• Journal of Society of Preventive Korean Medicine
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• v.22 no.1
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• pp.1-14
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• 2018

Objectives : This study aimed to analyze the characteristics of uninsured herbal medicine(UHM) users and the economic and social barriers of UHM utilization. Methods : We used the Korea Health Panel Data, representative national survey on medical utilization and cost, provided by National Health Insurance Service and Korea Institiute of Health and Social Affairs. The frequency analysis was used to identify the characteristics of the respondents, and the cross-analysis (${\chi}^2-test$) was used to verify the relationship between their characteristics and the usage of UHM. In order to analyze the determinants of using the UHM considering the individual's characteristics, logistic regression analysis and multiple regression analysis were conducted for those who used the Korean medicine (KM) outpatient service in 2015. Results : The usage of UHM was significantly lower for those (1) who's age of 20 to 65; (2) who have the university or higher education degree; (3) who live in Jeju province, and (4) who bought the herbal medicine for other health related purposes. On the other hand, the usage of UHM for those (1) who have the first quintile of household income; (2) who have the chronic respiratory disease; (3) who have been taking the medicine for health promotion purpose for more than 3 months and (4) who have purchased the food which has health promotion function was significantly higher than others. The patients who have chronic musculoskeletal diseases accounted the most among the UHM users. Conclusions : There was the considerable inequality in the usage of UHM among household income groups, which provides policy rationale for UHM to be covered by national health insurance. To facilitate the coverage expansion, restrictive covering model can be considered for children and adolescents, or for patients with muskuloskeletal diseases who have the high demand for UHM.

• Health Policy and Management
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• v.1 no.1
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• pp.116-135
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• 1991

Few studies have been conducted on the detailed routes of medical care utilization under the National Health Insurance. This study was undertaken to identify the utilization patte군 of health care facilities among industrial workers and their dependents. One of the largest health insurance association was purposively chosen for this objective. The association had 345, 757 members as of 31 December, 1990. The study sample of 297, 948 subjects have been drawn from the membership pool on the basis of their continuous membership status during 1 January through 31 December 1990. This study has tried to identify differential utilization patterns between acute and chronic conditions, and among standard income classes. All the diagnoses were recoded in a manner to achieve the objective of this study. As for acute diseases, most age group had used one medical facility as much as by 60% except the age group of 1-4, This young age group had used over three different health facilities as much as by 10.9-15.8%. The finding suggests that some policy measures by sought for remedying the excessive/inappropriate use of services. In addition, mid-income classes(between 17 and 48) were more likely to use multiple sources of care than lower income classes(between 1 and 16) and upper income classes(above 49). This study has revealed that chronic cases are more likely to pursue multiple sources of care, however those with chronic conditions tend to use single health facility more than those with acute conditions(67.9% versus 52.4%). As many as 12.2% have visited more than three health facilities in chronic conditions, but 5.9% for acute conditions. The most likely source of care was primary clinics for both acute and chronic conditions. Compared with the role of general hospital, small-size hospitals found to play a minimal role in the care and referral of patients. This indicates the need of strengthening the function of small-size hospitals. While a minor cross utilization of western medicine and pharmacy was noted, no significant boundary crossing was identified between western medicine and oriental medicine, or between pharmacy and oriental medicine. It is too early to confirm that whether there is substitutability or cross utilization among these alternative sources of care. A further study is needed to identify these relationship.

• Journal of Acupuncture Research
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• v.24 no.5
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• pp.151-170
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• 2007

Backgraounds : Recent studies provide the evidences that the efficacy of acupuncture may be no better than placebo or inconclusive. These results are very different from those of the actual clinical situations in many acupuncture medical institutions. Objectives : The present study was designed to evaluate the influencing factors which affect the efficacy of acupuncture scale(FEAS) as the methodological assessment tool of acupuncture for examining acupuncture interventions and to demonstrate the importance of it in randomized controlled trials of acupuncture. Data sources : Electronic data were retrieved from NDSL, Pubmed, sciencedirect, LWW, OVID, Black-Well Synergy, Wiley Interscience, EBSCO HOST, springer, PML, and Kluwer. No electronic data were collected from MEDLIS and MEDLAS. Study selection : The inclusion criteria were five systematic reviews included in Alberta study and all randomized controlled trials obtained from their references. Study analysis : The acupuncture rationale, methods of stimulation, treatment regimen, and the practitioner's background were rated by FEAS, and the scores were compared with those by other methodological assessment tools. Results : The number of positive conclusions of high-rank RCTs by FEAS was the same as or higher than that of high-rank RCTs by other methodological assessment tools. Conclusions : We have analysed 5 systematic reviews and their objectives 58 RCTs using FEAS. Practitioner's background has been described slightly in some reviews and studies. It may directly influence the effectiveness of acupuncture negatively in the systematic reviews.

