• The Korean Society of Law and Medicine
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• v.8 no.1
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• pp.137-177
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• 2007

The medical expenses review system in Korea has developed under fee-for-service system with its own unique structure. The importance of reviewing medical expenses has been emphasized, as the size of medical expenditures moving through the health insurance legal context and its weight in the national economy have increased very rapidly. It is, however, analyzed that the feuds and arguments continue among the stakeholders for the lack of laws supporting the medical expenses review system. The medical expenses review is a series of administrative procedures, deciding whether claims from medical care institutions to the insurer are legal and valid or not. It mainly controls the increase of unnecessarily excessive health insurance claim and prevents fraudulent claim and abuse and checks the less use or unsuitable use of medical resources. It also works a function guarantees medical benefits for the appropriate treatment according to the object of health insurance system as a social insurance scheme. The dispute on legal base of the medical expenses review is about the source of law in the medical expenses review. There are the Health Insurance Act and administrative laws as jus scriptum and the guidelines of review as administrative orders. The medical expenses review should reflect various factors, such as the development of medical healthcare technologies, the health expenditures distribution, the financial situation of the health insurance, and the evaluation on the level of appropriate benefits. It is also likely to adapt to the traits of characters of medicine, and trends and transition, Besides it should judge the legality and the validity of medical benefits expenditures by synthesizing these all factors. And the evaluation system of appropriateness of medical benefits was administrative procedure which was consecutive with reviewing the medical expenses system and it was intended to make up for the result of reviewing the medical expenses in more comprehensive levels.

• Health Policy and Management
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• v.27 no.3
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• pp.256-266
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• 2017

Background: Primary health care (PHC) plays a major role to ensure the basic right and equal distribution of the essential health care services. This study presents comparative analyses of PHC in Korea and Uzbekistan, discusses the existing scenario and the challenges, and provides recommendations. Methods: This study reviewed secondary data from Korea's National Statistical Information Service and the State Committee of the Republic of Uzbekistan on Statistic, regulatory legislation, research reports, and policy papers by research and international institutions. We focus on comparing input and outcome health data, PHC structure, and health expenditure. Results: Overall health status of the population in Korea is better than in Uzbekistan; both countries achieved more than 95% immunization coverage. The reforms implemented in both countries provide initial health care service delivery. However, there are several challenges such as the distribution of the staff between urban and rural areas and interest of the graduates on specialization rather than working in PHC system. Conclusion: PHC plays an important role in the provision of medical services to the population, addressing both health and social problems; it is the best tool for achieving universal coverage for basic health needs of the population. The community health practitioners in Korea and nurses in Uzbekistan plays main role in universal coverage through providing essential health care services. Continuous reform of the PHC system should be directed to strengthen the capacity of the PHC staff in health promotion knowledge and activities as well as to encourage population to improve their own health.

• Health Policy and Management
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• v.26 no.4
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• pp.305-314
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• 2016

Background: The purpose of this study is to examine the characteristics of and factors associated with long-term care (LTC) utilization under public long-term care insurance (LTCI) among end-of-life older adults in Korea. Methods: Using a 5% sample of older people aged 65 or older and their health and LTC insurance data, two-part model analyses were conducted. We compared LTC uses and their determinants during the last year of life among decedents in the year 2010 with those of survivors. We also compared the medical uses of the same sample with their LTC uses. Results: The end-of-life elderly were more likely to use LTC, and their expenditure on LTC was higher than their counterparts. Whether or not older people used LTC during their last year of life was significantly affected by age, sex, health insurance, household income, and living alone; however, LTC costs of the decedents were only affected by functional status, which may have been due to the reimbursement scheme of the current LTCI, which is mainly based on functional dependency level. For the survivors, having chronic diseases significantly increased the likelihood of LTC use, which was not the case for the decedents. End-of-life elderly with relatively low social economic status were more likely to use the LTC other than medical services, while the health conditions affected their medical uses most significantly. Conclusion: The study findings provide key information for predicting demand related to the increasing LTC needs of Korean older people at the end of life.

