• 대한한방부인과학회지
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• 제21권3호
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• pp.218-230
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• 2008

Purpose: This study was performed to investigate the percentage of the oriental medical Ob & GY disease group in Korean Medical Health Insurance and to gain the basic data of enlargement and improvement of Acupuncture Benefits in the oriental medical Ob & Gy field. Methods: We requested data about the status of Insurance Benefits in 2005. 2006 to Health Insurance Review & Assessmenstatus Service(HIRA). And on the basis of this 2005. 2006 data, we analyzed the status of Insurance Benefits and Acupuncture Benefits in the oriental medical Ob & Gy disease group. Results: 1. Total health care benefit costs of Korean medical health insurance in 2005, 2006 took 4.38 percent and 4.25 percent of total health care benefit costs of Health insurance. 2. Total health care benefit costs of the oriental medical Ob & Gy disease group in 2005, 2006 took 0.38 percent and 0.40 percent of total health care benefit costs of Korean medical health insurance. 3. The percentage of Acupuncture benefits costs of the oriental medical Ob & Gy disease group in 2005, 2006 was merely 0.22 percent and 0.23 percent of total Acupuncture Benefits costs. 4. The main sick and wounded name of Ob & Gy diseases of Acupuncture Benefits was limited to Menstrual Disorder(K01)과- Uterus Abnormality(K13). Conclusion: The percentage of the oriental medical Ob & Gy disease group in Korean Medical Health Insurance was very low and the percentage of Acupuncture Benefits of he oriental medical Ob & Gy disease group was also very low. From now on, Searching ay of enlargement of Acupuncture Benefits in the oriental medical Ob & Gy field is required.

• 대한한의학회지
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• 제34권1호
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• pp.35-51
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• 2013

Objectives: The purpose on this study was to analyze medical health insurance to provide useful data to reestablish oriental medical insurance fees for long-term care hospitals. Methods: First, comparative analysis on medical health insurance was performed, calculating insurance fees of patients admitted to Mungyung Long-term Care Hospital. The oriental medical insurance fee of the patients was calculated as if the patients have been admitted to oriental long-term care hospitals, and the ratio of oriental medical insurance fee to western was calculated. Results: 1. The ratios of total medical expenses were 90% within 3 months and 82% over 3 months. 2. The ratios of co-pays were 86% within 3 months and 82% over 3 months. Conclusions: Oriental medical insurance fees need to be reevaluated.

• 대한예방한의학회지
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• 제12권3호
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• pp.21-34
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• 2008

Objectives : This paper analysed the alternative methods of calculating conversion factor for oriental medicine in the National Health Insurance and estimated the conversion factor(reimbursing price level) of the oriental medical services, based on health insurance claims data and macro economic data. Methods : Comparing cost accounting method, SGR model, and index model to estimate conversion factor in the national health insurance, six empirical models were derived depending on the scope of revenue considered in financial indicators. Classifications of data and sources used in the analysis were identified as officially released by the government. Results and Conclusion : Cost accounting analysis and SGR model showed a two digit decrease in the physician fee schedule of oriental medical services in the national health insurance, while index model indicated a positive increase in the fee reimbursed. As expected, SGR model measured an overall trend of health expenditures rather than an individual financial status of medical institutions, and index model properly estimated the level of payments to oriental medical doctors. Upon a declining share of health expenditures on oriental medicine, a global budget system fixed to a flat rate of total budget could be an opportunity as well as a challenge.

• 대한예방한의학회지
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• 제14권1호
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• pp.77-96
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• 2010

Objectives : This paper recommends a global budget based payment system for reimbursing oriental medical services in the national health insurance. Methods : We analyzed previous research outcomes related to oriental medical services and payment system We reviewed the experiences of other countries' global budget system in terms of their strength and weakness. In addition, we developed a reimbursement method for oriental medical services based on global budget. Results : Our reviews focused on global budget system of Germany, the Netherlands, the United Kingdom, Canada, France, and Taiwan. The estimation of global budget in the national health insurance was described in two scenarios. First scenario was to allocate oriental medical services in scale after signing a contract for global budget. In this case, 4.16% of the national health insurance expenditure was allocated for the oriental medical services. Second scenario was to estimate the global budget in a historical context. As a result, the first scenario in total budget was higher than the second, and we proposed a retrospective adjustment method for the gap between the budget and the actual expenditure Conclusions : The payment system for oriental medical services is recommended to shift from fee-for-service to global budget.

• 대한본초학회지
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• 제21권4호
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• pp.1-10
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• 2006

Objectives : Recently, the total medical expenses of the korean oriental medical service in national health insurance is on the increase every year. Herbal medicines are one of the major methods of the medical treatment. But the expenses of these herbal preparations that can receive benefits from insurance system are decreasing. Methods : In this research, we obtained statistical data of the benefit states of herbal preparations in herbal heath insurance during year 2001-2003 from Health Insurance Review Agency. We analyzed top twenty main diseases in herbal health insurance and mainly used prescription in these diseases. Results : There were wide differences in the application of prescriptions among diseases. For example, musculoskeletal diseases occupied an important position and Ojucksan took more than 50 percentage. Conclusion : We hope that this study could be a basic data for improving the benefit system of herbal health insurance and further studies should be carried out subsequently.

