• Journal of Preventive Medicine and Public Health
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• v.53 no.4
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• pp.266-274
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• 2020

Objectives: Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017. Methods: We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index. Results: The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05). Conclusions: Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

• Korean Journal of Health Education and Promotion
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• v.7 no.2
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• pp.78-88
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• 1990

The subject of this study is to review the practical approaches of Home Care Services. Included is a brief overview of its nature, providers of Home Care Services, recent history of Home Care Services, and the impact of the national movement toward cost containment in health care. The data used in this study are obtained from the Elderly Program of the Medical Services and other data on the Home Care Services in Japan. With the growing elderly population in Japan, it is to be expected that the medical care expenditure for this sector will continue to increase. With the aim of keeping expenditure for medical care within reasonable bounds, it is essential that this increasing expenditure on the elderly be used effectively. With the Health and Medical Services Law for the Aged was enforced, therefore, remuneration for medical treatment of the elderly and what is known as the staff placement standard at hospital for the elderly were rationalized. In addition to rationalization from the point of view of medical care supply, it is necessary to guarantee the appropriate treatment within the community and at home for those elderly who are bedridden but not in need of hospital care. For this it is required that Home Care Services, such as health services like visiting guidance by public health nurse in hospital of Health Center. So that the elderly can feel secure in receiving treatment within the community and at home, allowances for guidance on leaving hospital and for intermittent nursing and guidance thereafter are to be newly introduced. Home care Services in one aspect of comprehensive health care, it is comprised of health services provided to individuals and families in their homes. Its purposes include promoting, maintaining and restoring health, specifically maximazing independent functioning and minimizing the disabling effects of illness, including terminal illness. Services appropriate to the needs of clients and their families are planned, coordinated, and delivered by providers organized for the delivery of home health care through the use of contractual arrangement, employed staff, or a combination of the two.

• Korean Journal of Human Ecology
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• v.16 no.2
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• pp.315-331
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• 2007

The purpose of this study is to examine current situations about and factors related to expenditures of private education among pre-school children and to provide policy implications useful for future pre-school children education. The subjects of the study were parents of pre-school children under seven years of age, who lived in Seoul and Incheon area. The survey was conducted using parent questionnaire. The major findings of the study are: First, 86.8% of parents of pre-school children use private education and the average expenditure on it was 154, 446 won. Second, major factors determining their private education expenditure are educational level of parents, parents' job characteristics, household income, and region. Third, the most important reason for using private education among parents is to improve and excel in academic performance of their children. Forth, the higher the parents' expected returns from private education are, the higher the expenditure level of private education is. Fitth, the results of the logistic regressions showed that parents' attitudes toward private education was the most important factor in determining household economic burden associated with private education. The odds were 5 times greater for the parent group with strong desire for private education than for the parent group without it and 1.2 times greater for the parent group with high-expected returns from private education than the parent group without it. In conclusion, systematic, universal educational policies need to be developed to provide and support all the parents with pre-school children, given that their current economic burden is substantial. By providing such support, we can help parents focus on public education. This study examining current situations about and determining factors related to private education expenditures among pre-school children collected data limiting only Seoul and Inchoen area, therefore, future studies need to include data collected nationwide for generalizability of the findings. As well, development of more elaborated survey instruments and analytical methods would advance our understanding in the field.

• Journal of Preventive Medicine and Public Health
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• v.40 no.4
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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.

• 한국사회정책
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• v.23 no.2
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• pp.1-24
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• 2016

This paper examines whether the pension systems of the western countries which was traditionally classified into the Beveridgean and Bismarckian pension regime will converge after recent pension reforms in the financial sustainability and adequacy perspective by comparing between UK, Germany and Sweden. As a result of pension reforms for the last 20 years, the gap between the Beveridgean and Bismarckian pension regime will be likely to decrease and, in particular, the tendency to convergency in adequacy is found. Even though it is not jumped to a conclusion that public pension expenditure between the three countries is likely to converge, the tendency to convergency in financial sustainability is also found if the difference of demographic aging between countries is considered. The paper suggests that it is necessary to make agreement between the range of pension expenditure and replacement ratio that western countries suggest in pension debate in Korea, instead of hitherto useless controversy between financial sustainability and adequacy.

• Korean Journal of Social Welfare Studies
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• v.42 no.2
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• pp.97-122
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• 2011

After global economic crisis, most countries increased the welfare expenditure as a part of stimulus package. As a However welfare expenditure was decreased radically as the crisis was transmitted into the financial crisis. Which turning point is the welfare state going through now? Although the need for the welfare and the role of the state to take responsibility of public welfare has increased because of poverty and polarization, responses of the state against the crisis had focused on the aid to the financial industry and cutting taxes and showed limitations in coordination. Financial limitation of welfare expenditure, political individualism, the change of class politics and the mixture of the welfare institutions and financial institutions make have a pessimistic prospect of the retrenchment to the minimalist welfare state. As neoliberal state is continued cash benefits mainly for the middle class is being decreased. As a result, the direction the welfare states pursue is prospected to win over the poor by strengthening selectivity in welfare provision rather than class coordination.

