• Health Policy and Management
• /
• v.15 no.3
• /
• pp.40-59
• /
• 2005

The objective of this paper is to examine what impact the newly introduced Purchasing Price Reimbursement System, where insurance drugs are reimbursed at the prices as they were purchased by medical care providers under the maximum allowable cap, has upon the health insurer's financing situation. The impact of the Purchasing Price Reimbursement System is considered to be confined mainly to the inpatient department among three drug reimbursement fields such as inpatient department, out-patient department and pharmacy. Hypothesis was set and tested in this study for each of three components of inpatient drug reimbursement in health insurance, i.e. average price level, composition of drugs and their overall volume. Drug price level calculated in this study from 403 selected reimbursement drugs according to the Laspayres methodology revealed faster decline under the new Purchasing Price Reimbursement System than previously by $1.53\%$ on the annual average basis. However, additional 1.4 percent financial burden in the ratio of the total inpatient reimbursement was owed by the health insurer. This was analysed to be a combined result of both 2.0-3.1 percent of reduced reimbursement due to drug price decline and 3.4-4.5 percent of additional reimbursement due to drug volume increase. These results suggest that recalling the Purchasing Price Reimbursement System would not have so much impact upon the health insurer's financial situation given that the current compulsory separation between doctor's prescribing and pharmacist's dispensing is irrevocable.

• Korea Journal of Hospital Management
• /
• v.7 no.3
• /
• pp.121-136
• /
• 2002

The main purpose of this study is to examine the overall procedure of hospital's internal review of health insurance reimbursement, to present the case of protest against reimbursement cut, and hence to provide some information on hospital's management of medical revenue. The object of the case study is 'P' university medical center, possessing 5 different hospitals under its system. Presentation of the case of protest against reimbursement cut has following meanings: Firstly, to the hospitals that already have internal review departments, information on the details of the protest process and results can be exchanged. Secondly, to the Government and National Health Insurance Corporation, useful data are provided for the improvement of the rules and procedures of health insurance reimbursement. Thirdly, to the hospitals without internal review departments, fundamental materials on the internal review process are provided for the effective management of medical revenue.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
• /
• v.48
• /
• pp.3-23
• /
• 2010

In letter of credit arrangements, the issuing bank nominate a reimbursing bank which serves as a source of funds payment to the beneficiary. The reimbursing bank could be 3rd party bank or the issuing bank itself. In view of working capital requirements, most beneficiary want to get export proceeds in advance through nominated banks and therefore letter of credit usually permit the beneficiary to negotiate drafts, accompanied by required documents, to nominated bank. If the credit is available with the nominated bank, there must be a reimbursement instruction in the credit, because in this method of availability the issuing bank is obliged to reimburse the nominated bank if that bank acts on its nomination There are legal relationship among issuing bank, nominated bank and reimbursing bank with regard to reimbursement activities. Related rules are UCP and URR and UCC (in case of USA). Korean exporters and bankers do not appear to know well the role of reimbursement and usage. 3 cases (court case + ICC Opinion + bad practices) were employed to study the reimbursement mechanism and suggest better usages. The beneficiary is strongly recommended to know the benefit of reimbursement claim from independent reimbursing bank. The benefits include speed payment (thereby saving finance costs) and safe funds (in case of stop payment by the issuing bank right after the proceeds are reimbursed). And further the beneficiary banks (being nominated or claim banks) are also recommended to take advantage of the 3rd party reimbursement in view of the cases illustrated.

• Korean Journal of Clinical Pharmacy
• /
• v.27 no.4
• /
• pp.250-257
• /
• 2017

