• Journal of agricultural medicine and community health
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• v.16 no.2
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• pp.179-194
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• 1991

Despite its universal coverage of health insurance, the rural health insurance program(RHIP) stands at the crossroads in Korea. The RHIP has weaknesses in stability of financing, problems of inequities in the provision of health services and has suffered from high cost of running the program. The author has analyzed these problems from the perspective of health insurance policy and presented several options for improvement. First of all, this study urged the importance of a firm Governmental commitment of RHIP with the 50% subsidization of contributions as the Government had promised, instead of the current 40%. This can be justified from the 20% subsidization by the Government for the contributions of private school teachers and their dependents, who belong to richer segments of the population. Second, various cost containment measures ought to be sought curbing the rising demand for medical through strengthening health education and increasing individual responsibility, and tightening the claim review process. Third, this study requires the Government to run a demonstration project on the introduction of case payment system for primary health care. Fourth introducing an income-related cost sharing scheme is another possibility. Reforming the cost sharing formula for large medical expenditures is recommendable for a beginning. This measure can take the form of tax credit for medical expenditures of the poor. Fifth, the degree of financial adjustment among health insurance plans should be levelled up for enhancing stability of RHIP and social solidarity. Sixth, health policy should be redirected toward development of rural health resources and higher priority should be put on relieving difficulties in access to care. Seventh. the insurance plan owned-hospital needs to be developed or provision of health services in the medically underserved areas, and the need of such facilities is particularly acute for geriatric care, rehabilitation and renal dialysis, etc. Eighth, more generous insurance benefits are required of the elderly who are suffering the most : elimination of the maximum 180 days of benefit period and provision of glasses and artificial dentures, etc. Ninth. the economies of scale principle is working for the operating expenses of regional self-employed insurance plan. Thus, measures should be instituted to pursue an optimum size of health insurance plans. Lastly, excessive dependence on exclusion items is an evil so that some radical remedies are urgently required to cut them.

• Korea Journal of Hospital Management
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• v.24 no.1
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• pp.48-56
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• 2019

Purpose: As an interest in the elderly medical expenses increases, elderly people are increasingly purchasing indemnity private health insurance. Authors tried to investigate factors of having the indemnity private health insurance among the elderly people aged 65-75 years. Methods: We conducted panel logit regression analysis on 2,465 subjects as of 2016 using Korean Health Panel from 2010 to 2016. The dependent variable was whether to enroll in the indemnity private health insurance. The explanatory variables included socio-demographic characteristics, economic factors, health status, and health behaviors. Findings: As a result of the analysis of factors of purchasing indemnity private health insurances, it was analyzed that people with larger family, educated, pensioner, high household income or no disability were more likely to have indemnity private health insurance. Practical Implications: Considering the results of this study, the factor of purchasing indemnity private health insurance among elderly people were more likely to be their economic than demographic characteristics such as sex, age, and marital status. Policy makers should make efforts to reduce the burden on the elderly medical expense and to improve equity of medical use through institutional improvement such as raising age limit and lowering premium of indemnity private health insurance and expansion of public health insurance.

• Korean Journal of Social Welfare Studies
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• v.41 no.2
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• pp.35-65
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• 2010

The purpose of this study is to identify the relationship between health insurance and health by evaluating the impacts of health insurance coverage expansion on health care utilization and health status. To analyze the causal relationship between health insurance and health, this study employed a "difference-in-difference method" that could compare changes in health care utilization and health status across groups in health insurance coverage expansion in 2005. The researcher predicted that the expansion of health insurance coverage would be an exogenous source of variation in the prices of health service use. First, the difference-in-differences estimator between 'illness group' and 'non-illness group' revealed that the increase in coverage of inpatient care services would result from the increases in the stay of length of 'non-illness group' rather than that of 'illness group'. However, the difference-in-differences estimator between 'serious illness group' and 'chronic illness group' identified that the policy change that focuses on expansion of the coverage for 'serious illness' effects on the increases in health care utilization and promotion of health status. In summary, the changes of health insurance coverage focusing on serious illness and inpatient care have positive effects on health care utilization and health status of serious illness group. But, 'non-illness groups' with acute illness receive more benefits from the policy change than 'illness group' with chronic illness.

