• 보건행정학회지
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• 제31권4호
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• pp.399-408
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• 2021

The emergency medical service system in Korea was built upon the Emergency Medical Service Act, 1995 to respond adequately to be much in demand for emergency medical services. In addition, the government recognized the importance of the trauma care system and set out to plan for the designation and establishment of the regional trauma center by 2012. This study aimed to investigate features of quality management and trauma fee schedule on better understanding of trauma care system. First, quality management of the regional trauma center has been implemented by several quality programs involved in quality assessment, committee on trauma quality management, and mortality and morbidity conference. Second, the trauma fee schedule has reflected a specific quality of severe traumatic conditions and added the result to it, which are graded A, B, and C according to quality assessment. Although the government has contributed to instituting a trauma quality assessment program and trauma fee schedule for the regional trauma center, it could not lead to such a fixed standard for quality management of them. Therefore, it will promote discussion on the sustainability of the regional trauma center that requires reducing preventable trauma death rate and the way to apply comprehensive quality management.

• The Journal of Korean Physical Therapy
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• 제34권2호
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• pp.80-89
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• 2022

Purpose: In Japan, the long-term care insurance and health insurance acts have stipulated the visiting rehabilitation system to provide support at the national level. The prior case of Japan would provide guidelines for seeking a suitable policy direction in South Korea. This study aims to examine the historical transition process of the visiting rehabilitation system in Japan, and the issues that emerged in the process of the institutionalization of this system. Methods: To examine the historical transition process of the system, the regulations announced by the government and their reports were reviewed. The relevant issues were qualitatively analyzed based on the opinions of scholars, therapists, and interested organizations that were reported in published papers on the topic. Result: The visiting rehabilitation system has been implemented in the following chronological order: The Health and Medical Service Act for the aged (1982-2006), the Health Insurance Act (1988-), and the Long-term Care Insurance Act (2000-). Currently, visiting rehabilitation is provided through hospitals, clinics, visiting nursing stations, etc. The following issues came to the fore in the process of the institutionalization of the system: (1) the complexity of the system, (2) the necessity of changing perceptions into a life model approach, (3) insufficient service provision by therapists, (4) the lack of human resources and an education system, (5) the lack of awareness of care managers and doctors about visiting rehabilitation, and (6) the necessity of quality enhancement through a team approach. Conclusion: It is deemed worthwhile to refer to the visiting rehabilitation system in Japan and the issues that emerged in the process of institutionalizing the system while seeking a policy direction for a similar system in South Korea.

• 한국치위생학회지
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• 제16권4호
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• pp.531-538
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• 2016

Objectives: The purpose of the study is to investigate recognition and adequacy of dental service providers regarding dental prosthodontic treatment covered by dental auto insurance system. Methods: A self-reported questionnaire was completed by 320 dentists and dental hygienists in Seoul, Gyeonggido, and Incheon from February 22 to March 21, 2016. The questionnaire consisted of recognition and needs of auto insurance (4 items), and recognition of prosthodontic treatment covered by dental auto insurance system. Likert five point scale was used in the questionnaire. Data were analyzed by SPSS 21.0 program. Cronbach's alpha was 0.856 in the study. Results: The average of recognition was 2.62 and that of adequacy of auto insurance coverage was 1.98. The reasonable price of crown treatment was from 400,000 to 500,000 Korean Won in 67.9 percent of the dentists. But 49.8 percent of the dental hygienists answered that the reasonable price of crown was 300,000 to 400,000 Korean Won. The dentists preferred to treatment fee covered by dental auto insurance. The dental hygienists had a preference to combination of dental auto insurance and medical insurance fee. Conclusions: The opinion of the dental care providers should be considered and the adequate coverage of insurance would improve the dental health care.

• 대한물리의학회지
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• 제5권2호
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• pp.173-182
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• 2010

Purpose : This study aims to figure out problems in Korea's physical therapy, how to improve it, and the need for it by examining the nation's physical therapy charges. Methods : This study was performed based on materials from the National Health Insurance Corporation, Korean academic theses, and domestic medical charge system. Results : The number of patients with physical therapy stood at around 17,764,428 in 2008, and then has gradually rose to 3 out of 100,000 citizens. The National Health Insurance Charge System based on relative values, which has been applied since 2001, is not desirable in that it is increasing patients' financial burden. Also, in deciding the amount of work carried out by physical therapists, their amount of input time, efforts, labor, and stress from their patients were not considered and the false relative value system has made patients pay more. Conclusion : Korean medical insurance charges and the overall system should be improved, so that physical therapists can perform specialized services of global physical therapy and service receiving patients do not incur losses.

• 대한예방한의학회지
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• 제15권1호
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• pp.71-87
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• 2011

Objective : The present study is aimed at providing basic data to help oriental medical hospitals devise efficient operational plans by analyzing the medical expenses of in-patients in an oriental medical hospital and the factors affecting such expenses. Methods : PASW 18.0 was used to analyze the medical insurance program data of 929 patients who were discharged from a university oriental medical hospital(with 105 sick-beds) during the period from January 1 to December 31, 2010 after treatment under the coverage of health insurance and medical aid. Results : 1) Of all the patients hospitalized, 63.3% were females, their mean age was 52.73 years old, and 87.7% was covered by the health insurance program. The biggest number or 31.2% of the patients were treated by the department of acupuncture, 31.5% suffered mainly from the diseases of musculoskeletal system and connective tissues, and the average length of stay at the hospital was 19.49 days. 2) There were statistically significant differences in total medical expenses by age, clinical department in charge, principal diagnosis, and number of days hospitalized while daily average medical expenses differed depending on age, type of medical security, clinical department, principal diagnosis, and number of days staying at the hospital. 3) Total medical expenses were found significantly influenced by age, type of medical security, clinical department, principal diagnosis, and number of days hospitalized(explanatory power : 95.9%), whereas type of medical security, clinical department and principal diagnosis turned out to exercise significant influence on the daily average medical expenses(explanatory power : 26.9%). Conclusion : Oriental medical hospitals are suggested to make efforts to ensure geographical and economical accessibility for their main clients, the elderly and middle-aged, as well as to improve satisfaction of the clients with the medical service provided. They are also encouraged to work out systems to specialize in treatment with a focus on chronic degenerative and adult diseases. In addition, they are expected to try to enhance people's awareness of oriental medicine in an attempt to diversify the brackets of clients and increase frequency of their utilization.

