• Asian Pacific Journal of Cancer Prevention
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• 제15권13호
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• pp.5265-5270
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• 2014

Background: In Korea, the National Health Insurance program has initiated various copayment policies over a decade in order to alleviate patient financial burden. This study investigated healthcare spending and utilization in the last 12 months of life among patients who died with lung cancer by various copayment policy windows. Materials and Methods: We performed a retrospective cohort study using nationwide lung cancer health insurance claims data from 2002 to 2012. We used descriptive and multivariate methods to compare spending measured by total costs, payer costs, copayments, and utilization (measured by length of stay or outpatient days). Using 1,4417,380 individual health insurance claims (inpatients: 673,122, outpatients: 744,258), we obtained aggregated healthcare spending and utilization of 155,273 individual patient (131,494 inpatient and 103,855 outpatient) records. Results: National spending and utilization is growing, with a significant portion of inpatient healthcare spending and utilization occurring during the end-of-life period. Specifically, inpatients were more likely to have more spending and utilization as they got close to death. As coverage expanded, copayments decreased, but overall costs increased due to increased utilization. The trends were the same in both inpatient and outpatient services. Multivariate analysis confirmed the associations. Conclusions: We found evidence of the higher end of life healthcare spending and utilizations in lung cancer patients occurring as coverage expanded. The practice pattern within a hospital might be influenced by coverage policies. Health policy makers should consider initiating various health policies since these influence the long-term outcomes of service performance and overall healthcare spending and utilization.

• 간호행정학회지
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• 제5권1호
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• pp.99-111
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• 1999

The purpose of this study was to investigate the relationship between public health nurse's decentralization, participation of decision-making and organizational commitment and to provide basic data for the improvement of public health nurse's organizational effectiveness. Data were collected from Aug. 1 to Aug. 30, 1998 (collection rate-96%) through questionnaires by 163 public health nurses working in Taejon and Chungnam. The instruments were used Van de Ven and Ferry's Job Authority scale, Hage and Aiken's Hierarchy of Authority scale. Participation of Decision-making scale. and Mowday's Organizational Commitment Questionnaires. Collected data were analyzed by SPSS PC+. The results were as follows 1. There were significant differences of age(P<.05), career, spending time for major study, and experience who called expert(P<.01) to decentralization. 2. There were significant differences of career (P<.05), educational level, and spending time for major study(P<'OOl) to participation of decision-making. 3. There were significant differences of career. spending time for D1ajor study, self-evaluation to specialty(P<.01) and experience who called expert (P<.001) to organizational commitment. 4. 1) A significant correlation was found between decentralization and self-evaluation to specialty (P<.05), age, career, spending time for major study, and experience who called expert (P<.01.). 2) A significant correlation was found between participation of decision-making and self-eval-uation to specialty(P<.05), age, career, spending time for major study, experience to call expert, and decentralization (P<.01). 3) A significant correlation was found between organizational commitment and age(P<.05). career. spending time for major study, self-eval-uation to specialty, experience who called expert. decentralization, and participation of decision-making (P<.01). 5. Decentralization w·as the best predictor of or ganizational commitment(17%), also experience who called expert, self-evaluation to specialty explained the organizational commitment.

• KDI Journal of Economic Policy
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• 제30권2호
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• pp.99-128
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• 2008

민간보험은 공적보험과 보완적인 관계를 형성함에도 불구하고 우리나라의 민간보험은 소득계층에 따른 접근성 차이로 인한 사회적 불평등, 도덕적 해이로 인한 공적보험 재정악화 등의 우려를 낳고 있다. 그러나 이에 관한 실증적 분석은 그간 이루어지지 못하여 정책적인 방향을 정립하는 데 장애가 되어 왔다. 본 연구는 건강보험공단, 심사평가원, 민간보험사, 행정자치부 주민등록세대정보 등의 관련 정보를 종합하여 이에 대한 실증분석을 시도했다. 그 결과, 우리나라의 민간보험 가입률은 전 국민의 64%에 달하고 있으며, 고소득층과 저소득층 간에 민간보험 가입률의 차이가 나타나지 않았다. 이는 공적보험의 보장성이 미흡한 상황에서 저소득층 역시 갑작스런 의료지출에 대비하고 있으며, 민간보험이 의료접근성의 계층화를 초래하지 않고 있다는 것을 시사한다. 또한 민간보험 가입자는 평균적으로 미가입자에 비해 의료이용량이 높지 않았으며, Two-Part Model을 통해 다양한 변수를 통제했을 경우에도 동일한 결과가 나타났다. 연령대에 따른 차이로 미루어 이러한 결과는 노동시장과 연관된 한시적인 성격일 것으로 추측되나, 현재로서는 민간보험 가입에 따른 도덕적 해이가 강하게 나타나고 있다는 근거는 발견되지 않았다.