• Journal of Pharmacopuncture
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• v.18 no.1
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• pp.27-35
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• 2015

Objectives: In Korea, cancer is one of the most important causes of death. Cancer patients have sought alternative methods, like complementary and alternative medicine (CAM) together with Western medicine, to treat cancer. Also, there are many kinds of providers of CAM therapy, including providers of Korean oriental medicine therapy. The purpose of this study is to identify the behaviors of Korean oriental medicine therapy and CAM therapy providers who treat cancer patients and to provide background knowledge for establishing a new policy with the management and quality control of CAM. Methods: Structured and well organized questionnaires were made, and 350 persons were surveyed concerning the providers of CAM or Korean oriental medicine. The questionnaires were collected and analyzed. Results: The questionnaires (182) were collected. The questionnaires identified a total of 73 known providers, such as medicinal professionals or other providers of CAM suppliers, 35.6% of whom had had experience with treating cancer patients (52.6% vs. 29.6%). The treatment methods were a little different: alternative therapy and nutritional therapy being preferred by medicinal professionals and mind body modulation therapy and alternative therapy being preferred by other CAM providers. Four patients (7.4%) experienced side effects, and 6 patients (12.5%) experienced legal problems. As the method for managing the therapy, CAM providers, medicinal professionals, and other CAM providers had different viewpoints. For example, some CAM providers stated that both legislation and an official education on CAM or a national examination were needed as a first step to establish the provider's qualifications and that as a second step, a license test was needed for quality control. To the contrary, medicinal professionals stated that a license test was needed before legislation. Conclusion: Adequate management and quality control of CAM providers is thought to involve both education and legislation.

• Journal of Society of Preventive Korean Medicine
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• v.21 no.3
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• pp.29-42
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• 2017

Background : Efforts towards increasing insurance coverage for traditional Korean medicine (TKM) are being continued. However, various difficulties are faced in generating evidence for TKM due to limited financial support and the low quality of research methodology. Objectives : The objectives of this study were to review the Swiss evaluation program for complementary and alternative medicine (CAM) and assess the expansion in public health insurance coverage of complementary medicine as approved by referendum in Switzerland. Methods : The regulations of CAM in the European Union were assessed. Research articles, reports, government publications and websites which deal with the 'Programm Evaluation $Komplement{\ddot{a}}rmedizin$ (PEK)' and the referendum in Switzerland were searched for and analyzed. Results : The PEK was conducted from 1998 to 2005. The PEK evaluated the efficacy, utilization and cost-effectiveness of anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese medicine. However, clear conclusions could not be drawn from the evaluation according to the PEK Report. Later, a referendum was implemented in which 5 therapies would be added to the Switzerland Constitution with the support of the public. The coverage of CAM was approved by Swiss a plebiscite with an approval rate of 67.0%. Conclusions : The reason for the successful referendum is suggested to be public support and the solidarity with CAM experts and politicians. It may be surmised that recognition of the political efforts and scientific aspects required to expand insurance coverage of TKM, and towards obtaining public support, is necessary.

• Journal of Society of Preventive Korean Medicine
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• v.21 no.3
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• pp.1-10
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• 2017

Objectives : The purpose of this study is to investigate the practice patterns of traditional Korean medicine (TKM) doctors and the acceptance of payment model in order to develop a new TKM health insurance payment model linked with TKM clinical practice guidelines (CPGs). Methods : Lumbar herniated intervertebral disc (HIVD) and idiopathic facial palsy (IFP) were selected as a test diseases to develop a new TKM payment model. The level of benefit coverage in the National Health Insurance (NHI) was designed. The survey asked 228 TKM doctors about their practice patterns in HIVD and IFP patients and acceptance of new payment model. Results : Mean of medical cost for treatment of HIVD was 441,000 KW, mean of treatment period ranged from 4.9 to 17.5 weeks, and mean of number of treatment ranged from 14.6 to 50.4 HIVD patients. In the case of IFP, mean of medical cost for treatment of IFP was 468,000 KW, mean of treatment period was at least 4.2 and up to 15.9 weeks and mean of number of treatment ranged from 14.2 to 52 IFP patients. Conclusions : Current study suggests that mixed payment model of per-visit and episode-based model seem to be proper. The model 1 bundles both items which were covered and not covered by NHI in a rational way. The model 2 is based on the development and application of critical pathway. Lastly, model 3 suggests bundling of items covered by current NHI. Acceptance of TKM doctors is expected to be highest in the model 3.