Objective: The prevalence rate of osteoarthritis in Koreans aged 50 years or older is 14.3%, and the total amount of medical costs is more than KRW 1 trillion. Recently, the reimbursement guidelines for osteoarthritis treatment have changed. Methods: In this study, we sought to describe prescription patterns of nonsteroidal anti-inflammatory drugs (NSAIDs) and gastro-protective agent (GPA) and analyze the clinical and economic impacts of the new policy using the national health insurance claims data. The incidence of upper gastrointestinal adverse event by policy change was identified through the odds ratio, and changes in medicine and medical costs related to osteoarthritis through mean and median. Results: There were 204,552 patients before the reimbursement guidelines relaxation and 239,710 after it, a 17.2% rise. The prescription ratio was 3.3% for the patients prescribed with COX-2 selective NSAIDs alone and 1.3% for those with both COX-2 selective NSAIDs and GPA combination before the reimbursement guidelines relaxation. The reimbursement guidelines relaxation significantly increased their ratios to 6.9% and 2.8%, respectively. Gastrointestinal adverse events significantly reduced by 1.21%p after reimbursement guidelines relaxation. The average medicine cost per person increased significantly to KRW 140,291 from KRW 137,323 after the reimbursement guidelines relaxation, while the average medical cost per person slightly decreased from KRW 311,605 to KRW 310,755 after the relaxation, showing no meaningful difference. Conclusion: The reimbursement guidelines relaxation may influence on decreasing the upper gastrointestinal adverse event, increasing the medicine costs and maintaining the medical costs for osteoarthritis.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
• /
• v.12
• /
• pp.519-551
• /
• 1999

When an issuing bank issues a documentary credit, it must decide if the reimbursement will be a direct or simple or a bank-to-bank reimbursement. This decision is based on the bank that is nominated to pay, incur a deferred payment undertaking, accept drafts or negotiate. If an issuing bank decided bank-to-bank reimbursement, it must include the information in the credit instructing the nominated bank on how to obtain reimbursement. This instruction includes the name of the reimbursing bank, an indication that the reimbursement is subject to the Uniform Rules for Bank-to-Bank Reimbursements Under Documentary Credits ('URR'), ICC Publication 525 and any additional information that affects the nominated bank's ability to receive reimbursement. Until recently, reimbursements were the subject of outline regulation by Article 19 of the Uniform Customs and Practice for Documentary Credits ('UCP') and national law. Now, however, the International Chamber of Commerce has drafted URR, designed to emulate the harmonization of rules governing documentary credits achieved by the UCP. The URR are complementary to the UCP, which they are not intended to override or change. They became effective on July 1, 1996. The purpose of this study is to promote understanding on the Uniform Rules for Bank-to-Bank Reimbursements under Documentary Credits. In this paper, I studied the following subjects:(1) Bank-to-Bank Reimbursements tranaction under Documentary Credits, (2) Meaning of the URR's promulgation, (3) Analysis on the URR's Article. (1) General provisions and definitions, (2) Liabilities and responsibilities, (3) Form and notification of authorisations, amendments and claims, (4) Miscellaneous provisions.

• Journal of Korean society of Dental Hygiene
• /
• v.18 no.2
• /
• pp.177-189
• /
• 2018

Objectives: To provide necessary information for stable establishment of the national dental scaling reimbursement system. Methods: This study was conducted in 380 adults in their twenties or older for about one month from July 2017. The questionnaires were composed of general characteristics, recognition (awareness) of dental scaling, knowledge of the dental scaling reimbursement program, changes in perception before versus after introduction of the dental scaling reimbursement program, and interest in oral health. To investigate into any factors affecting changes of interest in oral health care after introduction of the dental scaling reimbursement program, a multiple regression analysis was performed. Results: The investigation into any factors affecting changes of interest in oral health care after introduction of the dental scaling reimbursement program showed that higher usual interest in oral health (p<0.001) and the consideration that the dental scaling charges have been affordable after introduction of the scaling reimbursement program (p<0.01) led to more changes in interest in oral health care. Conclusions: The above-mentioned results suggest that the dental scaling reimbursement program has brought favorable changes in the perception of dental scaling. It is expected that the said program will contribute significantly to the improved national oral health, and the Government should make constant efforts to develop it as a long-term policy for oral health improvement.

