• The Journal of the Korean life insurance medical association
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• 제3권1호
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• pp.269-273
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• 1986

We have examined 5,304 cases of claims by death that had occured for recent three years from January, 1983 to November, 1985 in Dae han kyoyuk Ins. Co. As a result, we came to following conclusions: 1. The total numbers of the deaths are increased for three years, but the deaths, classifying by medical examinations are decreased. 2. The great part of the death were due to Accident death(27.7%), occupied Number 1, malignant neoplasm(23.9%) Number 2 and Circulatory system disease(23.9%), which were the main canses of death in the insured people. 3. With age, section ranging from 30-39 years of death cases took extremely large portions by 35.2%. 4. For the period elapsed, the deaths within 2 years to ander 3 years, 18.6%, above 6 years, 18.6%, thus the period elapsed was longer more and more as years go. 5. By the deaths of malignant neoplasm, hepatoma in male and gastric cancer in female were important causes of death.

• Journal of Society of Preventive Korean Medicine
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• 제12권3호
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• pp.21-34
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• 2008

Objectives : This paper analysed the alternative methods of calculating conversion factor for oriental medicine in the National Health Insurance and estimated the conversion factor(reimbursing price level) of the oriental medical services, based on health insurance claims data and macro economic data. Methods : Comparing cost accounting method, SGR model, and index model to estimate conversion factor in the national health insurance, six empirical models were derived depending on the scope of revenue considered in financial indicators. Classifications of data and sources used in the analysis were identified as officially released by the government. Results and Conclusion : Cost accounting analysis and SGR model showed a two digit decrease in the physician fee schedule of oriental medical services in the national health insurance, while index model indicated a positive increase in the fee reimbursed. As expected, SGR model measured an overall trend of health expenditures rather than an individual financial status of medical institutions, and index model properly estimated the level of payments to oriental medical doctors. Upon a declining share of health expenditures on oriental medicine, a global budget system fixed to a flat rate of total budget could be an opportunity as well as a challenge.

• Journal of Preventive Medicine and Public Health
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• 제33권4호
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• pp.393-401
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• 2000

Objectives : To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. Methods : In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. Results : The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.5% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). Conclusions : After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.

• Journal of Preventive Medicine and Public Health
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• 제31권3호
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• pp.471-480
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• 1998

This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows : 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I. : 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (41.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and fortieg age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.

• The Journal of the Korean life insurance medical association
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• 제2권1호
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• pp.75-81
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• 1985

Urine contains protein and nucleic acid(urea, uric acid, creatinine, ammonia, amino acids), various organic and inorganic materials, vitamin, hormone, enzyme etc. The examination of gualitative or quantitative change of the above mentioned materials and picking up the abnormal materials are useful to diagnose diseases. The test strip for examination of urine is applied to the routine test, monitoring of medical therapy and recurrence, self monitoring, and screeing in preventive medicine. We have been using multitest strip for checking the bacterial infection(nitrite), PH, protein, glucose, ketone body, urobilinogen, bilirubin and occult blood. So it is possible to diagnose three groups of diseases as follows, abnormal metabolism of the carbohydrate, diseases of kidney and other urogenital system, diseases of hepatobiliary system and hemolytic disease causing abnormal metabolism of bile juice.

• The Journal of the Korean life insurance medical association
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• 제3권1호
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• pp.90-102
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• 1986

The gallbladder is a pear-shaped, thin walled sac located on the inferior surface of the liver between the right and quadrate lobe, in a recess called fossa vesicae felleae. It is 7.5cm-12.5 cm in length, 3.5 cm in the largest width, and has a volume of about 45 ml with a remarkable capacity for expansion. There are many kinds of diagnostic methods to evaluate diseases of biliary tract including gallbladder-Plain abdomen, Oral cholecystography. Intravenous cholangiography, Percutaneous transhepatic cholangiography(PTC), Endoscopic retrograde cholangiography(ERCP), Operative or T-tube cholangiography, Ultrasonography, Radioisotope study, Computed tomography, and Angiography. Especially, ultrasonography is the most effective and noninvasive study in these days. Plain abdomen, oral cholecystography, intravenous cholangiography, and ultrasonography have been performed in our clinic. Methods and findings of above mentioned study are discussed with consideration of references.