• Journal of Society of Preventive Korean Medicine
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• v.17 no.1
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• pp.149-162
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• 2013

Objectives : This study was conducted to estimate the future demand and supply of physicians for korean medicine from 2016 year to 2026 year in order to make an adequate manpower policy in a way of keeping a balance between demand and supply. Methods : Baseline projection method and trend analysis(a polynomial log power equation model) were used in the estimation of future supply and demand respectively. We used data about the amount of oriental doctors from Ministry of Health and Welfare Statistics Yearbook and the treatment days from HIRA Statistics Yearbook. Results : It was projected that the total number of physician of Korean medicine will be 25,178 registered and 18,967 available in clinical setting. According to polynomial equation model which explained the trend of demand and had the highest score of $R^2$ among the equation models, 3,800~5,600 physician in Korean medicine will be oversupplied in 2016 year, 9,000~10,700 physicians in 2021 year and 15,700~17,000 persons in 2026 year depends on annual working days which is 265days, 255days or 239days. Log equation model also showed that overall excess supply of physician manpower in Korean medicine. Conclusions : Alternative manpower policies for Korean medicine doctors should be implemented in a way of both dwindling supplies and growing demand in Korean medical service in terms of Korean medical services utilization and improving physician's productivity.

• Journal of Sasang Constitutional Medicine
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• v.15 no.3
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• pp.88-99
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• 2003

Background and Objective : The status of development of instruments to assess the 'health status' reflecting the concept of Sasang Constitutional Medicine is still far from satisfaction, despite their importance in building basic data for health promotion, evaluation of effectiveness of treatment, health policy and so on. for these reasons the health scale of Sasang Constitutional Medicine shod be developed. Therefore as from of preliminary research, this study is to review the concept of health and symptoms in health status in Sasang Constitutional Medicine. Methods : It was researched as bibliologically with Dong-mu's chief medical writings such as ${\ulcorner}Dongyi$ Soose $Bowon{\lrcorner}$(東醫壽世保元)${\ulcorner}Dongyi$ Soose Bowon Sasang Chobongyun(東醫壽世保元四象草本卷)${\lrcorner}$ - Results and conclusion : 1. In Sasang Constitutional Medicine, it is suggested that Inherent vitality(命脈實數) has relations to health and Knowledge-Acting(知行) is a primary factor which affects health. And it is thought that Healthy condition(完實無病) is that human being has enough Healthy energy(保命之主) of Small viscera. 2. In Sasang Constitutional Medicine, it is thought that stool, urine, sweating and digestion become important indexes to measure the physical health state. 3. In Sasang Constitutional Medicine, it is thought that the mental health is in control of inclination of mind by golden mean(中庸) and in tranquillity of constant mind according to constitution. 4. In Sasang Constitutional Medicine, it is thought that the social health is state thar can do social acting harmoniously by keeping away from alcohol, sexual appetite, property and power.

• Health Policy and Management
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• v.17 no.3
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• pp.1-25
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• 2007

Relative value scales introduced in 2001 remarkably improved health insurance fee schedule, but current relative value scales have many problems. In the beginning the government intended to introduce 'resource based relative value scales(RBRVSs)' like USA, but political adjustment of RBRVS studied in 19.17 weakened the relationship between relative value scale and resource consumption. So unbalance of health insurance fees are existing till now. Also relative value was not divided to physician work and practice expense, and malpractice fee was not divided separately. To correct the unbalance of current relative value scales, the refinement project of health insurance relative value scales started in 2003. The project team divided relative value scales into three components, which are physician work, practice expense, malpractice fee. Physician work was studied by professional organizations like Korean medical association. To develop the practice expense relative value, project team organized clinical practice expert panels(CPEPs) composed of physicians, nurses, and medical technicians. CPEPs constructed direct expense data like labor costs, material costs, equipment costs about each medical procedures. The practice expense relative values of medical procedures were developed by the allocation of the institution level direct & indirect costs according to CPEPs direct costs. Institution level direct & indirect costs were collected in 21 hospitals, 98 medical clinics, 53 dental clinics, 78 oriental clinics, and 46 pharmacies. The malpractice fee relative values were developed through the survey of malpractice related costs of hospitals, clinics, pharmacies. Putting together three components of relative values in one scale, the final relative values were made. The final relative values were calculated under budget neutrality by medical departments, that is, total relative value score of a department was same before and after the revision. but malpractice fee relative value scores were added to total scores of relative values. So total score of a department was increased by the malpractice fee relative value score of that department This project failed in making 'resource based' relative value scales in the true sense of the word, because the total relative value scores of medical departments were fixed. However the project team constructed the objective basis of relative value scale like physician's work, direct practice expense, malpractice fee. So step by step making process of the basis, the fixation of total scores by the departments will be resolved and the resource based relative value scale will be introduced in true sense.

• 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.