• Health Policy and Management
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• v.30 no.3
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• pp.409-417
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• 2020

Background: It is well known that the distribution of therapeutic materials is very complex. However, it is not easy to demonstrate the concrete problems caused by distribution channels empirically. The purpose of this study was to investigate the differences in the price of therapeutic materials according to the type of purchasing agency and the way in which medical institutions purchase therapeutic materials. Methods: This study compared the claimed prices and the maximum allowable prices for the items of therapeutic material used for general spinal surgery. Results: Ilsan Hospital, which purchased directly without a purchasing agent, had the lowest claimed prices, followed by a large professional purchasing agency, a foundation-related purchasing agency, and a general purchasing agency. In addition, the difference between the claimed prices and the maximum allowable prices according to the purchase type was larger in the expensive treatment materials, and in the case of the lower price treatment materials, it tended to converge to the maximum allowable prices. Conclusion: National health insurance spending for therapeutic materials are to be affected by the distribution channels of them. We proposed several ideas to rationalize the expenditure such as classification of therapeutic materials on the basis of price or other criteria.

• The Korean Journal of Emergency Medical Services
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• v.24 no.1
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• pp.25-36
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• 2020

Purpose: We analyzed the characteristics and differences in patients' medical benefits and health insurance based on disease severity classification. Methods: We examined 29,139 patients who visited the emergency medical center of K Hospital from January 1,2016 to December 31, 2016. Survey items included the Korean Triage and Acuity Scale (KTAS) classification of emergency and non-emergency situations ratio and type of insurance. Results: According to KTAS classification, 76.2% of patients exhibited an emergency condition and 23.8% exhibited a non-emergency condition. Emergency patients exhibited more trauma than non-emergency patients. According to the type of insurance coverage, the duration of stay in the emergency room was longer for patients with medical care than for patients with health insurance. Additionally, 119 ambulances use was significantly higher among patients with medical care. Conclusion: Policy discussions should address alternative ways to replace the 119 ambulances used by patients in this study. Additionally, health care administrators should identify alternative care agencies as potential alternatives to emergency room visits.

• 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.

• Quality Improvement in Health Care
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• v.26 no.2
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• pp.95-103
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• 2020

Purpose: This study was to examine whether a health care model that provides comprehensive medical services based on population groups to members of the medical cooperative is applicable as a policy alternative in terms of medical use and cost. Methods: Data were derived from National Health Insurance claim data in 2019. We compared the medical volume and expenses of patients who visited social cooperative-type medical clinics with other patients, control group who visited other clinics in a local area. Results: The average number of visit days was 25.3 days in social cooperative-type medical clinics, more than 24.2 days in the control group (p=.004). However, the average medical cost per visit was KRW 46 thousand in social cooperative-type medical clinics, which was significantly lower than KRW 51 thousand in the control group (p<.001), and the total medical cost was also KRW 16.1 billion in social cooperative-type medical clinics and KRW 16.9 billion in the control group. Conclusion: We identified that a population-based health care model might change patients' behaviors to health care services and decrease total medical cost. Further population based experiment is needed to develop alternative healthcare model.

• Korea Journal of Hospital Management
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• v.20 no.3
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• pp.36-44
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• 2015

The Activity Based Costing(ABC) means the process that makes clear how the actions and input resources have changed into service to calculate medical services costs. These days, the number of hospital which is using the ABC system is increasing to make their policy decision making efficient and run the hospitals more resonable. This study analyzes the unbalance in the level of health insurance service fee and the improvement plans based from 8 hospitals(ABC system) and 95 clinics(ABC survey). The cost recovery ratio has shown different levels according to each service type. A surgery service type recorded 76.8% and an evaluation & management service type is 84.6%, a treatment procedure type(85.8%), a function test type(91.6%) and health insurance fee even did not reach to the original cost. Meanwhile, a laboratory test type and imaging test type show high level of cost recovery ratio. they recorded 188.3% and 158.8%. Resultingly now of unbalance in the level of health insurance service fee accelerates supply of every test. so there is a need to make laboratory test type and imaging test type lower to keep balance with the surgery and medical service. These methods should be performed gradually with monitoring the unbalance fee ratio and for this, a panel medical institution have to be established for generalizations of studying result, fairness of selecting researching sample.

• Health Policy and Management
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• v.29 no.2
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• pp.184-194
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• 2019

Background: The extent of coverage rate of the public health insurance is still insufficient to meet healthcare needs. Private health insurance (PHI) plays a role to supplement coverage level of national health insurance in Korea. It is expected that reduce unmet need healthcare. This study was aimed to identify relationship between PHI type and the unmet healthcare need and its associated factors. Methods: Data were obtained from the 2014 Korea Health Panel Survey using nationally representative sample was analyzed. Respondents were 8,667 who were adults over 20 years covered by PHI but have not changed their contract. According to the enrollment form, PHI was classified into three types: fixed-benefit, indemnity, and mixed-type. To identify factors associated with unmet needs, multiple logistic regression conducted using the Andersen model factors, which are predisposing factors, enabling factors, and need factors. Results: Our analysis found that subjects who had PHI with mixed-type were less likely to experience unmet health care needs compared than those who did not have it (odds ratio, 0.80; 95% confidence interval, 0.66-0.98). As a result of analyzing what affected their unmet healthcare needs, the significant factors associated with unmet medical need were gender, marital status, residence in a metropolitan area, low household income, economic activity participation, self-employed insured, physically disabled, low subjective health status, and health-risk factors such as current smoking and drinking. Conclusion: The results of this study suggest that having PHI may reduce experience of unmet healthcare needs. Findings unmet healthcare needs factors according to various subjects may be useful in consideration of setting policies for improving accessibility to healthcare in Korea.

