• 대한예방의학회:학술대회논문집
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• 2000.10a
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• pp.173-174
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• 2000

• The Journal of Korean Medicine
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• v.26 no.2 s.62
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• pp.105-125
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• 2005

Objectives: The purpose of this study was to identify resources put into clinical. activities and identify a new RBRVS for oriental medical services in the Korean National Health Insurance. Methods: Based on a survey of physician's time, physical effort & technical skill, mental effort & judgment, and stress that were used for patient treatments, relative input values for the relevant clinical activities were estimated and rearranged in a way to be compared. with the current values in health insurance. Results: We found the actual resource-based relative values for oriental medical services statistically different from the current values, with a narrower variation in value distribution. Conclusions: The findings suggest the C\lrrent RBRVS should be revised to reflect the actual input resources into physicians activities and to avoid a distortion of physicians behavior.

• The Journal of the Korean dental association
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• v.57 no.9
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• pp.496-503
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• 2019

A dental implant has been covered by National Health Insurance (NHI) in Korea since 2014. Every year the age group covered was extended and the out-of-pocket payment was decreased. This study analyzed the dental implant utilization rate by the National Health Insurance customized DB during the last 5 years. As a result, the utilization rate has been rapidly increasing steeply. The differences by age and sex in the utilization rate of dental implants were explored. The inclusion of a dental implant in the NHI system contributed to improving the dental accessibility of the elderly in Korea. However, a deep discussion is needed whether it is appropriately provided to necessary patients. The utilization rate will increase further in the future. Therefore, continuous monitoring and critical policy review should be continued.

• Health Policy and Management
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• v.16 no.3
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• pp.37-51
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• 2006

This study evaluates the reliability of the discharge status variable m health insurance claims for identifying in-hospital patient deaths. This study used 2002 national health insurance claims and the cause of death statistics from Korean national statistical office. The Study data set included acute myocardial infarction (AMI) and coronary artery bypass graft (CABG) surgery patients in 133 general and tertiary hospitals. The gold standard containing patient death information was made and then compared with that of claims data. The hospitals were classified into four groups based on the number of deaths in each hospital. Simple kappa coefficients were calculated to evaluate the agreements of patient deaths between the gold standard and the insurance claims. CABG (83.9%) showed higher agreements than AMI(73.0%) in matched in-hospital patient death information between data sets. Simple kappa coefficients of CABG (0.63) and AMI (0.59) showed moderate or good agreements. The agreements, however, varied depending on the disease or hospital types. The fact that the agreements are only moderate to good indicates that the accuracy of in-hospital death information in claims is not high. n the variable is used to identify patient deaths, it may mislead people. Therefore, efforts should be made to improve the reliability of the discharge status variable in health insurance claims.

• Health Policy and Management
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• v.19 no.3
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• pp.1-26
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• 2009

Objectives : To identify target areas and set priorities among those areas identified for national quality evaluation. Methods : Target areas were identified from: i) analysis of the national health insurance claims data, mortality and prevalence data ii) various group surveys, including representatives from 22 medical specialty associations, 19 physician associations, QI staffs in hospital, civil organizations, and commissioners of Health Insurance Review and Assessment Service(HIRA) ⅲ) literature reviews and RAM(RAND/UCLA appropriateness method). The priority areas for national quality evaluation represented the full spectrum of health care and the entire life span. The criteria for selecting the priority areas were impact, improvability, and measurability. The priority areas were divided into three categories : short-term, mid-term, long-term. Results: Based on the group surveys and the data analysis, 46 candidates were selected as quality evaluation priority areas. 13 areas were selected as having a short-term priority areas: tuberculosis, community acquired pneumonia, stroke, ischaemic heart disease, diabetes, hypertension, chronic lower respiratory disease(asthma, chronic obstructive pulmonary disease), intensive care unit, emergency room, nosocomial infection, use of antibiotics, multiple medication and renal failure. This results suggested that we need to enlarge the target priority areas to the chronic diseases in short-term. Conclusions: The priority areas identified from the study will assist healthcare quality associated institutions as well as HIRA in selecting quality evaluation areas. It is required to develope and implement strategies for improving the quality of care within the next 5 years.

• The Journal of the Korean dental association
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• v.51 no.5
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• pp.265-273
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• 2013

The insurance payment plan for dental implants in Korea has been criticized because the payment priority has not been properly established, and the benefits are concentrated among middle-class citizens. In the current study, the relationship between the oral health condition and socioeconomic status of the elderly was analyzed using data from the Korea National Health and Nutrition Examination Survey (KNHANES). This study aims to determine the reason underlying the criticism of the insurance payment plan. The subjects were >65-year-old individuals in the 2010 and 2011 database of KNHANES. Data from 2,812 subjects were analyzed. The socioeconomic status was determined based on edentulousness, molar tooth loss, and presence of 28 teeth. According to the analysis, the average income was 1,560,000 won for edentulous elderly, 1,811,000 won for elderly who had lost molar teeth, and 1,896,000 won for elderly with 28 teeth (p<0.05). In addition, elderly with a low education level demonstrated a poor oral health condition (p<0.001). In conclusion, the insurance plan currently under examination is not properly designed for economically impoverished elderly because the plan only covers 50% of the costs and is limited to implantation of molar teeth only. This plan will not provide practical benefits to elderly with a poor socioeconomic status; therefore, the insurance payment plan needs to be improved so that the appropriate beneficiaries can be targeted.