• Health Policy and Management
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• v.26 no.4
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• pp.343-351
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• 2016

Background: This study aims to analyze the effects of insurance types on the medical service uses for heart failure inpatients using propensity score matching (PSM). Methods: 2014 National inpatient sample based on health insurance claims data was used in the analysis. PSM was applied to control factors influencing the service uses except insurance types. Negative binomial regression was used after PSM to analyze factors that had influences on the service uses among inpatients. Subjects were divided by health insurance type, national health insurance (NHI) and medical aid (MA). Total charges and length of stay were used to represent the medical service uses. Covariance variables in PSM consist of sociodemographic characteristics (gender, age, Elixhauser comorbidity index) and hospital characteristics (hospital types, number of beds, location, number of doctors per 50 beds). These variables were also used as independent variables in negative binomial regression. Results: After the PSM, length of stay showed statistically significant difference on medical uses between insurance types. Negative binomial regression provided that insurance types, Elixhauser comorbidity index, and number of doctors per 50 beds were significant on the length of stay. Conclusion: This study provided that the service uses, especially length of stay, were differed by insurance types. Health policy makers will be required to prepare interventions to narrow the gap of the service uses between NHI and MA.

• Journal of Society of Preventive Korean Medicine
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• v.23 no.3
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• pp.109-119
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• 2019

Background : Germany is the first country in the world to introduce modern systems of public health insurance, and the country which most widely uses complementary alternative medicine(CAM) in Europe. In early 21^st century, a large evaluation studies were conducted to include acupuncture in health insurance payments, which were eventually decided. Objectives : This study is to investigate and analyze the process of public policy determination on insurance coverage for acupuncture in German health insurance system. Methods : We collected the data and information through the literature search and from the websites of German government departments and health insurance organizations. To obtain contextual information, German experts of health insurance and acupuncture clinical study were interviewed. Results : As use of acupuncture had been growing, German public health insurers wanted to evaluate the validity of acupuncture coverage and sponsored three evaluation projects for clinical effectiveness of acupuncture using randomized clinical trials, systematic reviews, and pragmatic trials from 2001 to 2005. For some pain condition, acupuncture was founded not to be effective than sham acupuncture, but more effective than standard care. The federal joint committee of health insurance decided to cover acupuncture for chronic pain of lumbar spine and chronic pain in at least one knee joint due to gonarthrosis. Conclusions : Considering the controversial subject matter in the process of acupuncture's health insurance coverage in Germany, expanding the benefits of Korean medicine in Korea needs to come up with ways to overcome the difficulties of placebo effect, standardization and lack of literature evidence.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.1
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• pp.497-505
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• 2018

This study was conducted to investigate the characteristics of private health insurance subscribers and non-subscribers as they relate to severely ill patients, and to identify the factors of participation. The study was conducted using the National Health and Nutrition Examination Survey for 2015, and data were analyzed using SPSS ver. 23.0. The subjects were 417 patients with severe disease (cancer, heart disease, cerebrovascular disease) over 19 years of age. Crossover analysis was employed to identify differences between the state of private health insurance participation, while binary logistic regression analysis was used to confirm the factors affecting private health insurance subscription. Analysis of the effects of the subjects on the private health insurance participation rate revealed that the social and demographic characteristics were higher in younger individuals regardless of sex, residence, or marital status. Moreover, higher household income, regardless of the education level, was associated with a higher participation rate of health insurance target individuals compared to medical benefit target individuals. The private health insurance participation rate was low and the explaining power was 51.7%, regardless of subjective health awareness and walking practice. Therefore, efforts should be made to improve the living environment and support local governmental programs for the elderly, low income households, socially vulnerable groups with limited activities and groups with limited health behavior. It is also necessary to consider various health policies, such as providing government health education or programs to prevent severe illness.

