• 대한예방한의학회지
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• 제19권3호
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• pp.57-66
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• 2015

Objective : Private health insurance coverage in Korean medicine has been reduced since October 2009 for preventing unnecessary utilization. The aim of this study is to identify how private health insurance coverage reduction affects on the Korean medicine utilization. Method : We analyzed the Korea Health Panel data from 2008 to 2012. Panel negative binominal regression model was used to analyze the relationship between private health insurance coverage reduction and utilization of outpatient service. Panel tobit regression analysis was used to identify the relationship between private health insurance coverage reduction and health expenditure of outpatient service. Results : Private health insurance coverage reduction significantly dropped both utilization and health expenditure of outpatient service by 9%, 9.22% respectively. In addition, therapeutic utilization significantly decreased up to 10%. Conclusion : Private health insurance coverage reduction seems to have an effect to reduce both utilization and the health expenditure of Korean medicine outpatient service. This effect was more noticeable in the therapeutic utilization. Thus, more elaborate policy will be needed to prevent unnecessary utilization of Korean medicine.

• 보건행정학회지
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• 제24권3호
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• pp.283-290
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• 2014

Background: This study aimed to examine the relationship between home-visit nursing services and health care utilization under the public long-term care insurance program in Korea. Methods: We analyzed the long-term care need assessment database and the long-term care and the health insurance claim databases of National Health Insurance Service between July 2011 and June 2012. The sample includes a total of 20,065 home-visit nursing recommended-older beneficiaries who use home-visit nursing and/or home-visit care, based on a standard benefit model developed by the Health Insurance Policy Institute of National Health Insurance Service. The beneficiaries were categorized into home-visit nursing use and non-use groups, and the home-visit nursing use group was again divided into high-use and low-use groups home-visit nursing, based on their total annual home-visit nursing expenditure. Two-part models and negative-binomial regression models were used for the statistical analysis. Results: The home-visit nursing use was negatively associated with the number of outpatient visit and cost, while adjusting for all covariates. The home-visit nursing use was also negatively associated with the inpatient cost among the high home-visit nursing use group. Conclusion: The findings implies home-visit nursing use prevents health care utilization. Further studies and policy strategies that can promote and strengthen home-visit nursing services under the public long-term care insurance are necessary in Korea.

• 보건행정학회지
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• 제33권1호
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• pp.55-64
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• 2023

Background: Despite the various activities of the regional public hospitals, discussions are being made as to whether or not to continue due to the issue of financial deficit. Therefore, the main factors affecting the fiscal deficit were analyzed with 10-year data. Methods: This study is a panel analysis that analyzed the characteristics of 34 regional public hospitals and influencing factors on medical benefits for 10 years from 2010 to 2019. First, we analyze the determinants of medically vulnerable areas set by the government, analyze the trend of medical profit per 100 beds and medical profit rate from 2010 to 2019, and identify the factors that affect them. Results: Differences in medical profit per 100 beds and medical profit-to-medical profit rate were caused by market share representing regional characteristics, and both indicators improved as the number of outpatients increased. The important influencing variables are the number of doctors and nurses, and both indicators improve when there are specialists, but medical benefits decrease as the number of doctors increases when judged by the number of people per 100 beds. In addition, the number of nurses per 100 beds does not contribute to medical profit and has a negative effect on the medical profit ratio. Conclusion: As only regional characteristics were taken into account for medically vulnerable areas, operational characteristics need to be considered. The greatest impact on the finances of local medical centers is the proper staffing of doctors and nurses, and their efficient arrangement is the most important factor in financial stability.

• Journal of Preventive Medicine and Public Health
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• 제40권4호
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• pp.329-335
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• 2007

Objectives : To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. Methods : The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. Results : Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. Conclusions : We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.

• Journal of Preventive Medicine and Public Health
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• 제52권4호
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• pp.234-241
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• 2019

Objectives: To identify simultaneous behavioral changes in alcohol consumption, smoking, and weight using a fixed-effect model and to characterize their associations with disease status. Methods: This study included 7 000 529 individuals who participated in the national biennial health-screening program every 2 years from 2009 to 2016 and were aged 40 or more. We reconstructed the data into an individual-level panel dataset with 4 waves. We used a fixed-effect model for smoking, heavy alcohol drinking, and overweight. The independent variables were sex, age, lifestyle factors, insurance contribution, employment status, and disease status. Results: Becoming a high-risk drinker and losing weight were associated with initiation or resumption of smoking. Initiation or resumption of smoking and weight gain were associated with non-high-risk drinkers becoming high-risk drinkers. Smoking cessation and becoming a high-risk drinker were associated with normal-weight participants becoming overweight. Participants with newly acquired diabetes mellitus, ischemic heart disease, stroke, and cancer tended to stop smoking, discontinue high-risk drinking, and return to a normal weight. Conclusions: These results obtained using a large-scale population-based database documented interactions among lifestyle factors over time.