• The Journal of Economics, Marketing and Management
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• 제4권3호
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• pp.7-11
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• 2016

The purpose of this study is to examine the long term care insurance system that has been 9 years and to understand issues arose during settlement of the insurance system in accordance with provision of solutions to increase the quality of elders' long term care service. Also, the study is aiming at providing contribution to both satisfaction of customers and workforces at the field along with achievement of the primary goal that the elders' care service policy was aiming at. To achieve the purpose of the study, authors gathered and analyzed reports and literatures from books published domestically, governmental open data and statistical data related to policy on long term care service insurance for elders to examine current problematic issues of long term care insurance and to explore ways to improve by having case studies of advanced countries. The result of this study shows that there are differences in the way how participants of the programs react to registering to insurance of program for supporting elderly persons' social activities and employment despite Korean government is operating the programs along general guidance for the programs as a standardized guideline.

• Health Policy and Management
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• 제28권3호
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• pp.210-216
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• 2018

National Health Insurance Service (NHIS) has put a great effort on extending life expectancy, for last 40 years. The system has also made remarkable outcomes in achieving universal health coverage. However, it is facing challenges of low health insurance benefits and sustainability risk due to low birth rate and aging society at the same time. To overcome the difficulties and build a lifelong health security system for the nation, it is required for NHIS to make multilateral changes in its roles. Based on the quantitative growth achieved so far, NHIS needs to strive for the growth in quality by not only increasing coverage and reforming contribution imposition system, but also reorganizing the relevant systems such as lifelong health management support, rational adjustment to the medical fee, and benefit costs monitoring. In addition, it's important for NHIS to restructure the organizational culture by having specialty and communicating with people for high quality of administration and health insurance sustainability.

• Korean Medical Education Review
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• 제24권1호
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• pp.10-17
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• 2022

South Korea is not a wasteland of publicly funded health care-instead, it has a good medical social security system known as the national health insurance (NHI). The NHI of Korea has three unique features; (1) low premiums, low insurance fees, and low coverage; (2) obligatory designation of medical institutions; (3) and allowance of non-benefit services. These features have made hospitals and doctors interested in profit-seeking. However, the commercialization of medical institutions has taken place in both private- and public-established sectors. A basic problem of commercialization is the co-existence of the obligatory designation of medical institutions and non-benefit services. The problem became worse in the Kim Dae-Jung government because it officially permitted non-benefit services. Since 2000, the Korean government has consistently pursued benefit extension policies, but the coverage rates of the NHI have stagnated. In addition, premiums and current medical expenses have markedly increased because policy-makers have emphasized accessibility to the NHI, while ignoring important principles of medical social security such as a needs-based approach and patient-referral system. In order to resolve the commercialization problem, the obligatory designation of medical institutions to the NHI should be changed to a contract system, and non-benefit services should be prohibited at NHI institutions. We must re-establish the patient-referral system via a needs-based approach. We also need to build a primary healthcare system and public health policies. We should make a long-term plan for healthcare reform.

• Journal of Korean Academic Society of Home Health Care Nursing
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• 제26권3호
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• pp.253-264
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• 2019

The aim of this review is to present a German system of an outpatient care center under the German Health Insurance Act and home care (integration of medical care, basic care, bathing) under the Long-Term Care Insurance Act. This idea of a German integrated home care system should contribute to the development of a Korean home care model. Prior the introduction of long-term care insurance (1995), and with the of the health insurance law (1989), German outpatient care centers already provided medical and basic care services for patients with acute and chronic symptoms. Since 1995, patients with acute symptoms and rehabilitation periods under the Health Insurance Act have been eligible for home care. The Long-Term Care Insurance Act is intended for all citizens who are unable to carry out their daily activities for more than six months. In 2017, 13,657 (97%) of 14,050 outpatient care centers provided home care services after long-term care and health insurance. In other words, patients in Germany can use home care in both the acute and chronic phase at the same home care center, or 'integrated home-care center'.