• Journal of Society of Preventive Korean Medicine
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• v.10 no.2
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• pp.147-158
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• 2006

The purpose of this paper is to review the empirical study results of conversion factors(unit prices) for relative values of health care services in the national health insurance system and establish optimal classification of health care institutions for feasible contract of conversion factors between National Health Insurance Corporation(NHIC) and provider groups, based on legal backgrounds and types of health care service delivery system. some empirical research evidences shows the validity of applying multiple conversion factors to annual contract for reimbursement in the national health insurance. Policy recommendations suggest that clinic, hospital, general hospital, tertiary hospital, dental clinic, oriental medical clinic, pharmacy, and public health centers would be a basic category of provider groups for a meaningful price contract between the NHIC and providers.

• The Korean Nurse
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• v.32 no.5
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• pp.78-92
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• 1994

The purposes of this study were to evaluate the results of the hospital self inspection with the medical insurance and to offer basic materials to the medical insurance inspection and the education of medical insurance. The study was undertaken with 4,730 cases among the total 13,810 medical insurance in patients from Jan. 1990 to Dec. 1990 at one university hospital in Pusan. The major contents of the inspection were the omission of diagnosis and medical fee, curtailment, application mistake, the rates of inclusion, subtraction and total accumulation. The data were collected using patients charts and bills. The results of the paper analysis were as follows. 1. From the pre-discharge hospital self inspection, major omission were treatment and material fee but medication fee were moderately high and high curtailment was operation fee. 2. Decreasing order of operation fee adjustment were digestive(22.4%) muscular(22%) and neuro system operation(21.4%). Majority of the medication fee adjustments were injection form of medication(95.7%). 50% of the treatment fee adjustments were composed of injection fee(27.9%) and dressing or post-operative dressing fee(22.3%). 74.7% of material costs were composed of oxygen(30.6%), blood and the blood composed materials(44.1%). 3. Pre-discharge inspection showed 6% adjustment rate, 4.3% addition and 2.1% curtailment rate. Most of the adjustment were omission(66.1%). 4. Omission were divided by event omission(92.6%)and application mistake(7.4%). The decreasing order of omission fee were operation(21.84%), treatment(18.71 %) diagnosis(18.68%), medication (14.53%) and material costs(10.84%). So operation and treatment part were the major part of the total omission fee(40.55%). 5. The average omission of diagnosis were 1,800 per month.

• 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.

• Korean Journal of Health Education and Promotion
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• v.15 no.2
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• pp.217-233
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• 1998

This paper analyzed four different perspectives on health care reform in Korea in terms of the basic values, formulated problems and reform plans, implementation methods, and supporting groups. The medical security plan was insisted by social security specialists and social activists focusing on the integration of medical insurance coops in order to enhancing equity and right of the people. However, its perspective was limited to promoting security instead of reforming health care system. The government proposed the health care reform plans in 1994 and in 1997, focusing on promoting efficiency by remedying many problems in health care delivery system. However, its implementation was not successful due to the lack of organizational and financial supporters. Recently, two opposite proposals were issued. The market reform plan paid attention to revitalizing the market function to promoting efficiency by allowing hospitals to treat private patients instead of applying the medical insurance regulation. The government reform plan focused on intensifying governmental planning and intervention in the health care sector in order to removing inefficiency and promoting equity with the supports of social activists and labor unions. Finally, this paper proposed an alternative plan to promote harmonious social relationship between actors in the health care system.

• Journal of the Korean Society of Radiology
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• v.81 no.5
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• pp.1038-1052
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• 2020

Advancements of medical care with the use of new medical technologies have been promoting public health, but they can also place a financial burden on individuals and the country. Since the introduction of the health insurance system in 1977, the South Korean government has been attempting to control medical expenses. Radiological examinations have been a major target for cost reduction. Meanwhile, the radiological report fee has been combined with the technical fee for a long time; hence, its value has not been independently evaluated, and was also decreased proportionally with examination cost reduction. However, in the revised medical fee estimation system for MRI, the report fee has begun to be calculated separately from the technical fee, significantly contributing to the evaluation of the radiologists' work value. In conclusion, radiologists need to know and actively participate in the process of determining the insurance cost of radiological examinations and reports to get a proper value of their professionalism.

