• Research in Community and Public Health Nursing
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• v.19 no.4
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• pp.660-672
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• 2008

Purpose: To analyze the home care services provided to the elderly aged 65 and older by a hospital-based home care agencies and to investigate the effects of long-term care insurance for the elderly. Method: The subjects were the home care service recipients aged 65 and older in 172 hospital-based, home care agencies registered in Health Insurance Review & Assessment Service in January, 2007. The data were collected using a questionnaire from March 16 to April 15, 2007. The questionnaire return rate was 43.8%. Result: The hospital-based home care agencies were able to visit 66.5% of the national administrative districts. Of the home care service recipients, over 50% were 65 years old and older. About 43% of the agencies reported that over 50% of their patients would be subject to the long-term care insurance. They expressed concern that home care services would be withdrawn once the insurance system is initiated. Conclusion: This study suggests that hospital-based home care agencies need to manage home care services with long-term care insurance. It also recommends developing guidelines for the use of services and referrals.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.227-261
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• 2015

Cooperative associations are established in order to enhance the rights and the interests of their members and serve the local communities, and actually do much for the local society. And among these, consumer cooperatives are spontaneously founded, particularly in the spirit of mutual help, in order to promote the common welfare of the members. Meanwhile, because the current medical law qualifys noncommercial corporation to open medical institution, consumer cooperative and noncommercial- corporation cooperative which are established under the Cooperative Act have the right to do. However, though cooperative association should be founded for common interests of the members who are weaker parties of society, it became rapidly to be abused as means of circumvention of law. Especially as National Health Insurance Corporation stepped up the investigation and the collection of unfair profits against the hospital owned by non-medical personnel who are unable to establish a medical institution, setting up medical institutions as a roundabout way to avoid the restricts dramatically increased in number. In this study, we are going to introduce the current dualised normative system regulating the establishment of a medical cooperative association, and find a way to improve the system and make up for the week points. And we will look though the present situation about medical cooperative association's opening, operating, and closing, and review the normative and systematic improving plans.

• Korean Journal of Digital Imaging in Medicine
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• v.17 no.1
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• pp.1-7
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• 2015

Recently, dental PACS construction in dental hospital is fairly general. For this reason, inspection request works of dental PACS fee with Health Insurance Review & Assessment Service are more important for the financial stability in hospital and from now on status. But several departments in dental hospital, enforce a incoherent order system so inspection request situation is full of mistakes and omissions. As a result, financial stability in hospital rapidly change for the worse, as the case stands establishment of proper order system and match system is essential to resolve the issue. Consequently, we plan to establish the proposed idealized scheme.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.2
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• pp.395-400
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• 2015

Both Japan and Korea provide population-based screening programs. However, screening rates are much higher in Korea than in Japan. To clarify the possible factors explaining the differences between these two countries, we analyzed the current status of the cancer screening and background healthcare systems. Population-based cancer screening in Korea is coordinated well with social health insurance under a unified insurer system. In Japan, there are over 3,000 insurers and coordinating a comprehensive strategy for cancer screening promotion has been very difficult. The public healthcare system also has influence over cancer screening. In Korea, public healthcare does not cover a wide range of services. Almost free cancer screening and subsidization for medical cost for cancers detected in population-screening provides high incentive to participation. In Japan, on the other hand, a larger coverage of medical services, low co-payment, and a lenient medical audit enables people to have cancer screening under public health insurance as well as the broad range of cancer screening. The implementation of evidence-based cancer screening programs may be largely dependent on the background healthcare system. It is important to understand the impacts of each healthcare system as a whole and to match the characteristics of a particular health system when designing an efficient cancer screening system.

