• Journal of Preventive Medicine and Public Health
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• v.50 no.2
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• pp.91-99
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• 2017

Objectives: As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods: A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results: The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions: The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

• Journal of Preventive Medicine and Public Health
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• v.25 no.4 s.40
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• pp.399-412
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• 1992

This study was designed to investigate factors relating to fiscal deficit for regional health insurance. The financial statements for the fiscal year 1990 of nationwide 254 regional medical insurance societies were analyzed. Important findings are summarized below: 1. There were differences in the main reason fur the financial deficit among regions when deficit and surplus societies were compared by regions. The total revenue per enrollee, especially revenue from the premium contribution of a deficit society was significantly smaller than that of a surplus society in large cities and counties. On the other hand, the total expenditure per enrollee of a deficit society was larger than that of a surplus society in small cities. 2. Both low premium rate at the beginning of health insurance program and less effort to increase the premium rate were main factors for the smaller revenue from the contribution of a deficit society in large cities and counties. 3. Larger expenditures per covered person of a deficit society in small cities were explained with larger medical expenditures especially for out-patients services rather than larger administrative expenses. 4. A regression analysis showed that utilization rates in out-patient services were significantly associated with income and numbers of total medical care institution per capita within a region where a health insurance society located. Also expenses paid by insurer per visit were associated with the proportion of utilization for tertiary care hospitals as well as the proportion of utilization of public health centers.

• Proceedings of the KSR Conference
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• 2007.11a
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• pp.1683-1693
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• 2007

Urban has been operating Korail and the local autonomous entity in Korea. Over 70 LRTs will be constructed in the future, but it is hard to manage them due to structural deficit from construction debt, so Public finance plays a very important role in order to overcome a deficit. Therefore, it is necessary to plan detailed analysis and planned system about the expenditure of the amount which is borrowed from country and local government and business income from railroad companies like government grants, PSO. This research wishes to grasp the problem and present model about reasonable and efficient financial program, analyzing about increasing import and expenses of Urban.

• Journal of agricultural medicine and community health
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• v.25 no.2
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• pp.217-230
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• 2000

For the longest time, our government has played an inconsiderable role in the public health services of Korea, especially as it relates to their investment. Voices have cried out against increases in national health expenditure and for more establishment of public medical facilities. In light of this, the necessity and importance of public medical facilities have come into focus amidst the recent medical crisis. When public medical facilities filled in the gap created by the suspension or closure of private hospitals and clinics as a result of this national crisis and acted as a safety net, the demand for more establishment of such facilities increased. Although patient diagnosis and treatment are the first priority of public medical facilities, they must also deal with scopes that private medical facilities do not deal with, dislike, or have difficulty with. In this respect, the closure or privatization of public hospitals to reduce their number just because of their low profits or financial burdens that must be carried by the government is to ignore their innate importance and social role; therefore, we must do all we can to block such efforts and further empower these public health facilities according to demands of the time. The improvement of public health services can be realized by redefining its goals and roles, increasing government funding, strengthening of existing public health facilities and reorganizing the public health services system. Even if public health facilities were to increase their medical services and be reinforced, they cannot take on all the services related to public health services, Therefore, in a country like ours where public health services come second to private health services in the health care system, the health of citizens can be safeguarded only when private and public facilities cooperate and private medical facilities share the social responsibilities. Only the show of interest and effort by government, politicians, health professionals, professional organizations and public can initiate the improvement that is sought.

• Journal of Korea Technology Innovation Society
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• v.15 no.3
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• pp.649-674
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• 2012

The purpose of this study is to investigate the effects of public R&D subsidies on private R&D. We have analyzed rationales for the public R&D subsidy from different perspectives. On the basis of literature review, a two step research model is constructed: participation phase (when firms benefit from public subsidies) and decision phase (when firms make decision on additional R&D investments). Using propensity score matching(PSM) method, we compare the potential outcome of the treated group to a matched controlled group of non-subsidized firms. The data used in this paper was collected from various sources. The Korean Innovation Survey 2008(manufacturing sector) is a main source of data. Financial data such as revenue, asset and capital stock, and number of employees were supplemented from the Nice Information Service KIS Value database. The R&D survey, conducted by MEST(Ministry of Education, Science and Technology) each year, was also used for the R&D expenditures of the manufacturing firms. This study comes up with the following empirical results. First, a firm's innovation capability, financial constraints, and sector appear to influence the selection of firms who were benefited from government's financial supports for R&D. Second, empirical results show that public R&D funding complements private investment on average and appear to have perpetual effects on the following year. Finally, sectoral difference in the effect of public subsidies on firms' R&D investment was confirmed. In addition, SMEs show more positive effects than large firms.

