• 대한예방한의학회지
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• 제20권3호
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• pp.31-43
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• 2016

Objectives : It focuses on what the consumers expected Korean medicine to improve on, and analyzes patients' impressions. Methods : This research is based on the Ministry of Health and Welfare's Survey on Usage of Korean Medicine (2008, 2011, and 2014) and was new analysis for our research objective. Results : The general consensus among the consumers was uncertainty of effectiveness, expensive costs, side effects, need for expertise, lack of scientific evidence, expansion of diseases treated, and improvement of equipment. Consumers distrusted Korean medicine due to its uncertainty of its effectiveness, expensive costs, side effects, and lack of scientific evidence for its effectiveness, and avoided using Korean medicine. Conclusions : These results seem to be a combination of the Korean medicinal doctors treating patients not based on evidence but on their individual experiences, lack of health insurance for Korean medicine resulting in expensive costs, lack of research on toxicity and safety of Korean medicine, and lack of scientific and clinical studies for evidence-based research. To solve these problems, the Korean medicine community needs to standardize treatments based on evidence, and look to Chinese medicine for possible solutions.

• 약학회지
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• 제58권2호
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• pp.99-106
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• 2014

This study explores the prescribing pattern of generic drugs and the relationship between socio-demographic factors and the use of generics in South Korea. The analysis was based on claims data of 2011 from Korean National Health Insurance. We examined utilization, costs, and market share of oral preparations by original and generic product. Multiple logistic regression was performed to evaluate the predictive factors of generic use among multi-source medications. Generics accounted for 37~41% of utilization and 34~41% of costs in the insured market of oral preparations. In the generic market, costly generics made up about 58~61%, 56~66% of volume and value, respectively. Other things being equal, institutional factors affected generic use to the largest degree. The odds of having generics were 6 times higher in clinics, 4 times higher in hospitals, and 1.7 times higher in general hospitals than in teaching hospitals. Those in metropolitan or rural area were more likely to prescribe generics than those in the capital area. While generics were frequently prescribed for off-site pharmacy (OR=1.173), the odds of having generics was 0.88 after weighting the data by units prescribed. This study empirically presented the pattern of generic prescribing, confirming the widely accepted view that costly generics were more likely to be utilized in the Korean market. Up to two thirds of the generic market consisted of costly products. The strongest factors affecting generic use were institutional variables.

• Journal of Preventive Medicine and Public Health
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• 제27권1호
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• pp.135-144
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• 1994

The purpose of this study compares determinants of eldery medical cost inflation with those of other age groups by analysing aggregated data with a deterministic model. The deterministic model of per capita medical cost inflation consists of increases in price, intensity of services, and medical utilization. We used a time series data($1985{\sim}1991$) from National Medical Insurance and analyzed by age groups. In total population, the average increase rates of inpatient and outpatient medical costs were respectively 9.5% and 8.8% during 6 years and the major cause of inflation was the increase in service intensity in both of inpatient and outpatient cases. But in the population of 65 years old and over, the average increase rates of inpatient and outpatient medical costs were respectively 13.8% and 14.8% and the major cause of inflation was the increase in per-capita medical utilization in both of inpatient and outpatient cases. Also, the increase in service intensity of 65 years old and over was the highest of other age groups. This pattern was similar during study periods. We concluded that the level of medical cost-inflation and the determinants in eldery was the highest-especially in per capita medical utilization, therfore, the inflation of medical costs in eldery will be higher than other age groups for the furture in Korea.

• Asian Pacific Journal of Cancer Prevention
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• 제14권9호
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• pp.5249-5255
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• 2013

Background: The purpose of this study was to develop a single measure of cancer burden (SMCB), which can prioritize cancer sites by considering incidence and mortality. Materials and Methods: Incidence data from 1999 to 2010 were obtained from the Korea Central Cancer Registry. Mortality data from 1999 to 2010 were obtained from Statistics Korea. The SMCB was developed by adding incidence and mortality scores. The respective scores were given such that incidence and mortality were classified by ten ranges of equal intervals. Results: According to the SMCB in 2010, stomach cancer ranked $1^{st}$ in males with 20 points, and colorectal cancer was $2^{nd}$ with 11 points. Breast cancer and thyroid cancer were joint $1^{st}$ with 11 points for females. The SMCB for females was less than that for males. The burden of stomach cancer was $1^{st}$ in males from 1999-2010. The incidences of lung cancer and liver cancer decreased, whereas thyroid cancer and colon cancer increased during the period. Breast cancer and thyroid cancer burden showed tendencies to increase in females. Comparison of SMCB with disability-adjusted life years (DALY) and socioeconomic costs in 2005 showed that the top five cancer sites were similar, but there were differences in the size of the cancer burden. Conclusions: The SMCB indicated that the burdens of stomach cancer in males and thyroid and breast cancers in females were large. The single measure showed an advantage, reflected as the equivalent dimensions of incidence and mortality, whereas DALY and economic costs showed tendencies to reflect premature death.