• 보건행정학회지
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• 제20권1호
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• pp.37-63
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• 2010

Public expenditures on long-term care are a matter of concern for Korea as in many other countries. The expenditure is expected to accelerate and to put pressure on public budgets, adding to that arising from insufficient retirement schemes and other forms of social spending. This study tried to foresee how much health care spending could increase in the future considering demographic and non-demographic factors as the drivers of expenditure. Previous projections of future long-term expenditure were mainly based on a given relation between spending and age structure. However, although demographic factors will surely put upward pressure on long-term care costs, other non-demographic factors, such as labor cost increase and availability of informal care, should be taken into account as well. Also, the possibility of dynamic link between health status and longevity gains needs to be considered. The model in this study is cell-base and consists of three main parts. The first part estimated the numbers of elderly people with different levels of health status by age group, gender, household type. The second part estimated the levels of long-term care services required, by attaching a probability of receiving long-term care services to each cell using from the sample from current year. The third part of the model estimated long-term care expenditure, along the demographic and non-demographic factors' change in various scenarios. Public spending on long-term care could rise from the current level of 0.2~0.3% of GDP to around 0.44~2.30% by 2040.

• 사회복지연구
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• 제42권1호
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• pp.433-461
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• 2011

이 연구는 복지국가 재편기에 공적연금의 급여 관대성과 지출의 변화추이 및 결정요인을 밝히고자 하였다. 특히 공적연금 제도에서의 경로의존성을 밝힌 방대한 질적 연구들의 심층적 논의를 계량적 비교국가연구의 흐름에 통합하여 공적연금제도의 변화에 영향을 미치는 중요한 요인으로서 공적연금제도의 구조(structure)에 주목하였다. 한편, 복지국가 발달을 설명했던 산업화 이론과 권력자원 이론이 복지국가 재편기 공적연금정책의 변화를 설명하는 데에도 유용한가를 검증하고자 하였다. 1980-2007년까지 서구 복지국가 13개국을 대상으로 분석한 결과는 다음과 같다. 첫째, 공적연금제도의 구조에 따라 연금급여 관대성과 지출수준에 상이한 변화 추이가 확인되었다. 둘째, 결합시계열 회귀분석 결과, 연금구조는 제도 관대성과 지출에 영향을 미치는 가장 중요한 요인임이 밝혀졌다. 셋째, 고령화의 영향력은 연금급여 관대성을 통제한 상태에서도 유의미하게 나타나, 고령화가 연금지출을 증가시키는 요인으로 나타났다. 다만 신사회적 위험 정도가 높을수록 노인에 대한 현금지출 집중도는 낮아졌다. 넷째, 권력자원 이론은 재편기의 연금정책 국면에서는 설명력이 통계적으로 입증되지 않았다.

• Journal of Preventive Medicine and Public Health
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• 제56권5호
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• pp.475-480
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• 2023

Objectives: This study examined differences in health care spending and characteristics among older adults in Korea by high-cost status (persistently, transiently, and never high-cost). Methods: We identified 1 364 119 older adults using data from the Korean National Insurance Claims Database for 2017-2019. Outcomes included average annual total health care spending and high-cost status for 2017-2019. Linear regression was used to estimate differences in the outcomes while adjusting for individual-level characteristics. Results: Persistently and transiently high-cost older adults had higher health care spending than never high-cost older adults, but the difference in health care spending was greater among persistently high-cost older adults than among transiently high-cost older adults (US$20 437 vs. 5486). Despite demographic and socioeconomic differences between transiently high-cost and never high-cost older adults, the presence of comorbid conditions remained the most significant factor. However, there were no or small differences in the prevalence of comorbid conditions between persistently high-cost and transiently high-cost older adults. Rather, notable differences were observed in socioeconomic status, including disability and receipt of Medical Aid. Conclusions: Medical risk factors contribute to high health care spending to some extent, but social risk factors may be a source of persistent high-cost status among older adults in Korea.