• Journal of Preventive Medicine and Public Health
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• v.53 no.4
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• pp.266-274
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• 2020

Objectives: Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017. Methods: We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index. Results: The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05). Conclusions: Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

• Journal of Korean Public Health Nursing
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• v.3 no.2
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• pp.47-76
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• 1989

The objectives of this study was to analyze the major causes of decreasing utilization rate of health care institutios in pilot-project area of regional medical insurance, Kwang-hwa and Kun-wi country. After the implementation of medical insurance, utilization rate of health institutions turned out' to be lower than it was estimated, when the pilot-project of regional medical insurance was planned. It might be due to changes in inhabitant's behavioral attitude toward medical insurance. So this study was made to find measures for financial stability by increasing utilization rate of health care institutions and to be available for basic demand-supply program of medical care. The hypothesis of this study was as follows; First. there is difference in understanding health care institutions between Kun-wi and Kwang-hwa. Second. respondesnts of inquiry survey have exact knowledge of their past experience of treatment taken prior to enforcement of medical insurance, Questionaire survey was made as to each 700 household among total 11, 884 households in Kun-wi and 20,919 households in Kwang-hwa. In case of Kun-wi, 70% of inquired households (491) gave their answers. In Kwang-hwa, the number was 560 households (80% of inquireds). Dollected data was processed and analyzed by way of using SPSS batch system. To evaluate facto rs distribution aspects of data and to make comparison between two area, percentage and $X^2$ distribution were applied. The results were as follows; L The utilization rate of health care institutions in Kun-wi and Kwang-hwa was lower than it was estimated. when pilot-project of medical insurance was planned. 2. Prior to the implementation of medical insurance. inhabitants in two area chose the medical institutions considering such factors. First was medical care fee cheap. second in habitant's residence, Third was the institutions conveniently easy of access. 3. After the implementation of medical insurance. 26.1% of inqurieds in Kun-wi and 41.6% in Kwang-hwa, changed medical institutions. In case of Kwn-wi, from health care institution (p 0.05), and in case of Kwang-hwa, vice versa, from general medical institutions to health care institutions. 4. Evaluation by factors were made such as follows. Inquired gave high marks to following facts: In case of Kun-wi, general medical institutions were difficult of access and relation between patients: was not friendly, but burden of medical expenditure was light. Effects of treatment and facilities was good. In case of Kwang-hwa, inquired gave high evaluation marks to the follow ing facts; facilities of medical institutions was not good, but the burden of medical expenditure was light. 5. After the implementation of medical insurance, the services was evaluated as good, but inquired hopec for lessening the burden of medical expenditure. 6. In case of exact understanding of cost-sharing, the evaluation rate in Kwang-hwa was higher than that of Kun-wi (p < 0.005). And positive attitude toward necessity of medical insurance was also good in Kwang-hwa (p < 0.05). 7. In case of inquired's attitude toward medical institutions, Kwang-hwa showed positive response (p < 0.05) 8. In the case of comparison between general medical institution and health care institution, two area showed similar positive response; medical manpower, facilities of medical institutions and effest: of treatement was good. 9. In comprehensive evaluation of benefit-service; the general medical institution's positiveness was higher than that of health care institutions in Kun-wi. But in Kwang-hwa vice-versa. 10. If the medical expenditure of general medical institution and health care institutions was equal 77% of inquireds in Kun-wi and 59.1% in Kwang-hwa answered that they chose general medical insurance. Considering results above mentioned, the conclusion of this study was made as follows. 1. In Kwang-hwa county, where the understanding of health care institutions's was good, the utilization's of health care institutions was shown high. Therefore, in case of Kwang-hwa, betterment: should be made to induce increasing utilization rate for negative factors of health care institutions. 2. In case of Kun-wi, where the understanding of health care institutions was on the decrease, measures for changing such negative factors should be taken by way of strengthening public relations. And cases of Kwang-hwa should also be studied. 3. On the side of financial stabilization and establishing health care delivery system, primary health care should be available. Therefore, the major cause of inhabitant's avoiding health care institutions should be known. And measures for activating that institutions have to be taken. So, the facilities of health care institution have to be improved up to the level of clinic. And supportive measures for securing equipment and improving health care services should also be taken. It is necessary that strategy for public relations should be employed with policy considerations and supports.

• Journal of Preventive Medicine and Public Health
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• v.56 no.1
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• pp.67-76
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• 2023

Objectives: Previous studies have reported that people with disabilities are more likely to be impoverished and affected by excessive medical costs than people without disabilities. Public transfer income (PTI) reduces financial strain in low-income households. This study examined the impact of PTI on catastrophic health expenditures (CHE), focusing on low-income households and households with Medical Aid beneficiaries that contained people with disabilities. Methods: We constructed a panel dataset by extracting data on registered households with disabilities from the Korea Welfare Panel Study 2012-2019. We then used a generalized estimating equation model to estimate the impacts of PTI on CHE. A subgroup analysis was carried out to assess the moderating effects of family income levels and health insurance types. Results: As PTI increased, the odds ratio (OR) of CHE in households that contained people with disabilities decreased significantly (OR, 0.92; 95% confidence interval [CI], 0.89 to 0.94; p<0.001). In particular, PTI effectively reduced the likelihood of CHE for low-income households (OR, 0.85; 95% CI, 0.81 to 0.89; p<0.001) and those who received medical benefits (OR, 0.78; 95% CI, 0.68 to 0.89; p<0.001). Conclusions: This study highlights the positive effect of PTI on decreasing CHE. Household income and the health insurance type were significant effect modifiers, but economic barriers seemed to persist among low-income households with non-Medical Aid beneficiaries. Federal policies or programs should consider increasing the total amount of PTI targeting low-income households with disabilities that are not covered by the Medical Aid program.