• Korean Journal of Clinical Pharmacy
• /
• v.23 no.2
• /
• pp.89-96
• /
• 2013

This article aimed to introduce 'risk sharing' schemes for pharmaceuticals between drug manufacturers and healthcare payer. Published literature review was undertaken to summarize risk sharing concepts and collect information on existing scheme examples in other countries focusing on new anticancer drugs. Risk sharing schemes could be categorized into health outcomes-based and non-outcomes (financial) based ones. Outcome-based schemes could be broken down into performance-linked reimbursement and conditional coverage. Performance-linked reimbursement can be further broken into outcomes guarantee and pattern or process of care and conditional coverage included coverage with evidence development and conditional treatment continuation schemes. Non-outcome based schemes included market share and price volume at population level, and utilization caps and manufacturer funded treatment initiation at patient level. We reviewed the fifteen examples for anticancer drugs that risk sharing agreements in response to the inherent uncertainties and increased costs of eleven anticancer drugs. Of them, eight cases were coverage with evidence development schemes. The anticancer drugs except bevacizumab and cetuximab were all listed on the national health insurance formulary in Korea, with reimbursement criteria defined on the basis of approved indications and administrations. Risk sharing approach may be a useful tool to ensure values for drug expenditure, but there are a number of concerns such as high administration costs, lack of transparency and conflicts of interest, especially for performance-based health outcomes reimbursement schemes.

• Health Policy and Management
• /
• v.10 no.4
• /
• pp.20-56
• /
• 2000

The purpose of this article was to evaluate the effects of reimbursement system on the basis of diagnosis-related groups(DRGs). We searched articles which was published from 1970 to 2000 using MEDLINE ； Key words "diagnosis-related groups, DRGs, prospective payment system, PPS. Then we reviewed 97 articles on classifying them into several categories of contents. It seems that the effects of DRGs in controlling hospitals cost in the U.S. was not clear cut. The U.S. Medicare PPS using DRGs remains vulnerable to compensatory increases in ambulatory care and long-term care facilities utilization despite cost per case and cost per admission being reduced. Also some research indicated the possibilities of deterioration in health care service quality. So putting theses results together, much more consideration is needed before the application of DRGs reimbursement system in Korea. Particularly there is the crucial difference between U.S. health care system and Korean, we must be aware of the limitations of DRGs and revise the DRG system to applicable in Korea.orea.

• Health Policy and Management
• /
• v.14 no.4
• /
• pp.48-74
• /
• 2004

Considering the existence of asymmetric information between doctor and patient, the doctor's reimbursement method has been considered as a desirable policy device of improving efficiency of patient's use of medical care in terms of its affecting doctor's practice pattern by determining doctor's practice revenue. By using the Community Tracking Study (CTS) physician data set, which includes not only various information on doctors practice arrangements and sources of practice revenue, but also vignettes of various clinical presentations, this paper investigates doctor's reaction to the financial incentive under the control of patient's specific medical situation. Under the econometric model for exploring the effect of doctor's reimbursement method on his/her practice patterns; referring patients, recommend doctor-visit or medical tests, the Hausman's specification test was used for checking out the possibility of the doctor's reimbursement method being endogeneized explanatory variable. In the case where the endogeneity problem of doctor's reimbursement method exists, the 2SLS method was used for correcting that problem, and the multiple regression method was used in the case where the problem is found to be nonexistent. Based on the empirical results, this paper finds that doctors do appear to respond to financial incentive. The empirical results show that the doctor's reimbursement method statistically significantly affects doctor's practice pattern and are coincident with the theoretical result proposed by previous researches, This results suggest, as doctor's practice revenues are mainly determined by prospective method, such as capitation, doctors would more refer their patients to specialists, and hesitate in recommending doctor-visit or medical exam.

• Proceedings of the Korea Contents Association Conference
• /
• 2006.05a
• /
• pp.322-326
• /
• 2006

There are the road of the artificial government property and rivers of the natural government property in representative Public Facilities applied National Reimbursement Law. Art.5. Doctrine on Responsibility of Public Facilities. Recently damage of a people has frequently been occurring caused by the flood of rivers and the flood disaster, and a people tends to request national reimbursement regarded it not as a natural disaster but as a man-made disaster. Especially the flood repeatedly occurred by the flood of rivers and destructive of the embankment of rivers, and it is also occurring in repairing rivers. Therefore a nation have to take responsibility of compensation for damage because of defect of conservation of rivers, and pay attention to improving the facilities of conservation and at the same time expand the range of responsibility. Thus the range of this study limits the national reimbursement of conservation of rivers among National Reimbursement Law. Art.5. Compensation for Damages on Defect about an Establishment and Management of public Facilities. Within this range, the objection of this study is to seek controversial issues and solutions, which belong with national reimbursement responsibility about conservation of rivers, as every principle of law and precedent coming under natural government property about compensation for damages caused by defect of conservation of rivers is analyzed and examined.