• Journal of Society of Preventive Korean Medicine
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• v.24 no.2
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• pp.83-94
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• 2020

Backgrounds : To reduce the patients' economic burden of herbal decoctions use, in 2012, Korean government decided to implement the pilot project of herbal decoctions coverage in the National Health Insurance. Objectives : This study aimed to analyze the policy decision-making process for the pilot insurance project in 2012. Methods : Official documents, research papers, statistical reports, and news articles, etc. on the coverage of herbal decoctions were searched and collected. We used the Kingdon's Policy Stream Model to analyze how the policy of pilot project of herbal decoctions coverage was decided, and who were the main activists for the decision-making process. Results : Components to be included in the 'Problem stream' were the decline in the profits of Korean Medicine institutions, the contraction of the herbal decoctions use, and the fiscal surplus of National Health Insurance. In the 'Policy stream', there were several model studies for herbal decoctions coverage, and examples of herbal benefits in other social insurances. In the 'Political stream', there were the legislative initiatives by member of the National Assembly and the promotion of insurance coverage by the Association of Korean Medicine(AKOM), etc. Policy window for herbal decoctions coverage was opened by the combination of these three streams with the efforts of policy activists, such as the executives of AKOM, and policy researchers. Conclusions : The policy decision process for health insurance coverage of herbal decoctions was analyzed using Kingdon's model, and the analysis shows that the combination of political streams and entrepreneurs' competencies can be an important driving force in policy decision making.

• Journal of Preventive Medicine and Public Health
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• v.24 no.3 s.35
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• pp.265-278
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• 1991

This study was to examine the effects of insurance coverage on the utilization of public health institutions and to identify the factors associated with the utilization. The data were obtained from household interview surveys conducted twice in Hwachun Gun, Kangwon Do. The time period covered in the first survey was December $17{\sim}31$, 1987, before the implementation of regional medical insurance for the self-employed, and that of the second survey was January 28 $\sim$ Febuary 11, 1990, after its implementation. Major findings emerged from the analysis can be summarized as follows (1) Medical care utilization of rural people markedly increased after they were covered by medical insurance. The insurance coverage increased the utilization of public health institutions as well, and this increase was mainly attributable to the utilization by chronically ill patients. (2) Between 1987 and 1990, the proportion of the utilization of public health institutions over whole medical care utilization decreased. But the proportion increased for chronically ill patients covered by regional medical insurance during the same time span. (3) The results of logistic regression suggested that the rural self-employed utilized public health institutions at an increased rate after they were covered by medical insurance. It was also indicated that the increase resulted from the utilization by chronically ill patients. (4) The relative importance of public health institutions for rural medical care decreased after the implementation of regional medical insurance. But considering that the utilization of public health institutions by chronically ill patients increased after insurance coverage, attention should be directed to improving the capability of public health institutions to control chronic degenerative diseases.

• The Journal of the Convergence on Culture Technology
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• v.10 no.3
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• pp.667-673
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• 2024

This study aims to diagnose the issues arising from the relationship between the out-of-pocket maximum in health insurance and private indemnity health insurance and propose policy tasks for institutional improvement. Through literature research, the study analyzed the damage to consumers caused by the non-payment of refunds exceeding the out-of-pocket maximum and the changing role of indemnity insurance due to the strengthening of health insurance coverage. The results confirmed that unilateral interpretation of insurance clauses and incomplete sales practices infringe upon consumer rights, and that insurance premiums do not decrease despite the reduction in coverage of indemnity insurance. Therefore, the study emphasized the urgency of institutional improvements such as rationalization of product structure, transparency of risk rate calculation, and reinforcement of consumer information provision, as well as the need for social consensus on the rational division of roles between health insurance and private insurance. This study is significant in that it provides policy implications for the developmental reorganization of the healthcare system.

• The Korean Journal of Health Service Management
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• v.5 no.4
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• pp.177-192
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• 2011

The arguments exist that private health insurance(PHI) policy holders tend to use the health care services more than non-policy holders due to their little out-of-pocket spending, resulting in the adverse effects on the finances of National Health Insurance. This study aims to increase the objective understanding of the issue and to draw a direction of further research, by reviewing the articles, reports and statistics which examined the effects of purchasing PHI policies on health care utilization. Significant differences in healthcare utilization, except for the very partial increase of utilization in outpatient settings, have been not found. The similar trends of the results have existed in a few previous studies which tried to control the endogeneity of medical use and health insurance with latent variables which affect the decision on medical use and health insurance. However, we can not exclude the potential change of healthcare utilization patterns because the portion of the insured of indemnity PHI is becoming rapidly larger in the market. For further research, we should try to obtain the objective information of subjects' past medical history, health status, health related behavior, and income affecting purchase of PHI and utilization of healthcare services. And the efforts of controlling the endogeneity of medical use and health insurance with latent variables which affect the decision on medical use and health insurance, are very considerable.