• 보건행정학회지
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• 제27권3호
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• pp.191-198
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• 2017

Moon Jae-in Government announced the Government's 5-Year Plan on July 19, 2017, President Moon directly announced the Government's Plan for Benefit Expansion in National Health Insurance on August 7, 2017. The main contents of the announced expansion include benefit coverage for all medically necessary services with control over non-covered service occurrence, a decrease in the cost-sharing upper limit, and monetary support for catastrophic medical costs. Although past governments have been continuously striving for benefit expansion in the last 15 years, this plan has its breakthrough aspect in that all medical services will be covered by the National Health Insurance. In alignment, there are important tasks to solve: attaining a proper fee schedule, reforming the healthcare delivery system, and improving healthcare quality. This plan is a symptom oriented action in that it is limited in reducing patients' out-of-pocket money, unlike the systematic approach of the National Health Insurance. The sustainability of the National Health Insurance is being threatened due to South Korea's low birth rate, rapidly aging society, and low economic growth, in addition to the unification issue of the Korean Peninsula, medical utilization of the elderly, management of non-communicable diseases, and so on. Therefore, the Government needs to plan the National Health Insurance system reformation including actions addressed toward medical consumers.

• 보건행정학회지
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• 제30권2호
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• pp.192-198
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• 2020

Background: Korea National Health Insurance Service (NHIS) is operated as a social insurance system in which people pay a portion of their monthly income as insurance premiums and receive benefits when they experience illness or injury. Since 2005, the national health insurance remained surplus accumulating cumulative reserves each year. However, as of 2018, NHIS revenue recorded 62.11 trillion won and spending of 62.29 trillion won. The deterioration of NHIS finances is expected to accelerate with the aging population, income growth, new medical technology development, and enhanced security policies. Methods: To examine the financial health and sustainability of NHIS, we estimated the future revenue and spending until 2030 using the data from Korea Health Insurance Review and Assessment Service statistical yearbook. 2004-2018 average percentage change in NHIS revenue and spending was calculated. We estimated the future NHIS financial status using two methods. In the first method, we calculated the revenue and spending of the future NHIS by applying the 2004-2018 average percentage change to the subsequent years consecutively. In the second method, we estimated the future NHIS financial status after adjusting for the predicted demographic changes such as the aging population and declining birth rate in South Korea. Results: The estimates from this study suggest that the NHIS's cumulative reserves will run out by 2024. Conclusion: In terms of spending on current health insurance, there should be a search for ways of more efficient spending and funding options.

• 대한치과기공학회지
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• 제38권4호
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• pp.327-342
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• 2016

Purpose: The purpose of this study was to investigate the cognition of denture fabrication activities and its cost in National Health Insurance for elderly denture. Methods: A self-administered questionnaire was completed by 41 dental laboratories' owner who was research subjects of HIRA(Health Insurance Review & Assessment Service)'s policy research for elderly denture in 2011. The questionnaire consisted of general characteristics of the subjects, dental technicians' knowledge of national health insurance coverage of elderly denture, job-related changes after national health insurance coverage of elderly denture including validity of denture fabrication activity classification and the cost for each service. Each question was measured by Likert 5 point scale or frequency. The collected data were analyzed by SPSS 16.0. Results: Most of the research subjects had been fabricating national health insurance coverage denture(92.7%), also had ample knowledge of national health insurance coverage denture for elderly. Job-related changes after national health insurance coverage of elderly denture revealed marginal differences in the quality. The validity of fabrication activity classification of resin based complete denture was $3.71{\pm}1.023$ by Likert 5 point scale. Conclusion: The goal of national health insurance for elderly denture is to promote elderly's health and well-being. To fabricate denture is a very important part of the denture treatment. For this reason, denture fabrication activity classification and the cost analysis plan should be duly reflected in the policy of national health insurance for elderly denture.

• 대한치과교정학회지
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• 제44권6호
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• pp.330-341
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• 2014

A 19-year-old woman presented to our dental clinic with anterior crossbite and mandibular prognathism. She had a concave profile, long face, and Angle Class III molar relationship. She showed disharmony in the crowding of the maxillomandibular dentition and midline deviation. The diagnosis and treatment plan were established by a three-dimensional (3D) virtual setup and 3D surgical simulation, and a surgical wafer was produced using the stereolithography technique. No presurgical orthodontic treatment was performed. Using the surgery-first approach, Le Fort I maxillary osteotomy and mandibular bilateral intraoral vertical ramus osteotomy setback were carried out. Treatment was completed with postorthodontic treatment. Thus, symmetrical and balanced facial soft tissue and facial form as well as stabilized and well-balanced occlusion were achieved.

• 대한족부족관절학회지
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• 제22권3호
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• pp.116-119
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• 2018

Gout occurs mainly in monoarthritis and is found in more than 50% of cases in hallux of the foot. In addition, symptoms sometimes begin in the hand, wrist, and elbow, but they are rarely observed in the spine. The patient was referred for tuberculous polyarthritis due to antituberculosis drug failure. Inflammatory findings were observed in the lumbar, elbow, wrist, hand and foot areas. Surgery was performed on the foot area and a pathology diagnosis revealed gouty arthritis. We report this case with a review of the relevant literature.