• Journal of Korean Public Health Nursing
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• v.5 no.1
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• pp.70-95
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• 1991

The ageing problem of the population has been emerging in Korea since 1970's so that it is expecting the elderly 65 years and over among the total population from $4.5\%$ in 1988 to be $6.3\%$ in year 2000. This study was conducted to provide secure policy development in coming years for the aged on medical and health care aspects based on the examining current status of the aged problems and health care policies and systems. The study divided into four parts; The first part examined the medical insurance program and public assistance program of the health services in relation to the aged. The second part emphasized on reduction of medical care cost for the aged. The third part studied the regular health check-up program and health education for the aged. The fourth part examined the chronic disease management programs for the aged and strategies of the health care service quality improvement and specialized programs. The following recommendations made as the results of the study. 1. At present, the medical insurance program and public assistance program for the medically indigent is not appropriate to the elderly because it is a part of general medical insurance program so that Health Security Law for the Aged is proposed. 2. Medical cost will be increased due to the high occupancy rate of hospital beds and long stay of the elderly so that it is recommended to develop an early discharge program, home health care program, Health hospice and an althernative programs. 3. At present, a regular health check-ups for the elderly is not included in medical insurance program so that it is recommended to be included in the insurance program and at the same time health education program thoroughly developed for the aged. 4. To make proper medical and nursing services on chronic diseases for the elderly, it is recommended manpower development, specialized clinics or hospitals, nursing homes and an equivalent long term care facilitices should be established on the community based and a research institutions also to be related to supper the care programs.

• Journal of Korean Medicine Rehabilitation
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• v.28 no.1
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• pp.133-144
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• 2018

Objectives Since the health insurance coverage for traditional Korean medicine is very low, some physicians and researcher have suggested that government's institutional support is needed for korean medicine field. Therefore We examine the use of traditional medicine and western medicine in Taiwan, which operates a similar health insurance system to Korea. Methods We selected several studies from Pubmed and NHIRD, that could be used to numerically evaluate the use of traditional medicine. We reviewed the current status of medical use in Taiwan and compare it with that of Korea. Results Through a total of 87 studies, We found that 26.59%~31% of Taiwanese use Traditional medical institutions more than once a year, and the use of traditional medicine has been increasing since 2000. In adults than children, in women than men, the use rate of traditional medicine was high. Especially, herbal medicine was the most common intervention, accounting for 70% of traditional medical care. Conclusions The core of low insurance coverage for traditional Korean medicine is in lack of coverage for herbal medicine. Taiwan's case shows that the unmet demand for traditional Korean medicine of the Korean population can exist widely.

• Journal of Preventive Medicine and Public Health
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• v.42 no.4
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• pp.267-273
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• 2009

Objectives : To compare the performance of three comorbidity measurements (Charlson comorbidity index, Elixhauser s comorbidity and comorbidity selection) with the effect of different comorbidity lookback periods when predicting in-hospital mortality for patients who underwent percutaneous coronary intervention. Methods : This was a retrospective study on patients aged 40 years and older who underwent percutaneous coronary intervention. To distinguish comorbidity from complications, the records of diagnosis were drawn from the National Health Insurance Database excluding diagnosis that admitted to the hospital. C-statistic values were used as measures for in comparing the predictability of comorbidity measures with lookback period, and a bootstrapping procedure with 1,000 replications was done to determine approximate 95% confidence interval. Results : Of the 61,815 patients included in this study, the mean age was 63.3 years (standard deviation: ${\pm}$10.2) and 64.8% of the population was male. Among them, 1,598 2.6%) had died in hospital. While the predictive ability of the Elixhauser's comorbidity and comorbidity selection was better than that of the Charlson comorbidity index, there was no significant difference among the three comorbidity measurements. Although the prevalence of comorbidity increased in 3 years of lookback periods, there was no significant improvement compared to 1 year of a lookback period. Conclusions : In a health outcome study for patients who underwent percutaneous coronary intervention using National Health Insurance Database, the Charlson comorbidity index was easy to apply without significant difference in predictability compared to the other methods. The one year of observation period was adequate to adjust the comorbidity. Further work to select adequate comorbidity measurements and lookback periods on other diseases and procedures are needed.

• Journal of Society of Preventive Korean Medicine
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• v.21 no.3
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• pp.29-42
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• 2017

Background : Efforts towards increasing insurance coverage for traditional Korean medicine (TKM) are being continued. However, various difficulties are faced in generating evidence for TKM due to limited financial support and the low quality of research methodology. Objectives : The objectives of this study were to review the Swiss evaluation program for complementary and alternative medicine (CAM) and assess the expansion in public health insurance coverage of complementary medicine as approved by referendum in Switzerland. Methods : The regulations of CAM in the European Union were assessed. Research articles, reports, government publications and websites which deal with the 'Programm Evaluation $Komplement{\ddot{a}}rmedizin$ (PEK)' and the referendum in Switzerland were searched for and analyzed. Results : The PEK was conducted from 1998 to 2005. The PEK evaluated the efficacy, utilization and cost-effectiveness of anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese medicine. However, clear conclusions could not be drawn from the evaluation according to the PEK Report. Later, a referendum was implemented in which 5 therapies would be added to the Switzerland Constitution with the support of the public. The coverage of CAM was approved by Swiss a plebiscite with an approval rate of 67.0%. Conclusions : The reason for the successful referendum is suggested to be public support and the solidarity with CAM experts and politicians. It may be surmised that recognition of the political efforts and scientific aspects required to expand insurance coverage of TKM, and towards obtaining public support, is necessary.