• The Korean Journal of Health Service Management
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• v.12 no.4
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• pp.59-72
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• 2018

Objectives : This study was performed to investigate health care system recognition and influential factors using the data from the "2017 Health Care Experience Survey". Methods : Data on 7,000 participants in the Health Care Experience Survey were drawn and statistically examined using a t-test, ANOVA, and multiple regression analysis. Results : First, the significant factors of health care service satisfaction were education, income, region, chronic diseases, unmet medical needs, satisfaction with doctors and institutions, and the health care system's reliability and importance. Second, the influential factors of willingness to pay additional health insurance premium were age, occupation, income, health status, chronic diseases, unmet medical needs, satisfaction with health care institutions, limit to utilization of medical services, necessity of health care reform, and the health care system's reliability, satisfaction, importance. Conclusions : Since the additional burden for improving the health care has been negative to the socially disadvantaged, there should be efforts to provide stable health care funding for financial stability of the health insurances by considering public opinions and reaching social consensus.

• The Korean Journal of Applied Statistics
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• v.24 no.1
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• pp.145-159
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• 2011

National long-term care insurance started in July, 2008. We try to make up for weak points and develop a long-term care insurance system. Especially, it is important to upgrade the rating model of the category of need for long-term care continually. We improve the rating model using the data after enforcement of the system to reflect the rapidly changing long-term care marketplace. A decision tree model was adpoted to upgrade the rating model that makes it easy to compare with the current system. This model is based on the first assumption that, a person with worse functional conditions needs more long-term care services than others. Second, the volume of long-term care services are de ned as a service time. This study was conducted to reflect the changing circumstances. Rating models have to be continually improved to reflect changing circumstances, like the infrastructure of the system or the characteristics of the insurance beneficiary.

• Health Policy and Management
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• v.19 no.3
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• pp.109-124
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• 2009

Background: This study aimed to examine whether cases of punishing false claimants threat general physicians to check their medical cost claims with care to avoid being suspected, and identify empirically general deterrence effects of the on-site investigation system in the Korean National Health Insurance. Methods: 800 clinics were selected among a total of 15,443 clinics that had no experience of on-site investigation until June 2007 using a stratified proportional systematic sampling method. We conducted logistic multiple regression to examine the association between factors related to provider's perception of on-site investigation and high level of perceived deterrence referring to fear of punishment after adjusting provider's service experiences and general characteristics. Results: The probability of high perceived deterrence was higher 1.7 times (CI: 1.13-2.56), 2.73 times (CI: 1.68-4.45) each among clinics exchanging the information once or more per year or once or more for 2-3 months than among clinics no exchanging the information about on-site investigation. Also, the probability of high perceived deterrence was higher 2.27 times (CI: 1.28-4.45) among clinics that knows more than 3 health care institutions having experienced an on-site investigation than among clinics knowing no case. Conclusion: A clinic knowing more punishment cases by onsite investigation and exchanging more frequently information about on-site investigation is likely to present high perceived deterrence. This result will provide important information to enlarge preventive effects of on-site investigation on fraud and abuse claims.

• Journal of Preventive Medicine and Public Health
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• v.40 no.4
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• pp.329-335
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• 2007

Objectives : To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. Methods : The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. Results : Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. Conclusions : We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.

• Health Policy and Management
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• v.9 no.1
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• pp.1-29
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• 1999

The Government has recently planned to improve the medical insurance drug price systems by removing the drug margin occurring from the difference between the official and purchasing prices, and instead by setting prices through adding drug administration casts calculated to the purchasing costs. In the circumstances, the major policy and implementing issues are how to define the drug administrance cost and how to calculate them. This study attempts to provide for the conceptional and operational definitions and thereby develop a costing model for the cost. The relationship between the current systems of medical services costs and prices were reviewed to define the concept of the costs. The study defined the costs from the narrow and wide prospective of meaning, and three operational definitions were provided. The costing model was developed applying the departmental costing principles. Finally, several prerequisites that have to be considered for the implementation of the definition and the model from the practical viewpoint.

• Health Policy and Management
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• v.29 no.1
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• pp.40-48
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• 2019

Background: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment. Methods: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City. Results: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001). Conclusion: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.