• Journal of Family Resource Management and Policy Review
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• v.13 no.1
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• pp.147-168
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• 2009

The purpose of this study is to research support systems of the community child care services for optimum work-family balance. For this purpose, the questionnaire to be completed combined four areas: the workplace, school, community and home. Then questions concerning demographic factors and community-related aspects were analysed for this article. After analyzing 197 questionnaires, supplementary questions were asked, by interview to 10 samples. Full-time working wives (eg. working from 9am to 6pm) who have 1 or more children under 10 years old, living in Seoul and Gyeonggi province were collected as samples. The results were as follows: First, child care from family and relatives, and community services was properly used during the week, but dual working parents took complete charge of child care on Saturdays. Second, emergency child care was usually provided by the family, while relatives and community child care services were used less. Third, parents spent 17% of their monthly income on total child care expenditure. Fourth, community child care services were not used often, but the level of satisfaction with them was very high. Finally, they used relatives' services for safety reasons and community services for location, and only based on informed decisions. Therefore, Saturday child care programmes need to be initiated to help physically and mentally tired parents, with more general provision of positive and diverse public support systems.

• Quality Improvement in Health Care
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• v.22 no.1
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• pp.29-37
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• 2016

Readmission which reflects capacity to manage patients and general level of medical services has been known for one of the causes of medical expenditure due to inefficient service. Compared to disease-specific readmission, hospital wide readmission (HWR) is relatively easy to understand, and has merit to get over limitation of collateral medical services assessment; therefore, a growing interest in development and usage of readmission indicator as quality of care indicator focusing on all-disease is detected. In this study, we investigate current state of risk standardized readmission rate indicator used in the United States, the United Kingdom, and Canada, and examine the considerations when using readmission rate as quality indicator in Korea. Differences in risk-adjustment methods were showed among countries. The United States do not control race not to hide socio-demographic factors on readmission. Canada shows differentiation compared to other countries about reflecting community factors. All three-countries utilize readmission rate as monitoring quality of care rather than incentives or penalty due to the fact that readmission rate could not represent the whole quality of hospital and has a limitation at controlling socio-economic factors. Therefore, for usage readmission rate as quality indicator in Korea, preparing readmission classification standard for Korean medical environment and additional methods for acquiring information by using discharge summary is need. Moreover, continued discussion with clinical specialists is needed for obtain clinical reliability and validity.

• Journal of the Korean Home Economics Association
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• v.42 no.3
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• pp.119-130
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• 2004

The purpose of this study is to estimate the rate of credit card payment for private education. The results of study can be used to improve credit card handling problems of private educational institutes, leading toward improvements in income transparency, increase in tax burden equity and long-term economic welfare improvement for individual households. 424 households out of 586 household that were surveyed in September of 2002 had 1,700 cases private extracurricular education. 67 of the 1,700 cases that did not have expenditure records were removed from the analysis. Only 3.67％ out of 1,633 cases were paid by a credit cards and the amount of credit card payment were only 5.65％ of the total amount spent for private education. The average fee of private educational institutes that allow credit card payment was higher than the fees of private institutes which don't allow a credit card payment or those of private institutes where consumers don't know whether a credit card payment was allowed. The average fee of private education paid by credit cards was 34,465.46 won higher than that paid by cash. Credit card payments to private educational institutions is an important social issue with respect to fair tax collection and tax burden equity since most private educational services operate in fairly small sizes and are offered by the self-employed, and the expense of private education is a fairly large proportion of the household income. It is also important for consumers if credit card acceptance expands alternatives that consumers can choose in private education. Therefore, credit card payment should be encouraged in private extracurricular education. To do this, private education providers should be forced to join a credit card payment service by the National Tax Service. A regulation that prohibits the refusal of credit card payments should be required, and credit card service charges of private education providers should be incrementally decreased. Also, consumer education and public promotions for credit card use instead of cash in paying for private education fees are recommended.