• 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.

• 의료법학
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• 제21권1호
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• pp.69-105
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• 2020

의료보장제도에서 진료수가는 의료보장체계의 근간을 이루는 매우 중요한 요소이다. 국민건강보험법은 진료수가의 결정방식에 관하여 계약제를 채택하였고, 그 계약의 내용은 상대가치점수에 대한 점수당 단가를 정하는 것이다. 그에 따라 건강보험 요양급여비용은 매년마다 물가상승이나 경제 상황의 변화에 따라 조정된다. 반면, 의료급여의 경우, 의료급여법에서는 진료수가의 결정방식에 관한 내용을 규정하지 않고, 모든 사항을 보건복지부 장관에게 위임하고 있다. 그에 따라 보건복지부 장관은 2001년부터 혈액투석 치료에 관하여 정액수가제를 채택하고 있다. 이러한 혈액투석 정액수가제에 대해서 2017년 헌법소원이 제기되었고, 헌법재판소는 2020년 헌법소원 심판 청구를 모두 기각하였다. 이 글에서는, 위 헌법소원 사건을 중심으로 진료수가제도의 의미와 내용을 살펴보고, 이에 대한 헌법적 한계로 3가지 원칙을 제시한다. 그 원칙의 첫째는 법률유보의 원칙, 둘째는 포괄위임금지의 원칙, 셋째는 비례의 원칙이다. 그러한 관점에서 검토해 보면, 혈액투석 정액수가제는 상당히 위헌적인 제도로 판단된다.

• 간호행정학회지
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• 제11권4호
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• pp.449-467
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• 2005

Purpose: This study aims to offer the fundamental data in order to cost the nursing service on the basis of the NIC and a close examination of the interventions that are contained in the health insurance cost list under the system of the current health insurance. Methods: The data is handled with the SPSS 10.0 program. The participants' general peculiarity is calculated in terms of the real number and the percentage, and the performing frequency of the nursing interventions is calculated in terms of the mean and the standard deviation. the correlation between the participants' general peculiarity and the performing frequency of the nursing interventions is analysed with t-test or one way ANOVA of SPSS. Results: In the performing frequency of the nursing interventions, the domain of "the physiological: basic" was the highest as 2.69${\pm}$1.21, the domain of "the behavioral" was the lowest as 2.11${\pm}$1.12. There were 50 core interventions in the medical unit, 48 in the surgical unit, 24 in the MICU and 33 in the SICU. The health insurance cost items contained commonly in the core interventions of each unit were 12, and the health insurance cost items except 12 items contained commonly in the core interventions of each unit were appeared 14 items in the medical unit, 6 in the surgical unit, 7 in the MICU and 2 in the SICU. The core interventions contained commonly in four units of the medical unit, the surgical unit, the MICU & the SICU are 18. And among these, the core interventions contained in the health insurance cost items are 10; pain management, hyperglycemia management, analgegic administration, medication administration: intravenous, oxygen therapy, pressure ulcer prevention, fluid management, fluide monitoring, intravenous(IV) insertion, intravenous(IV) therapy. As the result of the comparison & analysis between the core interventions of the NIC and the health insurance cost items, the core interventions contained in the health insurance cost list are 21(29 as the health insurance cost items). Conclusion: In the performing frequency of the nursing interventions, the domain of "the physiological: basic" is being performed most frequently, and in the performing frequency of the core interventions, the interventions of the domain of "the physiological: complex" is being performed most frequently. On the basis of these results, the writer hopes that the attempts to interlink the nursing interventions into the nursing cost by using of standard terms and the efforts to cost the nursing services would also be made in the future constantly.

• 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.

• 한국경제지리학회지
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• 제21권1호
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• pp.1-19
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• 2018

본 연구는 의료서비스의 제공과 이용이 공간적으로 일치하는지를 파악하여 국내 의료전달체계의 공간적 효율성 개선에 기여하고자 하였다. 국민건강보험 표본코호트DB를 이용하여 의료기관 특성, 이용자 특성, 이용 특성에 따라 거주 시도 내외의 의료기관을 이용하는 데에 어떤 특성이 있는지를 분석하였다. 대부분 거주 시도 내의 의료기관을 이용하고 있으며 2002년에 비해 2013년 거주 시도 내 이용 비율이 소폭 증가하였고 요양기간은 줄어들었으며 보장 정도는 높아졌다. 거주 시도 내 의료기관을 이용할 때보다 외부 의료기관 이용하는 경우 상급기관 이용 비율과 고소득분위의 비중이 컸고 요양기간이 더 길었으며 보장 정도는 낮았다. 요양병원의 증가와 함께 초고연령층의 거주 지역 외부 기관 이용 비율이 줄어들었고, 거주 시도 외부 기관을 이용할 때 찾는 전문과목의 비중이 달라졌음을 밝혔다.