• 보건행정학회지
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• 제17권2호
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• pp.1-17
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• 2007

Limited coverage for health care services of National Health Insurance(NHI) in Korea has been ongoing policy issue but additional NHI financing through raising contribution or taxes in order to improve coverage faces substantial obstacles. Private health insurance(PHI) is often considered as an alternative financing source to improve coverage. Recent reform that attempted to stretch the role of PHI allowed life insurance companies to provide complementary PHI, indemnity plan which will pay for uncovered services by NHI and out-of-pocket spending for covered services. Although complementary PHI may relieve financial burden of patients, it may significantly raise NHI spending as well as total health expenditure since little out-of-pocket spending may increase utilization of health care. So far, there has not been enough discussion about concerns of potential adverse effect resulting from extended role of PHI. This study investigated potential increase of NHI spending followed by extension of complementary PHI through sensitivity analysis. The amount of NHI spending for services that would be covered by complementary PHI was calculated using 2005 NHI statistics and expected complementary PHI enrollment rate by age and sex. Expected utilization increases were obtained based on price elasticities$(-0.2{\sim}-0.5)$ from previous studies and expected coverage rate$(50{\sim}80%)$ of complementary PHI and then converted to monetary figures. Because coverage rate of complementary PHI has not been determined yet, we employed the sensitivity analysis using coverage rate of $50{\sim}80%$. Findings demonstrate that additional spending for health care services is expected to be $426{\sim}1,702$ billion won, corresponding amount payed by NHI $298{\sim}1,192$ billion won. In conclusion, since complementary PHI may raise NHI spending significantly, there should be an agreement whether this additional cost would be accountable and acceptable in our society. Potential inefficiency resulting from extended role of complementary PHI should be considered since public and private financing do not operate in isolation and there should be more discussion on proper role of PHI in Korea.

• 보건의료산업학회지
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• 제10권3호
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• pp.199-211
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• 2016

Objectives : This study compared the influencing factors on life satisfaction after retirement between public pension and specific corporate pension recipients. Methods : This study used the fifth year data of 2013 from the raw data of the Korean Retirement and Income Study collected by the National Pension Research Institute. The data analysis in this study was done with the chi-square test, t-test, and linear regression using SPSS ver. 22.0 to verify the relevance between the general characteristics of pension recipients. Results : This study shows that there was a difference in expenditures and health care costs between public pension and special corporate pension recipients. The influencing factors on life satisfaction for public pension recipients were the level of spending, whether there were limitations in daily life and social activity, whether recipients had financial assets and health care costs while for specific corporate pension recipients, they were education level, level of spending and chronic diseases. Conclusions : A health policy that maximizes life satisfaction and takes into account the type of pencion needs to be considered and implemented.

• 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.

• 한국사회정책
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• 제19권3호
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• pp.9-47
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• 2012

본 연구는 가구의 사교육비 지출과 다른 소비지출과의 관계와 소득계층에 따른 그 차이를 분석하였다. 분석결과, 빈곤층의 사교육비 지출 수준은 중산층과 상층가구에 비해 적을지라도, 가구의 소비지출에서 차지하는 비중은 높게 나타난다. 또한 가구의 사교육비 비중이 증가 또는 감소로 인해 조정되는 소비 비목은 소득계층에 따라 차이를 보인다. 즉 중산층과 상층은 사교육비 비중 변화에 따라 탄력적으로 다른 소비를 조정하는 반면, 빈곤층은 탄력적으로 조정할 수 있는 소비 항목에 제약이 있었다. 이는 빈곤층은 사교육비 지출로 인한 소비지출의 제약으로 인해 생활에 필요한 충분한 소비를 하지 못할 가능성을 보여준다. 빈곤층 가구에서 사교육비 지출은 가구의 경제적 부담을 증가시킬 뿐만 아니라 가구 소비의 위축을 가져와 실질적인 경제적 안녕을 저해할 가능성이 높다. 따라서 빈곤층의 사교육비 부담과 지출의 증가로 인한 경제적 안녕의 훼손과 불안정한 소비로 인해 발생하는 제반의 문제를 예방하기 위한 사회적 노력이 필요하다.