 1,8 times higher than that of imported herbal medicines. By companies, the highest price was 117.5% higher, and the lowest price was 57.3% lower than the average price. Conclusions : The price of herbal medicines varied by production year, region and company. This results suggest that comprehensive payment model needs to be considered in modeling the health insurance coverage for herbal medicine decoctions.

• Health Policy and Management
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• v.27 no.2
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• pp.97-102
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• 2017

On May 10, 2017, Moon Jae-in's Government launched. The election pledges of Moon's Government in healthcare sector were extracted from those of president election camp and Democratic Party. The main pledges were enhancing the coverage of healthcare costs, management of healthcare costs for elderly, restructuring the health insurance contribution system, and improving the public nature of healthcare system. There are many policy tasks to realize the electoral pledge, especially, financial task is main. The National Planning and Advisory Committee are setting the policy priorities and making the detailed plans. Although this paper deals the initial evaluation of main election pledges, the precise evaluation is needed for the final plan of healthcare policy.