• The Korean Society of Law and Medicine
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• v.14 no.2
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• pp.173-214
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• 2013

Traditionally, the Supreme Court has held that medical treatment agreements covered by national health insurance should be distinguished from other medical treatment agreements which are viewed as a consummation of the autonomous free will between doctor and patient. Namely, the Supreme Court views medical treatment agreements covered by national health insurance to be bound by the National Health Insurance Law with the intent to promote the applicability and comprehensiveness of the national health insurance scheme. Yet, issues of voluntary non-reimbursable treatments are triggered not only by the mistakes or moral hazard of medical care institutions but also by systemic limitations of national health insurance coverage criteria. Thus, there is a need for legislative measures that allow certain medical treatments to be included or reflected in the national health insurance coverage system so that patients may receive prompt and flexible medical treatments. To reflect such concerns, the Supreme Court made an exception for voluntary non-reimbursable treatments and developed a strict test to be applied in such cases in Supreme Court Judgment 2010 Doo 27639, 27646 (ruled on June 8, 2012 by the Grand Bench). Such judgment, however, is not a fundamental overturn of the Supreme Court's prior rulings that voluntary non-reimbursable treatments are not allowed under the law. It is only a slight revision of its previous stance for cases in which there is a lack of legislative measures to make coverage of a new yet valid medical treatment possible under the current national health insurance coverage system.

• The Korean Society of Law and Medicine
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• v.8 no.1
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• pp.137-177
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• 2007

The medical expenses review system in Korea has developed under fee-for-service system with its own unique structure. The importance of reviewing medical expenses has been emphasized, as the size of medical expenditures moving through the health insurance legal context and its weight in the national economy have increased very rapidly. It is, however, analyzed that the feuds and arguments continue among the stakeholders for the lack of laws supporting the medical expenses review system. The medical expenses review is a series of administrative procedures, deciding whether claims from medical care institutions to the insurer are legal and valid or not. It mainly controls the increase of unnecessarily excessive health insurance claim and prevents fraudulent claim and abuse and checks the less use or unsuitable use of medical resources. It also works a function guarantees medical benefits for the appropriate treatment according to the object of health insurance system as a social insurance scheme. The dispute on legal base of the medical expenses review is about the source of law in the medical expenses review. There are the Health Insurance Act and administrative laws as jus scriptum and the guidelines of review as administrative orders. The medical expenses review should reflect various factors, such as the development of medical healthcare technologies, the health expenditures distribution, the financial situation of the health insurance, and the evaluation on the level of appropriate benefits. It is also likely to adapt to the traits of characters of medicine, and trends and transition, Besides it should judge the legality and the validity of medical benefits expenditures by synthesizing these all factors. And the evaluation system of appropriateness of medical benefits was administrative procedure which was consecutive with reviewing the medical expenses system and it was intended to make up for the result of reviewing the medical expenses in more comprehensive levels.

• The Korean Society of Law and Medicine
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• v.8 no.2
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• pp.69-118
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• 2007

In providing general medical treatments, the medical service contract between the patient and the doctor is the mutually responsible onerous contract. However, the nature of the mutually assumed contract standings of the patient and the doctor has been changing since the implementation of the national health insurance program. For instance, besides the cases of beyond excessive medical charges and medical negligence, if the doctor charged for his/her medical treatments violating the post-treatment/nursing cover criteria, the overpaid medical charge, regardless of being collected with the patient's consent, has to be refunded back to the patient. Medically needed aspects, treatment results, and unfair benefits favoring the patient are not at all taken into consideration in the health insurance scheme. This makes it easier for patients to get refunds for their share of the medical payments by involving the Health Insurance Review & Assessment Service or the National Health Insurance Corporation, without engaging in civil law suits (for reimbursement claim) against doctors. In other words, the doctor's responsibility to provide medical treatments and the patient's responsibility to pay for the medical treatment provided within the contractual realm are being demolished by the administrational arbitration of the National Health Insurance system. The basic rights of medical service providers, and the patient's right to choose are as important constitutional rights, as the National Health Insurance program, which is essential in the social welfare system. Furthermore, the development of the medical fields should not be prevented by the National Health Insurance system. If the medical treatment services can be divided into necessary treatments, general treatments, and high quality treatments, the National Health Insurance is supposed to guarantee the necessary and general treatments to provide medical treatments equally to all the insured with limited financial resources. However, for the high quality treatments, it is recommended that they should not be interfered by the National Health Insurance system, and that they should be left to the private contract between the patient and the doctor.

• The Korean Society of Law and Medicine
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• v.8 no.2
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• pp.119-164
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• 2007

Improving the formal objection system regarding reviewing medical expenses requires authority and confidence in the aspect of well-functioning the health insurance review and assessment system, legally and appropriately. The purposes of improvement of the formal objection system should aim for protecting the people's right of health. On handling the formal objections, the disputes of the rights should be settled economically and promptly by fairness, specialty, and objectivity in the health insurance review and assessment administration. Therefore, in order to promote the administrative specialty of health insurance, the formal objection committee needs to be organized independently and guaranteed expertly. Under the current formal objection system, however, the organization of committee lacks right-relief function, recognition and public relation as a health insurance appeal system, and related professional man powers. It is also analyzed that there are several controversial points, such as mass deliberation to the formal objection committee and its conference procedure. As a measure of improvement, it is analyzed that the committee needs to be organized independently with a proper number of professional man powers. The strict deliberation procedures and the prohibition of the decision-making by non-conference are also required to be empowered. The formal objection procedure provides the beneficiaries and the claims legitimately, so that it secures the legal relations on the health insurance system. Therefore, on the conference process of formal objection, the expert and guaranteed protection should be provided promptly, and its procedures to the appellants should also be assisted kindly.

