• Health Policy and Management
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• v.26 no.1
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• pp.63-70
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• 2016

Background: Selective health benefit was introduced for decreasing economic burden of patients. Medical devices with economic uncertainty have been covered as selective health benefit by National Health Insurance since December 2013. We aimed to analyze impact of selective health benefit to medical expenditure and provider behavior focused on electrosurgery (ultrasonic shears, electrothermal bipolar vessel sealers) for gastric cancer patients covered since December 2014. Methods: We used the National Health Insurance claims data of 2,698 patients underwent gastric cancer surgery between August 2014 and March 2015. Medical cost and patient sharing per inpatient day were analyzed to verify that covering electrosurgery increased medical expenditure and changed provider behavior from open surgery to endoscopic or laparoscopic surgery. Additionally, we analyzed the claim rate of medical device or goods relating gastric endoscopic and laparoscopic surgery. Results: Medical cost and patient sharing per inpatient day were increased after covering electosurgery as selective health benefit (39,724/1,421 won). However, there were no medical expenditure increases after adjusting claim of electosurgery and patient sharing was decreased 1,057 won especially. The coverage of selective health benefit did not increase the claim rate of medical device or goods related endoscopic or laparoscopic surgery, either. Conclusion: Covering electosurgery decreased patient economic burden and did not change of provider behavior. Expanding selective health benefit is needed to decrease economic burden of severe patients. Further study should evaluate the long term effect with accumulated data.

• Health Policy and Management
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• v.29 no.2
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• pp.206-219
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• 2019

This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2018 constructed according to the SHA2011, which is a manual for 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 analyzing health accounts of OECD member countries. Particularly, scale and trends of the total CHE financing as well as public-private mix are parsed in depth. In the case of private financing, estimation of total expenditures for (revenues by) provider groups (HP) is made from both survey on the benefit coverage rate of National Health Insurance (by National Health Insurance Service) and Economic Census and Service Industry Census (by National Statistical Office); and other pieces of information from Korean Health Panel Study, etc. are supplementarily used to allocate those totals into functional classifications. CHE was 144.4 trillion won in 2018, which accounts for 8.1% of Korea's gross domestic product (GDP). It was a big increase of 12.8 trillion won, or 9.7%, from the previous year. GDP share of Korean CHE has already been close to the average of OECD member countries. Government and compulsory schemes' share (or public share), 59.8% of the CHE in 2018, is much lower than the OECD average of 73.6%. 'Transfers from government domestic revenue' share of total revenue of health financing was 16.9% in Korea, lower than the other social insurance countries. When it comes to 'compulsory contributory health financing schemes,' 'transfers from government domestic revenue' share of 13.5% was again much lower compared to Japan (43.0%) and Belgium (30.1%) with social insurance scheme.

• The Korean Journal of Health Service Management
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• v.6 no.2
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• pp.165-177
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• 2012

This study examined market size of private health insurance premium and individual characteristics associated with the market size change in Korea, using wave 1 (2008) and wave 2 (2009) of Korea Health Panel. The market size was 24.4 trillion Korean won in 2008 and 26.9 trillion in 2009. The increase rate of private health insurance premium among those who were the elderly, single, or the poor was higher than that among their counterpart respectively. Health status and utilization were insignificant in determining the increase rate of private health insurance premium. These findings were more obvious among the uninsured in 2008 than among the insured in 2008. The increase of private health insurance premium in Korea imply the increase of willingness-to-pay for health risk through private sector. The authors suggest policy intervention for accessability to health care for the underprivileged and weak through enlargement of Korean social health insurance benefit.

• Journal of Chest Surgery
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• v.49 no.sup1
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• pp.37-43
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• 2016

Background: While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. Methods: After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. Results: The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040-an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309-an increase of -24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. Conclusion: Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time, effort, and resources; therefore, by analyzing the various factors affecting the supply of cardiovascular surgeons, an active intervention of policies can be prescribed for the areas that have failed to meet the appropriate market distributions.

• Health Policy and Management
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• v.22 no.3
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• pp.451-465
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• 2012

In order to strengthen assurance of National Health Insurance, co-payment should be reduced. This can happen with collaborative efforts of patients, medical institutes, and government altogether at the same time. This research applied Dutton(1986)'s medical service research model with high R-square, and analyzed 2008 Korea Health Panel Data (Beta Version 1), that was examined by Korea Institute for Health and Social Affairs and National Health Insurance, in order to figure out influential variables on co-payment. In result of Multiple Linear Regression Analysis, R-square was 46.7%, the older the age, the patients who had surgery, the longer days of hospital treatment are, the higher gross income of a household is, the more hospitalized in upper grade general hospitals, and the more upper grade rooms and selecting a doctor are used. The results have statistical significance. When conducting research applying medical service research model, there is a need to apply Dutton(1986)'s medical service research model with high R-square. In order to strengthen assurance of National Health Insurance, first conditions should be that patients are hospitalized in upper grade general hospital, and at the same time, are patients who had surgery with long stay of hospitalization. In addition, if proven that patients used upper grade rooms and selecting a doctor due to lack of regular treatment and rooms, for certain number of days of such hospitalization, it is suggested to be provided with health care insurance in upper grade rooms and selecting a doctor in calculating co-payment limit.