• Quality Improvement in Health Care
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• v.2 no.2
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• pp.112-129
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• 1996

Background : A small number of high cost patients usually spend a larger proportion of scarce health resources. Aged, long-term care and readmitted patients usually belong to these high cost patient group. Among others, long length of stay and readmission can be reduced by checking its cause, and these are the areas needed most of quality improvement activity. Characteristics of high cost medical users between health insurance program and medical assistance program were reviewed. Methods : The inpatient claims of health insurance and medical assistance program were analyzed. Patients were divided by 6 groups; long-term, mid-term, short-term, readmitted, cancer and aged. We defined high cost patients as those who had spent one and half million won and over per 6 months. Characteristics of high cost patients for each group were reviewed. Results : medical assistance patients used much more resources than the insured members in the average hospital cost per case but less in daily hospital cost. The former had a longer length of stay and had much heavier diseases. Major diseases of both group were cancer, diseases of circulatory system and chronic degenerative diseases. Gallstone and schizophrenia were more in the insured program. However, pulmonary tuberculosis, asthma were more common among the medical assistance patients. Early readmission before 2 weeks were 28-30% of the total readmission. Readmission rate in the malignat neoplasm and renal failure were 80% and more. Q.A program should be installed to prevent unnecessary readmissions. Conclusion : Almost 30% of early readmissions and admissions due to complications and long length of stay should be reviewed carefully to keep cost down and to enhance the quality of hospital care.

• Journal of Preventive Medicine and Public Health
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• v.22 no.1 s.25
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• pp.162-168
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• 1989

This study was conducted to analyse attitudes to a new health care system in a rural community. The specific purpose of this thesis was to classify attitudes to the patient referral system in Kangwha county, and to identify factors affecting the attitudes. Sampling was done by a multi-stage stratified cluster sampling method from the population. The data were collected in Kangwha county through a structured interview survey for two weeks in June, 1957. Attitudes to the patient referral system were classified into four types based upon answers to questions about awareness of the system, the recognition for the necessity of the system, and opinions on the improvement of the system. The four types of attitudes were active acceptance(10.2%), partial acceptance (27.2%), refusal(35.8%), and indifference(26.7%). The respondent's age, educational level, age of head of household, medical insurance fee, the number of ill family members, and the percentage of medical utilization by the family were the variables which affected the attitudes. The medical insurance fee, respondent's age, age of head of household, and the percentage of medical utilization by the family were the statistically significant discriminant factors of the four types of attitudes.

• The Journal of Korean Medicine
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• v.28 no.3 s.71
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• pp.244-260
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• 2007

Objectives : The purpose of this study was to provide lawmakers with basic data for the purpose of establishing a policy on health insurance for packed herbal medicine. Methods : To properly execute an insurance system for packed herbal medicine, we surveyed the following questions from May 1st to June 15th, 2006: (1)the way to pay the insurance benefits (2)specific impression (disease) names as related to insurance (3)the range of insurance coverage. We obtained answers from 304 Korea traditional doctors. Results : 89.4% respondents were agreed on execution of health insurance for packed herbal medicine. 93.86% respondents answered that the way to pay insurance benefits and the range of insurance coverage have to be changed properly. Most respondents answered that the coverage should be based on a specific disease being treated, not the current symptoms method which relates to the prescription. The execution of health insurance for packed herbal medicine is expected to increase the number of patients and make the Korean medical system more popular. Conclusion : The findings are expected to make it easier for the general public to get treatment by providing basic data with policy makers that will cover packed herbal medicine in insurance. Also, a proper Korea traditional health insurance program should be set up as soon as possible to widen the choice of medicine for the general public.

• The Korean Journal of Health Service Management
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• v.14 no.2
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• pp.55-65
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• 2020

Objectives: This study intends to analyze the relationship between medical service experience and subjective health awareness by using data from Panel Study of Worker's Compensation Insurance(PSWCI). Methods: Tte χ2-test was performed to investigate subjective health awareness and medical service experience relevance. Logistic analysis was performed to analyze the influencinge factors. Results: The subjective health awareness scored "bad" in"'lack treatment period" compared to "adequate treatment period" in medical service experience (OR = 2.603 [95% CI = 1.666-2.555]). Conclusions: To improve the subjective health awareness of patients with industrial accidents, the industrial accident compensation and medical care approval system should be improved, and long-term industrial accident insurance policies should be developed to accommodate direct and indirect medical services.

• The Journal of the Korea Contents Association
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• v.14 no.1
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• pp.200-208
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• 2014

This study analyze long debate issues by the analysis of existing studies and the effect of private health insurance in the satisfaction of health service utilization. Then make developmental role of private health insurance. The analysis results of literatures, high-income earners are more subscriptions and the poor people in health status are excluded. Thus, enable private health insurance has the potential to lead the polarization of people. The medical use of private health insurance subscriber is more than non-subscriber and is likely to result in additional expenditure spending of public insurance. The contribution of private health insurance on improvement of the health option is clear. However, is not clear the contribution on health care quality improvement and health service customer satisfaction. The contribution on the national health care system efficiency of private health insurance is not clear. Private health insurance in the satisfaction of health service utilization is on effect. In short, supplementary private health insurance is desirable in our country.