• 보건행정학회지
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• 제28권3호
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• pp.202-209
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• 2018

Health care has two different facets. One is commodity and another is a right of human being. Health care as a commodity is utilized by demand approach in market. Demand is determined by economic factors such as price and income. From the last third of the 19th century until the early 1920s, priority of sickness insurance was replacing the income that workers lost as a result of illness and injury. By the 1920s, the capacity of applied biological and medical science was remarkably developed. Development of medical science stimulated the cost of medical care, and the burden of increased medical care cost required new role of medical care security system. In 1942, Beveridge report was published in United Kingdom, and health care was considered as a right of human being. In 1948, United Nations declared heath care as a right in the Universal Declaration of Human Right. In most countries introduced new medical care security policy based on health care as a right. The viewing health care as a commodity must be shifted toward need based care as a right. Need were understood to rest on demographic, epidemiological, scientific, and medical knowledge factors. Bring needed care to the population could best be achieved institutionally by a hierarchy of provider organizations, guided by planning bodies, which would provide comprehensive benefits. In Korea, health care in social health insurance (SHI) is considered as a commodity not a right. However, health policies under SHI must be need approach based on health care as a right. Mismatch between health policies and ideology of SHI made big troubles. It is important to realize ideology of SHI for good health policies.

• 항공우주정책ㆍ법학회지
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• 제32권1호
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• pp.385-417
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• 2017

Insurances of space activities are divided into satellite insurance, astronaut insurance and third party liability insurance. Against the background of the rapid development of space commercialization, especially the increasing participation of private entities in space affairs, the present international and domestic mechanisms of space insurance are challenged. As a space-faring state which is in the process of developing space businesses, the regulations of space insurance in China are deserved to be discussed. Satellites insurance is at present well-developed, the "pre-launch", "launch" and "in-orbit" phases of satellites are all possible to be insured by related companies. China created the CAIA in 1997 to provide insurance for Chinese satellites. However, with more private entities start to involve in space as well as satellite industry, the regime established under the framework of CAIA is necessary to be modified, and the mechanism relating to space insurance brokers should be promoted. The astronauts are recognized as the envoy of humankind, and relevant international regulations are made to provide assistance to them in emergency circumstances. From the domestic perspective, astronauts will be fully insured. China creates a particular type of insurance for astronauts. However, once space tourism becomes a business, the insurance of the tourist will be demanded to be created. In order to promote China's space tourism, it is recommended to take the "Astronaut Group Insurance" as an optional model to space tourists, if the tourists are customers of a governmental-owned space company. Once private involvement of providing orbital/suborbital tourism service becomes a reality, new rules are required. Getting a third party liability insurance is deemed as an indispensable precondition for an applicant to get a launch permission. Domestic space laws will include provisions for the third party liability insurance. China's "Interim Measures" of 2002 realizes the importance of third party liability insurance and requires the permit holder to get it before entering the launching site. This regulation is different from the practices of other states. Concerning that China is the sponsor of APSCO, for the purpose of promoting commercial space cooperation, a harmonized approach to domestic law is recommended to be found.

• 보건행정학회지
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• 제20권1호
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• pp.87-102
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• 2010

The objective of this study were to examine the impact of medicaid coverage expansion policy aimed at improving access to primary care. The case-control study was conducted to compare preventable hospitalization(PH) rate in new medicaid recipients versus national health insurance(NHI) enrollees form 1996 to 2001. Rates of preventable hospitalization associated with ambulatory care sensitive conditions(ACSC) were calculated and standardized by age and sex. Multinomial logit regression model was used to control the confounding factors such as age, gender and charlson comorbidity index Annual PH rates in the new medicaid increased 1.64 times after medicaid expansion, with controling confounding factors. Meanwhile, annual PH rate in the NHI increased 1.68 times during the same period, with adjusting confounding factors. Current findings suggest that the new medicaid PH rate was less likely to rise than NHI PH rate after implementing medicaid expansion. This study is expected to provide policy-relevant evidence of medicaid expansion to include population with low income.

• 보건행정학회지
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• 제28권2호
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• pp.138-144
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• 2018

Background: Diagnostic imaging fee had been reduced in May 2011, but it was recovered after 6 months because of strong opposition of medical providers. This study aimed to analyze the behavior of medical providers according to fee changes. Methods: The National Health Insurance claims data between November 2010 and December 2012 were used. The number of exams per computed tomography was analyzed to verify that the fee changes increased or decreased the number of exams. Multivariate regression model were applied. Results: The monthly number of exams increased by 92.5% after fee reduction, so the diagnostic imaging spending were remained before it. But medical provider decreased the number of exams after fee return. After adjusting characteristic of hospitals, fee reduction increased the monthly number of exams by 48.0% in a regression model. Regardless type of hospitals and severity of disease, the monthly number of exams increased during period of fee reduction. The number of exams in large-scaled hospitals (tertiary and general hospital) were increased more than those of small-scaled hospitals. Conclusion: Fee-reduction increased unnecessary diagnostic exams under the fee-for-service system. It is needed to define appropriate exam and change reimbursement system on the basis of guideline.

• 보건행정학회지
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• 제30권3호
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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.