• Health Policy and Management
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• v.27 no.2
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• pp.149-156
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• 2017

Background: This study was conducted to evaluate the performance of the Hierarchical Condition Category (HCC) model, identify potentially high-cost patients, and examine the effects of adding prior utilization to the risk model using Korean claims data. Methods: We incorporated 2 years of data from the National Health Insurance Services-National Sample Cohort. Five risk models were used to predict health expenditures: model 1 (age/sex groups), model 2 (the Center for Medicare and Medicaid Services-HCC with age/sex groups), model 3 (selected 54 HCCs with age/sex groups), model 4 (bed-days of care plus model 3), and model 5 (medication-days plus model 3). We evaluated model performance using $R^2$ at individual level, predictive positive value (PPV) of the top 5% of high-cost patients, and predictive ratio (PR) within subgroups. Results: The suitability of the model, including prior use, bed-days, and medication-days, was better than other models. $R^2$ values were 8%, 39%, 37%, 43%, and 57% with model 1, 2, 3, 4, and 5, respectively. After being removed the extreme values, the corresponding $R^2$ values were slightly improved in all models. PPVs were 16.4%, 25.2%, 25.1%, 33.8%, and 53.8%. Total expenditure was underpredicted for the highest expenditure group and overpredicted for the four other groups. PR had a tendency to decrease from younger group to older group in both female and male. Conclusion: The risk adjustment models are important in plan payment, reimbursement, profiling, and research. Combined prior use and diagnostic data are more powerful to predict health costs and to identify high-cost patients.

• Journal of Agricultural Extension & Community Development
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• v.30 no.4
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• pp.229-241
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• 2023

This study aims to examine the farm household income and consumption structure change as well as farm income inequality. Data from the Agricultural Household Survey for the years 2016, 2021, and 2022 were hired to analyze farm income inequality by the Gini coefficient decomposition method. Results show that from 2016 to 2021, all income quintiles exhibited an increasing trend, but in 2022, income decreased across all quintiles. As a result of analyzing farm household consumption expenditure, consumption expenditure increased in all income quintiles in 2021 and 2022 compared to 2016, but consumption of optional goods decreased in the fifth quintile. In addition, it was found that farmers in the first quartile had higher consumption expenditures and expenditures on options than those in the second quartile. The analysis of farm income by region show that public subsidies increased significantly for general rural farmers than for farmers in special and metropolitan areas in all income quintiles during the period. In the case of the first quintile, farm household income in rural areas in special and metropolitan cities increased compared to general rural areas. In the fifth quartile, agricultural income and sideline income in general rural areas increased compared to rural areas in special and metropolitan cities, while rural areas in special and metropolitan cities increased non-business income compared to rural areas. Results of farming income inequality by income type show a steady decline in inequality from 2016 to 2022, indicating that the decreasing gini coefficinet of public subsidies is contributing to the decline in farm income inequality. Private subsidies and side income are shown to increase inequality.

• Journal of Society of Preventive Korean Medicine
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• v.11 no.1
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• pp.139-151
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• 2007

This paper evaluated the benefits of the National Health Insurance(NHI) and suggested the necessity of extending some oriental medical services into the benefits schedule in the NHI. Comparing the rate of public financing in national health expenditure in OECD countries and measuring out-of-pocket payments in total medical cost showed the level of insurance payments to total medical cost is approximately $50%{\sim}60%$ in Korea, which is quite insufficient to pay household medical expenses, although the NHI covers the whole population. A few of consumers' priority surveys for medical needs suggested herb medicine, muscle treatment, and manufactured herb medicine be included in the list of the NHI benefits, based on efficiency and equity criteria. It was estimated that the NHI can afford to cover these three items of oriental medical services.

• Proceedings of the KSR Conference
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• 2007.11a
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• pp.1683-1693
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• 2007

Urban has been operating Korail and the local autonomous entity in Korea. Over 70 LRTs will be constructed in the future, but it is hard to manage them due to structural deficit from construction debt, so Public finance plays a very important role in order to overcome a deficit. Therefore, it is necessary to plan detailed analysis and planned system about the expenditure of the amount which is borrowed from country and local government and business income from railroad companies like government grants, PSO. This research wishes to grasp the problem and present model about reasonable and efficient financial program, analyzing about increasing import and expenses of Urban.