• The Korean Journal of Health Service Management
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• v.10 no.4
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• pp.1-11
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• 2016

Objectives : The aim of this study is to investigate the actual condition of the occurrence and recovery of medical expenses through seafarers insurance and to provide basic data that will be helpful in the establishment of efficient hospital management strategies for medical expenses of insurance companies depending on the type of seafarers insurance. Methods : Three general hospitals located in Busan, Korea, were selected, and seafarers insurance claim data was collected from January 1, 2012 to December 31, 2013(24 months) and analyzed. There were 5,490 cases in total. Results : There was a significant difference in the distribution of disease incidence, accrued medical expenses, reimbursement of medical expenses, and the actual condition of medical receivables depending on the insurance company. Conclusions : Therefore, differentiated payback strategies for medical expenses are needed that consider the various seafarers insurance companies and their treatment characteristics.

• Korea Journal of Hospital Management
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• v.22 no.2
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• pp.58-69
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• 2017

Recently, with the increase in the number of private health insurance subscribers, interest in overuse of the medical service is increasing. This study analyzed the impacts of private health insurance (PHI) on medical institution selection in outpatient service utilization among persons with arthritis. In order to control patients' health status, we extracted outpatient episodes with the same disease (KCD6, M13) from Korea Health Panel. The unit of analysis was an outpatient visit with arthritis in 2014 (n=23,363). In the light of insurance coverage, we redefined three type of private health insurance (ex, indemnity, fixed benefit, and non-insured) as a test variable and two type of medical institution (ex, hospital and physician visit) as a dependent variable. We conducted a probit regression analysis to identify the impacts of PHI on medical institution selection controlling for heteroscedasticity. The results of this study showed that the insured with indemnity were more likely to choose hospital departments than clinics (marginal effect=0.0475, p=0.000). The impact of participation of fixed benefit PHI was not as clear as that of indemnity type (marginal effect=0.0162, p=0.047). In conclusion, this study confirmed that PHI, particularly indemnity type has a significant impact on the selection of medical institutions. Healthcare policy makers should consider that PHI not only affects the overall quantitative increase in healthcare utilization, but also influences the selection of medical institutions.

• Research in Community and Public Health Nursing
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• v.32 no.1
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• pp.64-72
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• 2021

Purpose: The purpose of this study is to analyze occupational accident compensation insurance coverage and occupational accidents incidence for special-type delivery workers. Methods: The data for occupational accident compensation insurance coverage and occupational accidents from 2012 to 2017 were analyzed through descriptive statistics. Results: Rates of occupational accident compensation insurance coverage of special-type delivery workers decreased gradually from 43.4% in 2012 to 28.5% in 2016, and 29.0% in 2017. Rates of occupational illnesses death per ten thousand workers increased gradually from 2.1‱ in 2013 to 3.1‱ in 2016, and 8.6‱ in 2017. All occupational illness deaths were due to cerebro-cardiovascular diseases. Road traffic accidents and slips accounted for the largest proportion of occupational accidents. Conclusion: Special-type delivery workers have a high risk of industrial accidents, so it is necessary to raise industrial accident insurance coverage and provide professional and systematic occupational safety and health services.

• Health Policy and Management
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• v.33 no.3
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• pp.325-337
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• 2023

Background: While there are many studies estimating the effects of private health insurance on various types of health care utilization, few have examined how such effects change in conjunction with important policy reforms in national health insurance (NHI). This study examined how the effect of private health insurance (supplemental and fixed cash benefit) on high-cost outpatient imaging test utilization changed following the expansion of magnetic resonance imaging (MRI) coverage in 2018, which is a key example of the NHI benefit expansion policy in recent years. Methods: Data from the 2017 and 2019 Korea Health Panel Survey, which contained information about healthcare utilization before and after the expansion of MRI coverage in 2018, were used. The incremental effect of private health insurance on high-cost outpatient imaging test utilization for each period were quantified and compared, with special attention given to the type of private health insurance. Results: While people with supplemental private health insurance were more likely to use high-cost outpatient imaging tests than those without, both before and after the expansion of MRI coverage, the incremental effect increased from 1.6% points in 2017 to 2.5% points in 2019. Conclusion: Benefit expansion in NHI does not necessarily reduce disparities in the use of health care between private health insurance subscribers and non-subscribers. The results of our study also suggest that the path through which private health insurance affects healthcare utilization may not be limited to the price mechanism alone but can be more complex.