• Quality Improvement in Health Care
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• v.28 no.1
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• pp.2-13
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• 2022

Purpose: This study assessed the status of the Development and Utilization of critical pathways (CP) in South Korea. Methods: We surveyed 195 hospitals obtained on the Korean Hospital Association website. Data were collected using structured questionnaires for staff members in charge of CP management personnel in these hospitals. The questionnaire included CP developed by the institutions, the coverage rates and completion rates of CP in the current year, and management indicators related to CP. The questionnaire also included CP support systems and content within the institutions and questions regarding the advantages of CP utilization and obstacles associated with the CP development process. Results: Analysis of the responses from 70 hospitals (35.9% response rate) showed that a total of 1,370 CP sets were developed. The number of CP related to surgery departments was 365 (26.6%), and CP related to surgery and procedure was 1,093 (79.8%), respectively. The CP coverage rate was the most frequently used indicator to monitor the effect of CP (97.1%), followed by the completion rate (90.0%) and the length of stay in hospital (61.4%). CP managers reported that CP were highly useful for communication (3.39±0.493) and accurate information provision (3.39±0.491). The perception that CP violated doctors' autonomy in treatment was relatively low (2.87±0.645). Conclusion: It is necessary to establish an infrastructure in hospitals for CP. CP can facilitate communication and provide accurate information.

• Health Policy and Management
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• v.31 no.4
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• pp.423-436
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• 2021

This article summarizes the structure of China's current social health insurance system and reviews the development status of China's private health insurance (PHI). China's medical security system is mainly composed of two parts: basic medical insurance (BMI) and PHI. Among them, the BMI provides reimbursement of basic medical expenses for the insured persons according to different proportions. PHI is a necessary supplement to the BMI and provides assistance to the insured persons in the event of illness or accident. By having PHI, people can obtain medical protection outside the coverage of BMI. In the development of PHI in China, the total medical cost is high and the insurance market size is large, but the proportion of PHI expenditure is low and the personal burden is high. Through this Chinese case, it will be helpful for mutual development between Korean PHI and national health insurance, for Korean insurance companies to enter the Chinese market, and for removing the medical burden on the people.

• Health Policy and Management
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• v.30 no.2
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• pp.164-177
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• 2020

This study aims to compare the experience of selected countries in operating separate payment system for new healthcare technology and to find implications for price setting in Korea. We analyzed the related reports, papers, laws, regulations, and related agencies' online materials from five selected countries including the United States, Japan, Taiwan, Germany, and France. Each country has its own additional payment system for new technologies: transitional pass-through payment and new technology ambulatory payment classification for outpatient care and new technology add-on payment for inpatient care (USA), an extra payment for materials with new functions or new treatment (C1, C2; Japan), an additional payment system for new special treatment materials (Taiwan), a short-term extra funding for new diagnosis and treatment (NUB; Germany), and list of additional payments for new medical devices (France). The technology should be proven safe and effective in order to get approval for an additional payment. The price is determined by considering the actual cost of providing the technology and the cost of existing similar technologies listed in the benefits package. The revision cycle of the additional payment is 1 to 4 years. The cost or usage is monitored during that period and then integrated into the existing fee schedule or removed from the list. We conclude that it is important to set the explicit criteria to select services eligible for additional payment, to collect and analyze data to assess eligibility and to set the payment, to monitor the usage or cost, and to make follow-up measures in price setting for new health technologies in Korea.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.11
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• pp.7463-7473
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• 2015

This study aims to analyze the effect of long-term care utilization on health care utilization of the national health insurance elderly. This study is a secondary data analysis of the long-term care insurance data that comprised of total 21,213 long-term care insurance with the level 1 elders who received either service or non-service. This study evaluated the impact of long-term care service on the probability of health care utilization experience and costs of health care utilization. The total medical cost, geriatric hospital's medical cost, inpatient day and geriatric hospital's inpatient day by 2007-2009 were significant factor influencing the long-term care utilization. This study suggests long term care system should proper medical service linkage system. The current long-term care insurance system should more resource allocation on long-term care utilization to increase the efficiency of insurance system.

• Health Policy and Management
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• v.24 no.3
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• pp.254-260
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• 2014

Background: The purpose of this study is to assume appropriate outpatient consultation time for each clinical department on the basis of measured outpatient consultation time and satisfaction of outpatient. Methods: We surveyed the feeling and satisfactory outpatient consultation time, satisfaction, revisiting intention and recommendation to others to 1,105 patients of single general hospital in Gyeonggi-do and measured their real outpatient consultation time from October 28 to November 27 in 2013. On the basis of satisfaction, we estimated appropriate outpatient consultation time through area under the receiver operating characteristic curve in logistic regression model. Results: Feeling outpatient consultation time was 5.1 minutess, satisfactory outpatient consultation time which was suggested by patient was 6.3 minutes, and real outpatient consultation time was 4.2 minutes. Department which had longest real outpatient consultation time was infection (7 minutes) and department which had longest satisfactory outpatient consultation time was neurology (9.4 minutes). From the univariate and the multiple linear regression analysis, real outpatient consultation time was longer in pulmonology patient, new patient and afternoon patient, satisfactory outpatient consultation time was longer in infection, neurology, neuropsychiatry, neurosurgery, and rehabilitation patient. Appropriate real outpatient consultation time was suggested as 5.6 minutes which differentiated high and low satisfied patient group. However, we could not assume appropriate outpatient consultation time for each clinical department because the number of patient who had bad satisfaction was too low. Conclusion: To improve patient's satisfaction, we hope outpatient reservation system is operated as each patient's outpatient consultation time is at least 5.6 minutes.