• The Journal of the Korea Contents Association
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• v.21 no.4
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• pp.96-110
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• 2021

Korea is faced with the challenge of adapting to the world's fastest - growing low birthrate, aging society, and low growth with low interest rate era. With low fertility and aging population, the factors of financial income of health insurance are decreasing, and the increase of public interest in health, high cost medical technology and the development of medicine are leading to increase expenditure of health insurance. In this study, I will examine the strengthen protection of health insurance, financial stabilization, and fairness of medical care. First, the present status and limitations of health insurance were identified through domestic policy report, domestic and foreign literature, and precedent research. Second, the foreign health insurance policy measures to stabilize the finances were examined separately. Based on this study, in order to maintain sustainable health insurance through reinforcement and financial stabilization of health insurance, the current financial income structure of health insurance must be renovated. It will be necessary to expand government subsidies and discover new tax revenues. In addition, a policy to save finances by reorganizing the medical bill payment system and medical delivery system will also be needed.

• KDI Journal of Economic Policy
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• v.31 no.1
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• pp.71-103
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• 2009

Considering the expenditure size of public institutions centering on public enterprises, about 28% of Korea's GDP in 2007, public institutions have significant influence on the Korean economy. However, still in the new government, there are voices of criticism about the need of constant reform on public enterprises due to their irresponsible management impeding national competitiveness. Especially, political controversy over appointment of executives such as CEOs of public enterprises has caused the distrust of the people. As one of various reform measures for public enterprises, this study analyzes the effect of internal governance structure of public enterprises on their managerial performance, since, regardless of privatization of public enterprises, improving the governance structure of public enterprises is a matter of great importance. There are only a few prior researches focusing on the governance structure and managerial performance of public enterprises compared to those of private enterprises. Most of prior researches studied the relationship between parachuting employment of CEO and managerial performance, and concluded that parachuting produces negative effect on managerial performance. However, different from the results of such researches, recent studies suggest that there is no relationship between employment type of CEOs and managerial performance in public enterprises. This study is distinguished from prior researches in view of following. First, prior researches focused on the relationship between employment type of public enterprises' CEOs and managerial performance. However, in addition to this, this study analyzes the relationship of internal auditors and managerial performance. Second, unlike prior researches studying the relationship between employment type of public corporations' CEOs and managerial performance with an emphasis on parachuting employment, this study researches impact of employment type as well as expertise of CEOs and internal auditors on managerial performance. Third, prior researchers mainly used non-financial indicators from various samples. However, this study eliminated subjectivity of researchers by analyzing public enterprises designated by the government and their financial statements, which were externally audited and inspected. In this study, regression analysis is applied in analyzing the relationship of independence and expertise of public enterprises' CEOs and internal auditors and managerial performance in the same year. Financial information from 2003 to 2007 of 24 public enterprises, which are designated by the government, and their personnel information from the board of directors are used as samples. Independence of CEOs is identified by dividing CEOs into persons from the same public enterprise and persons from other organization, and independence of internal auditors is determined by classifying them into two groups, people from academic field, economic world, and civic groups, and people from political community, government ministries, and military. Also, expertise of CEOs and internal auditors is divided into business expertise and financial expertise. As control variables, this study applied foundation year, asset size, government subsidies as a proportion to corporate earnings, and dummy variables by year. Analysis showed that there is significantly positive relationship between independence and financial expertise of internal auditors and managerial performance. In addition, although business expertise and financial expertise of CEOs were not statistically significant, they have positive relationship with managerial performance. However, unlike a general idea, independence of CEOs is not statistically significant, but it is negatively related to managerial performance. Contrary to general concerns, it seems that the impact of independence of public enterprises' CEOs on managerial performance has slightly decreased. Instead, it explains that expertise of public enterprises' CEOs and internal auditors plays more important role in managerial performance rather than their independence. Meanwhile, there are limitations in this study as follows. First, in contrast to private enterprises, public enterprises simultaneously pursue publicness and entrepreneurship. However, this study focuses on entrepreneurship, excluding considerations on publicness of public enterprises. Second, public enterprises in this study are limited to those in the central government. Accordingly, it should be carefully considered when the result of this study is applied to public enterprises in local governments. Finally, this study excludes factors related to transparency and democracy issues which are raised in appointment process of executives of public enterprises, as it may cause the issue of subjectivity of researchers.