• 보건행정학회지
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• 제24권3호
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• pp.219-227
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• 2014

Background: Current trends in Korea population aging with advances in public health and clinical medicine foretell rises in the prevalence of not only chronic diseases but also patients with multimorbidity. One important aspect in analyzing multimorbidity is to define the list of chronic diseases included when calculating multimorbidity index. The objective of this study is to describing the effect of multimorbidity on healthcare cost in Korea using US Office of the Assistant Secretary of Health (OASH) list. Methods: We analyzed the Korea Health Panel Data representing non-institutionalized Korean adult populations aged 20 and more. We calculated multimorbidity index based on OASH list and estimated the prevalence and healthcare cost for each OASH chronic disease. Results: In 2011, 15.2 million (39.6%) Koreans aged 20 and more were living with chronic condition. The health care cost due to chronic diseases, accounted for 80.2% of the overall healthcare costs and the prevalence of chronic conditions, the prevalence of multimorbidity and healthcare cost increased with ages. In the analysis using OASH list, 40% of the adult population over the age of 20 and 66.7% of the population over the age of 65 was affected with multimorbidity. In most of diseases in OASH list, prevalence of mulitmorbidity was high and healthcare cost increased with multimorbidity. Conclusion: OASH chronic disease list that accounts for 72.4% of prevalence and 86.7% of healthcare cost of persons with chronic conditions in Korea. OASH chronic disease list would be a useful and representative indicator for studying multimorbidity.

• 보건행정학회지
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• 제29권2호
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• pp.130-137
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• 2019

The fee-for-service system is used as the main payment system for health care providers in Korea. It has been argued that it can't reflect differences in the medical practice costs across regions because the fee schedule is calculated based on the average cost. So, some researchers and providers have disputed that there is need for adopting geographic practice cost index (GPCI) used in the United States for the Medicare program for the elderly to the fee-for-service payment system. This study performed to identify whether the difference in the practice costs among regions exists or not and to examine the feasibility of applying GPCI to Korea payment system. For this purpose, we calculated modified-GPCI and examined considerations to introduce GPCI in Korea. First we identified available data to calculate GPCI. Second, we made applicable GPCI equations to Korea payment system and computed it based on four types of regions (metropolitan, urban, suburban, and rural). We also categorize the regions based on the availability of the medical resources and the capability of utilizing them. As a result, we found that there wasn't any significant difference in the GPCI by regional types in general, but the indices of rural areas (0.91-0.98) was relatively low compared to the indices of other regions (0.96-1.07). Considering the need to use GPCI floor, the pros and cons of using GPCI, and the concern of the regional imbalance of resources, the introduction of GPCI needs to be carefully considered.

• 보건행정학회지
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• 제33권1호
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• pp.19-28
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• 2023

Background: With the enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act in February 2018, legal guidelines for physician orders for life-sustaining treatment (POLST) were presented. This study was conducted to analyze the association of writing POLST on the use of health care before death. Methods: The study analyzed the electronic medical records and POLSTs of 1,003 adult patients who died at a tertiary hospital located in Seoul from February 4, 2018 to February 4, 2019. Results: Of the deaths, 80% (n=804) completed POLST. Among patients who completed POLST before death, 51% (n=412) were written 1-7 days before death, and only 31% (n=246) were completed by patients themselves. 99% (n=799) decided to withdraw or withhold cardiopulmonary resuscitation. As a result of analyzing the effect of POLST on medical use before death, it was found that POLST and inpatient cost had a significant negative correlation, and POLST completion significantly reduced death in the intensive care unit (ICU). However, both inpatient costs and death at ICU increased when the POLST was completed by surrogate decision-makers rather than patients themselves. Conclusion: The enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act provided a legal basis for withdrawing and withholding meaningless life-sustaining treatment. By specifying the treatment to be received at the end of one's life through the POLST, inpatient treatment costs and death at the ICU were decreased. However, the frequent decision-making by the surrogates and completion of POLST close to death may hinder the original purpose of the law.

• 보건교육건강증진학회지
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• 제8권1호
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• pp.14-21
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• 1991

In accordance with the rapid industrialization in Korea, there have been remarkable changes in the health environment. The major changes are ; the change of disease structure, the aging of population structure, the diversification of health needs and the increase of health care costs. Because most of health problems stems from the environment, national health policy should be conducted according to the environmental changes. It is necessary for the voluntary organizations as well as the government ones to plan and participate the national health promotion movement on a national level so as to make the people form the attitude that health promotion is better than cure. Also, it is desirable that national health promotion movement be implemented gradually especially by four steps, 1) preparation step; 2) enlightenment step: 3) implementation step: 4) evaluation step.

• 한국임상약학회지
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• 제23권2호
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• pp.89-96
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• 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.

• Journal of Preventive Medicine and Public Health
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• 제27권4호
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• pp.793-805
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• 1994

Investigating the existence of volume-outcome relationships for specific disease groups relates directly to the policy issue of whether, and how, specific inpatient services should be regionalized. This study examined whether medical costs and lengths of stay as outcomes were affected by changes in volume within hospitals. Based on the claims data obtained from National Federation of Medical Associations, each six disease categories from medical and surgical conditions were selected and 29,720 cases from 1,266 hospitals were analyzed. Main findings of the research can be summarized as follows: 1. Analyzing volume and cost per case relationship, tonsillectomy class 1, hernia procedure class 0, appendectomy and cesarean section class 0,1 in surgical conditions showed negative relationship significantly. In cases of medical conditions, costs per case in respiratory neoplasm class 2, COPD class 1, 2, digestive malignancy were also related to volume negtively. 2. Comparing volume with length of stay per case, lens procedure class 0, hernia procedure class 0, appendectomy class 0,1, cesarean section class 1 in surgical conditions showed negative relationships significantly. In medical conditions, volume of respiratory neoplasm class 2, COPD class 1,2, digestive malignancy class 0 were associated with negatively. 3. Within same disease categories, changes in cost and length of stay per case to volume were more remarkable in severe cases. These results suggested a significant inverse relationship between disease cases and cost, length of stay per case as outcome variables.