• Journal of Korean Physical Therapy Science
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• v.3 no.2
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• pp.1065-1077
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• 1996

Fees for medical insurance services in Korea has not being been set based on service costing. Recently in the USA, fees for physican services are determined by developing and applying Resoure Based Relative Value Scales (RBRVS). This study attempts to develop relative value scales for personal factors of rehabilitative and physical therapeutic services. The personal factors were classified into four categories as having been done in the USA;service time, treatment technology and physical efforts, mental efforts and judgement, and stress. Input factors were measured using Magnitude Estimation Method (MEM), and relative value units were calculated for each of twenty eight rehabilitative and physical therapeutic services. Results show that service time surveyed differs from that provided in the public fee schedules in 24 services; the three personal factors but the service time are highly correlated; the physical therapists hold treatment technology and physical efforts to be the most important factor in setting the for services; and that relative values developed for noninsurance services such as Silver Spike Electrode (SSP) and Proprioceptive Neuromuscular Facilitation (PNF) are higher than those of similar insurance services. The policy implications and measures for improvement for the above findings were suggested respectively.

• The Korean Society of Law and Medicine
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• v.10 no.2
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• pp.37-82
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• 2009

Korea has gained the much more performances in the fields of pubic health laws and related policies on the basis of the substantial economic achievements. In 1977, the social medical insurance was established for companies with more than 500 employees, and in 1989, Korea successfully achieved the national medical insurance system covering the total population within only 12 years beginning with multiple insurers. There remained some problems, however, to be improved such as both the low level of contribution rates and benefit packages due to the inefficiency in utilizing limited medical resources. In 2000, all insurers were unified into a single insurer (National Health Insurance Corporation), and special independent Health Insurance Review & Assessment Service (HIRA) was also established. From the origin of medical insurance system in 1977, the Korean reimbursement system has been fee-for-service system, and after the establishment of HIRA, it has been providing objective and expert medical cost review services and health quality assessment services.

• Journal of Preventive Medicine and Public Health
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• v.23 no.2 s.30
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• pp.185-193
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• 1990

The purpose of this study is to observe the pattern of change in medical care utilization over time in early years of insurance coverage. The source of data is the benefit records file of a voluntary medical insurance society for covering the four-year period, from 1982 to 1985. The measure of medical care utilization used in this study is the age-sex standardized percentage of the enrollee who have visited a physician over total analytical population during a three-month period. For six cohorts by the year of enrollment ($1979{\sim}1984$), the relationship between the utilization and duration of insurance coverage was examined controlling for the calender year and season. In the analysis, logistic multiple regression and residual analysis were employed. It was observed that medical care utilization rapidly increased during the early stage of insurance coverage, and after then increased at a slower rate over time to become almost stable in about twenty months.

• Health Policy and Management
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• v.19 no.2
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• pp.36-50
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• 2009

Korean Government had performed three pilot programs to introduce the long term care insurance system. Persons aged 65 or older who are dependent on others for daily living could use long term care services in the pilot program. The long-term care insurance covered nursing home services, home care services and cash benefits. The cash benefits are included that for elderly at home and for patients in geriatric hospital. This study investigated whether there had been any change in the medical care utilization according to cash benefits for geriatric hospitalization. This study used National Health Insurance claims and Long term Care Insurance claims 2003 through 2006. Data were composed of subjects who undertook both insurance coverage. The subjects was divided into two groups. Case group included participants with the cash benefits of geriatric hospitalization. Control group included persons without the cash benefits selected by random sampling according to the distribution of case group. This study showed that the amount of medical care utilization of the case group is more significantly increased than the control group after adjusted their health condition and functional condition. This result will be helpful for making decisions on whether the cash benefit of geriatric hospitalization can be introduced into long term care insurance system.

• The Korean Journal of Applied Statistics
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• v.31 no.6
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• pp.693-706
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• 2018

It is very important to support the elderly with disability ageing in place. Assisting devices can help them to live independently in their community; however, they have to be used appropriately to meet care needs. This study develops an assisting device recommendation system for the beneficiaries of long-term care insurance that include algorithms to decide the most appropriate type of assisting device for beneficiaries. We used long-term care (LTC) insurance data for grade assessment including 8,084 beneficiaries from July 2015 to June 2016. In addition, we collected standard care plans for assisting devices, that power-assessors made, considering their performance and ability that could subsequently be matched with grade assessment data. We used a decision-tree model in data-mining to develop the model. Finally, we developed 15 algorithms for recommending assisting devices. The findings might be useful in evidence-based care planning for assisting devices and can contribute to enhancing independence and safety in LTC.

• Journal of Preventive Medicine and Public Health
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• v.28 no.2 s.50
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• pp.450-461
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• 1995

This paper tested by using Micro TSP, an empirical econometric analysis to approve officially a hypothesis of price elasticity of the demand for medical care services in Korean national medical insurance and the economic effect of health care delivery system with time-series datas of Medical Insurance Statistical Yearbook$(1981\sim1993)$. The results suggest that the Korean medical insurance system shows moral hazard due to the change of coinsurance and the economic effect according to intervention of the health care delivery system, but it is different by insurers regardless of the same structure of the medical insurance scheme.

• 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 Korea Institute of Information, Electronics, and Communication Technology
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• v.14 no.1
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• pp.70-77
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• 2021

This paper was reclassified industries related to the 4th industrial revolution into manufacturing, information and communication services, finance and insurance services, and science and technology services by comparing the industry association table with the Korean standard industry classification. And the economic ripple effect was analyzed by exogenizing the four sectors of the industry using a demand-driven model. The wholesale and retail and product brokerage services were measured to be large in the manufacturing, information communication services, and science technology service sector according as a result of analysis of the production inducement effect, added value inducement effect, and employment inducement effect. And the financial and insurance services were analyzed to be large in the financial and insurance services sector. The import inducement effect was analyzed to be the largest in all sectors of the fourth industry. As a result of the forward and backward linkage effect, it was confirmed that the manufacturing and the information communication services sector were the intermediate primary production type sensitive to economic fluctuations. Also it was confirmed that the financial and insurance services and the science technology services sector were the final primary production type.

• Journal of Preventive Medicine and Public Health
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• v.22 no.1 s.25
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• pp.1-7
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• 1989

This paper examines the failure to promote adequate preventive health care in the U.S. It focuses specifically on the preventive health services of screening, counseling, and immunization. It explores evidence on their effectiveness, as well as coverage under current private and public health insurance plans. It concludes with a proposal to expand health insurance coverage for preventive services and to reimburse physicians directly for preventive health services provided to patients.

• The Korean Journal of Applied Statistics
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• v.27 no.5
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• pp.667-679
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• 2014

National Health Insurance Service(NHIS) provide care-plans for beneficiaries in the long-term care insurance(LTCI) systems that help them use LTC services appropriately. The care-plan includes recommendations for the most adequate type of care (gold standard) for beneficiaries. This study develops a decision-support system to determine the appropriate type of care plan. To develop a model, we used a data set that well-trained assessors in the NHIS investigated as a gold standard for beneficiaries: nursing home care, home-visit care, home-visit bathing, home-visit nursing, or day and night care. The decision-support system was established through a decision-tree model, because it may be easy to explain the algorithm of a decision-support system to working groups and policy makers. Our results might be useful in evidence-based care planning in an LTCI system and contribute to the efficient use of LTC services.