• 보건행정학회지
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• 제26권1호
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• pp.71-78
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• 2016

The value of using health insurance claim database is continuously rising in healthcare research. In studies where comorbidities act as a confounder, comorbidity adjustment holds importance. Yet researchers are faced with a myriad of options without sufficient information on how to appropriately adjust comorbidity. The purpose of this study is to assist in selecting an appropriate index, look back period, and data range for comorbidity adjustment. No consensus has been formed regarding the appropriate index, look back period and data range in comorbidity adjustment. This study recommends the Charlson comorbidity index be selected when predicting the outcome such as mortality, and the Elixhauser's comorbidity measures be selected when analyzing the relations between various comorbidities and outcomes. A longer look back period and inclusion of all diagnoses of both inpatient and outpatient data led to increased prevalence of comorbidities, but contributed little to model performance. Limited data range, such as the inclusion of primary diagnoses only, may complement limitations of the health insurance claim database, but could miss important comorbidities. This study suggests that all diagnoses of both inpatients and outpatients data, excluding rule-out diagnosis, be observed for at least 1 year look back period prior to the index date. The comorbidity index, look back period, and data range must be considered for comorbidity adjustment. To provide better guidance to researchers, follow-up studies should be conducted using the three factors based on specific diseases and surgeries.

• 보건행정학회지
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• 제19권1호
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• pp.62-80
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• 2009

The purpose of this study was to examine the factors influencing the attitude toward the increasing role of private health insurance(PHI). In the Korea Welfare Panel Data 2007, a sample of 1,675 (adjusted by weight value: 1,607) respondents on an opinion on promoting PHI was used in the study. With independent variables including socio-demographic characteristics, health status, health-related behavior, and opinions on welfare service, ordered-probit model was used to analyze the attitude toward PHI. Negative opinion on the increasing role of PHI were responded by 54.6%(n=877) of the respondents, whereas 22.2%(n=373) were positive and 23.2%(n=357) were neutral. Old people, the better off, those with worse self-assessed health status, and those having an experience of health examination tend to have the positive attitude toward the increasing role of PHI. Women, those with chronic diseases or disorders and those who do not agree that comprehensive welfare benefits reduce work incentive showed negative attitude toward PHI. When comparing the needs for PHI before and after medical utilization, ex-ante need tends to strengthen the tendency to support private health insurance. This study will contribute to the discussion on the optimal mix of public and private health insurance in Korea by a better recognition of attitude toward PHI and health care system.

• 보건행정학회지
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• 제30권2호
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• pp.151-163
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• 2020

This study reviewed primary care purchasing issues of the Indonesian single-insurer, BPJS-K, in the context of triangular power relations between the government, the insurer, and the providers, and considered its challenges of purchasing as the national single-insurer. Some literature reviews and interviews with Indonesian stakeholders and residents were used to describe the historical and social contexts of Indonesian healthcare and social health insurance systems especially focusing legal and institutional status of BPJS-K and primary care provision and delivery conditions in remote areas. Though BPJS-K directly belongs to the presidential office of Indonesia, it has limited power in terms of purchasing as a single insurer. Mainly it was due to the lack of primary care resources, Ministry of Health's strong power as the regulator and provider, and BPJS-K's powerlessness against monitoring and quality of care assessment. Ambiguous accountability was another issue among the insurer and the Ministry of Health. This created confusions in primary care provision. It is suggested that each agencies' accountability should be obvious in terms of legal, political, and social contexts.

• 보건행정학회지
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• 제15권3호
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• pp.79-93
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• 2005

The purpose of the study is to identify Ambulatory Care Sensitive Conditions (ACSC) and their potential health insurance applicability in Korea, using the correlation and regression analysis with the empirical data provided by Korean Health Insurance Review Agency(KHIRA). Here, ACSC would be thought of as conditions that when timely and effectively treated in the outpatient medical services can help reduce the risk of hospitalizations. As for ACSC, reducing accessibility for outpatient visit results in increasing hospitalization. In this respect, the ACSC concept is popularly adopted as one of the performance indicators of the national health system. As one of main results, fortifying the accessibility to necessary health care in a way of sharing appropriately the role with private health insurance can lead to the efficiency of national health care delivery systems in view of total health care expense, in particular in a case of ACSC children. Lastly, we would like to strongly suggest that the disease treatment data set reported to KHIRA needs to be opened to private insurance companies only for illness experience investigation.

• 보건행정학회지
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• 제11권1호
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• pp.62-86
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• 2001

This study purports to Investigate the determinant of job satisfaction and the organizational commitment of medical insurance review nurses working at Korean hospitals. The independent variables contain three groups of determinants: organizational characteristics variables(job autonomy, work unit control, role variety, role ambiguity, role conflict, workload, resource inadequacy, coworker support, supervisor support, distributive justice, promotional chances, job security, and job hazard), environmental variables(job opportunity, spouse support, and parent support), and psychological variables (met expectation, work involvement, positive affectivity, and negative affectivity). The sample used in this study consisted of 445 medical insurance review nurses from 89 hospitals nationwide. Data were collected with self-administered questionnaires and analyzed using multiple regression analysis. The results of the study are as follows : 1) the following variables, listed in order of size, have significant effects on job satisfaction : role ambiguity(－), distributive justice(＋), work involvement(＋), role variety(＋), met expectation(＋), negative affectivity(－), job autonomy(＋), and positive affectivity(＋). 2) the following variables, listed in order of size, have significant effects on organizational commitment: met expectation(＋), work involvement(.＋), distributive justice(＋), job security(＋), role variety(＋), positive affectivity(＋), negative affectivity(－), resource inadequacy(＋), and tenure(－). 3) the variance of job satisfaction and organizational commitment explained by the variables used in the study are 30.0% and 39.1% respectively. 4) In comparison to the results of other studies on the determinants of job satisfaction and organizational commitment of clinical nursing staff working at hospitals, the results of this study indicate that three variables of distributive justice, work involvement, and role variety are especially important for improving the level of job satisfaction and organizational commitment of medical insurance review nurses.