• Journal of Preventive Medicine and Public Health
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• v.42 no.1
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• pp.5-11
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• 2009

Objectives : This study was conducted to estimate the socioeconomic cost of injuries in South Korea. Methods : We matched claims data from national health insurance, automobile insurance and industrial accident compensation insurance(IACI), and mortality data obtained from the national statistical office from 2001 to 2003 by patients unique identifier. Socioeconomic cost included both direct cost and indirect cost: the direct cost was injury-related medical expenditure and the indirect cost included loss of productivity due to healthcare utilization and premature death. Results : The socioeconomic cost of injuries in Korea was approximately 1.9% of the GDP from 2001 to 2003. That is, 12.1 trillion KRW(Korean Won) in 2001, 12.3 trillion KRW in 2002, and 13.7 trillion KRW in 2003. In 2003, direct medical costs were 24.6%(3.4 trillion KRW), the costs for loss of productivity by healthcare utilization were 13.0%(1.8 trillion KRW), and the costs for loss of productivity by premature death were 62.4%(8.6 trillion KRW). Conclusions : In this study, the socioeconomic cost of injuries in Korea between 2001 and 2003 was estimated by using not only health insurance claims data, but also automobile insurance, IACI claims and mortality data. We conclude that social efforts are required to reduce the socioeconomic cost of injuries in Korea, which represented approximately 1.9% of the GDP for the time period specified.

• Smart Media Journal
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• v.6 no.2
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• pp.50-56
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• 2017

Due to new social environment, expenditure on eating out has increased over the last few year, thereafter the food-tech industries have steadily grown as well. We have studied what variable would affect customer's choices when they plan to eat out or order in. There are two variables are taken into account to prove it. Firstly, it is climate changes, such as an amount of rainfall, snowfall and clouds. Secondly, it is days, such as seasons and holidays. Based on this, we looked up the SikSin user's behaviors patterns, then did analysis of the daily data provided by the Meteorological office. By the end of the study, it turned out that two variables, climate changes and days, both have a strong influence on customer's choices. It is considered that this research outcome will make contributions to small businesses founders who want to take the initiative, marketing managers and people who are engaged in the food-tech industry.

• Journal of International Area Studies (JIAS)
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• v.22 no.1
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• pp.135-160
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• 2018

This study aims to predict the likely effect of economic sanctions on North Korea by examining case studies of Iran and Iraq. While UN sanctions against Iraq had immediate negative consequences for society, such as causing famine and reinforcing the authoritarian regime, sanctions against Iran had some productive consequences after they were reinforced by the U.S. and EU in significantly reduced oil exports and government expenditure, which in turn led to regime change and willingness to negotiate nuclear programs for economic recovery. Apart from these distinct differences, sanctions in both countries caused high inflation, shortage of necessary supplies, and increased unemployment. Case studies of Iran and Iraq also reveal that the sanctions disproportionately affected women and children, which implies that the recently reinforced economic sanctions of the U.S. and China against North Korea will cause more suffering of similarly socially marginalized groups in North Korea.

• Korea Journal of Hospital Management
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• v.24 no.3
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• pp.1-10
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• 2019

Purpose: The purpose of this study was to investigate determinants of purchasing indemnity private health insurance and its impact on the healthcare utilization among outpatients with chronic disease. Methods: The study analyzed 4,997 chronic ill patients using 2015 Korean Health Panel data. Logistic regression analysis was conducted to analyze the factors affecting the purchase of indemnity private health insurance and multiple regression analysis was conducted to analyze the effect of private health insurance on the number of outpatient visits and outpatient expenditures. Findings: The age, education level, and number of chronic diseases were significant factors affecting the purchasing of indemnity private health insurance among chronic patients. As a result of analyzing the impact of indemnity private health insurance on healthcare utilization, the number of outpatient visits for those who enrolled in the indemnity private health insurance was higher than the number of outpatient visits for those who did not. But there was no statistically significant difference in outpatient medical expenses. Practical Implications: The results of this study shows that indemnity private health insurance may cause inequality in the healthcare utilization of the socially vulnerable. It is necessary to seek ways to strengthen the health security of chronic disease patients and high-risk elderly people who need more healthcare.