Korea has introduced the levy-grand system in the vocational learning finance. The standard unit price system of training cost was utilized in the distribution of training budget and the reimbursement system including total or partial training cost return has been operated in the corporate training after completing the learning course particularly. The standard unit price was calculated in the base of analyzing on supporting budget by the government per training institutions and corporate payment decision to learning institutions. The proposing standard unit price system of training cost was analyzed in the current standard price unit of training cost and then an improvement policy and the implication are derived from it. At the result of this study, the current government supporting level to e-learning and postal distance learning indicates good status.
Background : Utilization review has been adopted as a vehicle for cost and utilization control of health care services. Its role was further stressed and expanded through the establishment of Health Insurance Review Agency in 2001. This article is to introduce concept, activities, and effect of utilization review based on the experiences of U.S. and to suggest important characteristics for ideal utilization review activities at the national level in Korea. Method : Twenty-five articles related with utilization review were reviewed after being selected through web site search through Med Line and Richis. Result : Utilization review was introduced mainly for health care expenditure control either by insurer, provider or the third parties under the pressure of increasing health care cost. It's activities can be categorized to prospective, concurrent and retrospective review according to the time of service provision. Based on most of studies, utilization review has been effective in controling rising health care cost and utilization. However it's effectiveness assumes a reimbursement structure of managed care like capitation payment. More worse, it is still unknown it's effectiveness on quality of care. Conclusion : Utilization review should be employed to increase the cost effectiveness of medical care by optimizing quality and patient's outcomes while also attempting to reduce the use of resources. So, it should consider outcomes before expenditures, check for both under and over-use, and construct an structure in which consumption is reduced equitably. Aggressive adoption of utilization review in Korean health care setting with fee-for-service reimbursement structure might not be a cost-effective approach before adoption of prospective payment system such as D.R.G. and capitation.
Under the fee for service schedule of Korean health insurance system, rational fee for dental laboratory products based on the cost is required to be formulated. The purpose of this study was to find actual cost of dental laboratory products in case of a University Hospital. Materials of this study were used as follows : 1. Balance sheet at Dec. 31, 1992 and profit and loss report of the year 1992 of the sample hospital 2. Performance report of dental laboratory department. 3. Purchasing and other accounting bills of dental laboratory materials. The following methods were used. 1. Actual cost finding of dental laboratory department was performed. 2. Work sampling methods were used for measuring standard working time by the process of working. 3. To porcelain fused to metal crown(non-precious), Relative value of the cost of dental laboratory products was calculated as 1.00. 4. Fee and cost of those products were compared on the basis of Relative values. The results of the study can be summarized as follow : 1. Overall, it took longs time than other items. to product denture-related items. 2. When several teeth are made in a time, average production time is much sorter than when one tooth is made in a time. 3. The relative price cost of Dicor cast crown and denture related items are higher than the criterion items. 4. The material cost occupies average 11% out of the total price cost, proportion of personnel expenses is average as 60.0%. 5. Some of the components consisting of the price cost are not reflected adequately in setting the level of the reimbursement price. 6. Relative values of dental laboratory products price cost are varied in the range from 0.05 to 2.83, overall, the reimbursement price of dental products appears not to reflect adequately the price cost. On the basis of this study results, the following ideas would be suggested : 1. Fee Schedule of dental laboratory products should be renovated in order to reflect their costs. 2. Dental laboratory product manufacturers should be enlarged for the economy of scale which may be useful for cost- containment. 3. Dental laboratory producters themselves are required to be standardiqed according to the categories of skill.
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.
Picture archiving and communication system (PACS) is an image information technology system for the transmission and storage of medical images. In Korea the first full PACS was installed at Samsung Medical Center in 1994, but, the rate of distribution was very slow. The government's approval for the medical insurance reimbursement for full PACS examinations in November 1999 became the turning point. Thereafter the number of hospitals with full PACS has steeply increased. In September of this year, PACS was installed at 906 medical institutes, including most of university hospitals and general hospitals. The first full dental PACS was installed at Wonkwang University Dental Hospital in 2002. Now ten out of eleven university dental hospitals implemented full dental PACS. The current status and technological factors of dental PACS in Korean university dental hospitals and the future perspectives of dental PACS are described. (Korean J Oral Maxillofac Radiol 2008; 38: 189-94)
Demand for manpower of conducting pharmaco-economic evaluation was investigated. The priority order of conducting economic evaluation on the already listed drugs was set by the budget impact for health insurance by the therapeutic groups. Manpower demand was estimated by the Anatomical, Therapeutical, Chemical (ATC) code. The total number of economic evaluation on the already listed drugs is estimated to be 346 cases. Based on these numbers, at least 53${\sim}$102 of full-time-equivalent (FTE) manpower is needed for conducting economic evaluation per year in the following 5 years.
Objectives : This paper recommends a global budget based payment system for reimbursing oriental medical services in the national health insurance. Methods : We analyzed previous research outcomes related to oriental medical services and payment system We reviewed the experiences of other countries' global budget system in terms of their strength and weakness. In addition, we developed a reimbursement method for oriental medical services based on global budget. Results : Our reviews focused on global budget system of Germany, the Netherlands, the United Kingdom, Canada, France, and Taiwan. The estimation of global budget in the national health insurance was described in two scenarios. First scenario was to allocate oriental medical services in scale after signing a contract for global budget. In this case, 4.16% of the national health insurance expenditure was allocated for the oriental medical services. Second scenario was to estimate the global budget in a historical context. As a result, the first scenario in total budget was higher than the second, and we proposed a retrospective adjustment method for the gap between the budget and the actual expenditure Conclusions : The payment system for oriental medical services is recommended to shift from fee-for-service to global budget.