• 대한예방한의학회지
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• 제13권3호
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• pp.113-126
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• 2009

Objective : This research aimed to investigate and analyze the opinions of Oriental Medical Doctors (O.M.D.) on covering herbal medicines into National Health Insurance scheme. Methods : Structured questionnaires were e-mailed to the O.M.D.s listed on member's DB of the Association of Korean Oriental Medicine. Collected data were analyzed with the SPSS 12.0 program. Results : The insurance coverage for herbal decoctions was supported by 80.8% of the responders, the median reasonable price for daily herbal decoctions was \9,517, the minimum price median of daily herbal decoctions considering its costs was \8,080, and the daily technical fee median was \4,379. On health insurance coverage for herbal decoctions, O.M.D.s were specially considering the standardization of herbal medicines. Conclusion : In this study, majority of O.M.D.s assented to health insurance coverage for herbal decoctions, but considered standardization of herbal medicines and optional prescription fee. It needs to prepare plan for insurance coverage of herbal decoctions that reflect the character of oriental medicine and oriental medical institutions.

• 대한예방한의학회지
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• 제10권2호
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• pp.95-120
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• 2006

The purpose of this paper is to investigate the structure of cost-sharing for oriental medical services in the national health insurance. Out-of-pocket payment in ambulatory oriental medical care is a co-payment of KRW3,000 up to total expenses of KRW15,000, and co-insurance rate of 30% thereafetr. The empirical analysis based on medial claims data shows that the frequency of medical claims for outpatient care are mostly concentrated just below a total expenses of KRW15,000, and it decreases beyond a total expense of KRW15,000, while it rebounds between KRW17,000${\sim}$20,000. This means the current co-payment(KRW3,000) in oriental medical services should be applied up to a total payment of KRW17,000${\sim}$20,000, or the level of co-payment should be adjusted upward to KRW45,000 in order to be consistent in cost-sharing, between co-payment and co-insurance.

• Korean Journal of Acupuncture
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• 제24권3호
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• pp.67-79
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• 2007

Objectives : The Purposes of this study were to investigate payment system for oriental medical treatment as supplier of medical services, and to estimate reasonable levels of medical fee. Methods : This study made these following results by reviewing the answers which were given by 172 Korea traditional doctors from March 1 to April 15, 2006. Results : General satisfaction of payment system for oriental health insurance was $2.17{\pm}1.01$ $(mean{\pm}SD)$ on a 1-7 scale (median 4) as very low level. Reasonable medical fees which were answered by 172 Korea traditional doctor are higher than present fees, thus Korea traditional doctors think that present fees should be increased. And according to the survey, current insurance fees have a problem of disparity between each treatment fee. Conclusions : According to results of this study, current fees of oriental medical treatment are not rational. And this problem leads to distortion of medical treatment. Additional studies in thls field are needed.

• 대한한의학회지
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• 제30권4호
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• pp.64-78
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• 2009

Objectives: To research Korean oriental medical doctors' use of uninsured herbal extracts and how to bring about the insurance coverage of such herbal extracts. Methods: We surveyed Korean oriental doctors about the following issues from October 17th to November 15th, 2008: (1) Korean oriental medical doctors' knowledge about herbal extract insurance and the circumstances of oriental medicine in Korea, (2) their opinion on the coverage of currently uninsured herbal extracts and the dispensing of herbal extracts from pharmacies rather than from their clinics, (3) their use of herbal extracts, and (4) how to bring about insurance coverage of uninsured herbal extracts. Results: Over 70% of the respondents said that herbal medicine prescriptions have been reduced recently and that the existence of herbal medicine is in danger. In addition, 63.64% respondents agreed with expanding insurance coverage to include currently uninsured herbal extracts in spite of the fact that patients might have to obtain herbal extracts from pharmacies rather than from Korean oriental medical clinics. The average patient number per month of uninsured herbal extracts was 13.64 people, the average dosage was 5.64g, the average cost per day was 3,859 won, and the average prescription period was 2.65 days. Korean oriental medical doctors asked an average of 12,486 won for the medical examination-prescription fee and 3,292 won in fees for prescriptions obtained outside the hospital. If insurance coverage expands to include these herbal extracts, their usage is expected to increase 2.31 times. Conclusions: This study shows Korean oriental medical doctors' use of herbal extracts and their opinions about execution of herbal extracts' insurance. A periodic study such as this one will hopefully aid in establishing polices for uninsured herbal extracts' insurance.

• 대한한의학회지
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• 제26권2호
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• pp.105-125
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• 2005

Objectives: The purpose of this study was to identify resources put into clinical. activities and identify a new RBRVS for oriental medical services in the Korean National Health Insurance. Methods: Based on a survey of physician's time, physical effort & technical skill, mental effort & judgment, and stress that were used for patient treatments, relative input values for the relevant clinical activities were estimated and rearranged in a way to be compared. with the current values in health insurance. Results: We found the actual resource-based relative values for oriental medical services statistically different from the current values, with a narrower variation in value distribution. Conclusions: The findings suggest the C\lrrent RBRVS should be revised to reflect the actual input resources into physicians activities and to avoid a distortion of physicians behavior.