Since the inauguration of the medical insurance system in 1977, the increasing medical expenses which can be menace to tile finance of the medical insurance system, have become major concern in the medical insurance field In Korea. This study focuses on the determinants of the medical expenses in the health insurance in Korea and analyzes the impact of these factors on the increase in the medical expenses. The empirical work is done using the pooled cross-section and time-series data of the medical insurance for the self-employeds and the industrial workers from the year 1995 to 1997. The result of this study shows that the main determinants of the medical expenses in the health insurance are the ratio of the population of the aged to the total population, the frequency of the utilization, number of doctors per capita and the regime changes. Although the increasing trend in the medical expenses seems to be unavoidable, we probably need to add some efficiency to the medical expenses by suppressing the supply and the utilization of the unnecessary medical services. The fee-for-service reimbursement system of today can't suppress the supply of the unnecessary medical services effectively. So we need to convert the present fee-for-service system into DRG's which is known to reduce the medical costs. The increase in the medical expenses comes from a lot of factors. Therefore, we should develop more systematic and comprehensive measures to control the soaring medical expenses in consideration of the various factors such as demand, supply, and the organizational side of the medical system.
Recently, there has been an increasing need for long-term care and comprehensive health care services in community settings. The Ministry of Health and Welfare introduced the Hospital-Based Home Nursing Care Program in 2000. Before this initiative, there was a Home Nursing Demonstration Center, affiliated with the Seoul Nurse Association, had offered home nursing services with the financial support from the local government. since 1993, the Center's nursing staff has been engaged in a general hospital in an effort to provide home nursing care services within Korea's health care system. The purpose of this study was to analyze and identify characteristics of community-based home nursing care supplied by a community-based home nursing team engaged in a general hospital. Also. visit nursing care services provided by public health centers were evaluated in terms of accessibility and supply versus demand, to enhance the accessibility of low-income patients living in Seoul to home nursing care services. Data were collected from home nursing insurance reimbursement claims submitted by the community-based home nursing care team from March 1 to October 30 in 2001 and a questionnaire survey on home-visit nursing services of 25 public health centers in Seoul. The subjects consisted of 197 patients and 12 public health centers. The result were as follows. First, medical institution's community-based home nursing care program was better in technical quality than health-center-based home-visit nursing care. In addition. the pattern of the subject patients was similar to that of hospital-based home nursing care program. Second, there was a high demand for community-based home nursing care while only a small number of home-visiting nurses served at public health centers in Seoul. As a result, many patients could not receive adequate care. Finally, we suggest that community-based home nursing care program should be introduced in the national health system to meet the at-home care needs of severely ill low-income patients. Furthermore, to better utilize home nursing and visit-nursing care resources and offer continued care for patients in community settings, an efficient referral network should be built among related institutions. This would require improvement of reimbursement system and amendment of the law related to health insurance system and community-based home nursing care services.
Park, Jung-Ho;Song, Mi-Sook;Sung, Young-Hee;Ham, Myoung-Lim;Yun, Seon-Ok
Journal of Korean Academy of Nursing Administration
/
v.3
no.2
/
pp.151-165
/
1997
A cost analysis for hospitalized patients was performed based on the KDRG classification in order to determine an appropriate nursing fee under the PPS(Prospective Payment System). The data was collected from 20 nursing units of three tertiary hospitals and two secondary hospitals from August 26 to September 15, 1996. The study consisted of 148 inpatients diagnosed for lens procedures(KDRG 03900), tonsillectomy &/or adenoidectomy(KDRG 16100), Cesarean section(KDRG 37000), or vaginal delivery(KDRG 37300) without any complications. The direct or indirect nursing hours of each patients were measured. Then, direct or indirect nursing expenditures of four nursing units, operating room and delivery room were computed. Finally, the resources used including average total nursing hours, average length of stay and average nursing cost of each KDRG were estimated as follows; 1) The average total nursing hours were 640 minutes for lens procedures, 403 minutes for tonsillectomy &/or adenoidectomy, 934 minutes for appendectomy with complicated principal diagnosis, 1,094 minutes for Cesarean section and 631 minutes for vaginal delivery. Significant differences were found in average total nursing hours among hospitals. 2) The average length of stay in lens procedures were 5 days, 4 days for tonsillectomy &/or adenoidectomy, 6 days for appendectomy with complicated principal diagnosis, 8 days for Cesarean section and 3 days for vaginal delivery. All results were within normal determined by the Ministry of Health and Welfare although significant differences existed among hospitals, especially with average length of stay for leng procedures between tertiary hospitals and secondary hospitals which was greater than for those of others. 3) The average nursing cost were 87,146 Won for lens procedures, 69,600 Won for tonsillectomy &/or adenoidectomy, 128,337 Won for appendectomy with complicated principal diagnosis, 151,769 Won for Cesarean section and 85,403 Won for vaginal delivery. These costs were 7.6%, 13.0%, 13.0%, 16.0% and 22.0%, respectively, of the official price fixed by the Ministry of Health and Welfare under the prospective payment system. Research for the analysis of nursing costs according to the severity of illness for those KDRGs shoud be carried out within the period of the PPS pilot project. In addition, a proper nursing fee schedule for a new reimbursement system based upon the result of the above research should be prepared in the near future.
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