• PNF and Movement
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• v.22 no.1
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• pp.101-111
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• 2024

Purpose: The purpose of this study was to investigate physical activity as a risk factor for neck pain recurrence using the National Health Insurance Data Sharing Service that utilizes a nationwide cohort in South Korea. Methods: Medical records spanning a two-year period were extracted from the National Health Insurance database for 541,937 patients who sought healthcare services for neck pain (ICD 10 codes: M54.2) in 2020 and completed the national health examination survey. Selected variables for analysis included age, gender, health insurance premium decile, regional health vulnerability index, body mass index (BMI), acuity, blood pressure, and types of physical activity. A mixed-effect multivariate logistic regression analysis was conducted to examine the recurrence rate of neck pain and identify risk factors for neck pain recurrence. Results: Among the participants, 124,433 patients (23.0%) experienced a recurrence of neck pain within two years, with higher recurrence rates observed among older individuals and females. Regression analysis revealed that the risk of neck pain recurrence increased with age (OR=1.51), being female (OR= 1.10), being a medical aid recipient (OR=1.51), and having anaerobic (OR=1.04) or vigorous physical activities (OR=1.06). By contrast, an increased health insurance premium decile (OR=0.96) and having moderate physical activity (OR=0.97) were associated with a decreased risk of neck pain recurrence. Conclusion: This study highlights the importance of moderate physical activity as an effective strategy for reducing the recurrence of nonspecific neck pain, underscoring the necessity for personalized physical activity programs for patients.

• The Korean Society of Law and Medicine
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• v.17 no.2
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• pp.177-219
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• 2016

A commercial advertisement is not only a way of competition but also a medium of communication. Thus, it is under the constitutional protection of the freedom of business (article 15 of the Constitution) as well as the freedom of press [article 21 (1) of the Constitution]. In terms of the freedom of business or competition, it should be noted that an unfair advertising (false or misleading advertisement) can be regulated as an unfair competition, while any restraint on advertising other than unfair one might be doubted as an unjustifiable restraint of trade. In terms of the freedom of press or communication, it is important that article 21 (2) of the Constitution forbids any kind of (prior) censorship, and the Constitutional Court applies this restriction even to commercial advertising. In this article, the applicability of these schemes to advertising of the so-called learned professions, especially physician, are to be examined, and some proposals for the reformation of the current regulatory regime are to be made. Main arguments of this article can be summarized as follows: First, the current regime which requires advance review of physician advertising as prescribed in article 56 (2) no. 9 of Medical Act should be reformed. It does not mean that the current interpretation of article 21 of the Constitution is agreeable. Though a commercial advertising is a way of communication and can be protected by article 21 (1) of the Constitution, it should not be under the prohibition of censorship prescribed by article 21 (2) of the Constitution. The Constitutional Court adopts the opposite view, however. It is doubtful that physician advertising needs some prior restraint, also. Of course, there exists severe informational asymmetry between physicians and patients and medical treatment might harm the life and health of patients irrevocably, so that medical treatment can be discerned from other services. It is civil and criminal liability for medical malpractice and duty to inform and not regulation on physician advertising, to address these differences or problems. Advance review should be abandoned and repelled, or substituted by more unproblematic way of regulation such as an accreditation of reviewed advertising or a self-regulation preformed by physician association independently from the Ministry of Health and Welfare or any other governmental agencies. Second, the substantive criteria for unfair physician advertising also should correspond that of unfair advertising in general. Some might argue that a learned profession, especially medical practice, is totally different from other businesses. It is performed under the professional ethics and should not persue commercial interest; medical practice in Korea is governed by the National Health Insurance system, the stability of which might be endangered when commercial competition in medical practice be allowed. Medical Act as well as the condition of medical practice market do not exclude competition between physicians. The fact is quite the opposite. Physicians are competing even though under the professional ethics and obligations and all the restrictions provided by the National Health Insurance system. In this situation, regulation on physician advertising might constitute unjustifiable restraint of competition, especially a kind of entry barrier for 'new physicians.'

• The Korean Society of Law and Medicine
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• v.20 no.2
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• pp.261-285
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• 2019

The essential policy of suicide prevention is to continuously manage and treat suicide attempted people through data base related to suicide retry rate and follow-up study report. In Korea, only few people are allowed to follow-up by the Personal Information Protection Act. As a result, the research participation rate and the service participation rate are rather low, so that the research participants is limited to a part of the suicide attempted people. Therefore, the policy proposals to be improved in the Ministry of Health and Welfare Act were examined comparatively in order to increase the practical utilization of the suicide prevention about Article 14 and Article 20 of the Suicide Prevention Act. As a criterion for policy improvement, measures for non-discrimination of information to be considered in terms of technical and ethical dimensions and non-profit research and medical information for medical purposes were suggested. In addition to the severity of the suicide, the suicide risk was assessed and the criteria for the objective assessment of the follow-up observation were considered in consideration of the severity of the suicide.

• The Korean Society of Law and Medicine
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• v.23 no.3
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• pp.47-87
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• 2022

Due to the COVID-19 pandemic, non-face-to-face treatment was temporarily permitted. A lot of consensus has been formed on the need to continuous non-face-to-face treatment. However, the current 「Medical Service Act」 only permits telemedicine between doctors and medical personnel. On the other hand, as a result of legal interpretation, there is an opinion that non-face-to-face treatment is allowed. But considering the overall legal system, non-face-to-face treatment is not allowed. Nevertheless, we have to consider the reality such as the development of science and technology and the outbreak of infectious diseases. Therefore, it is not advisable to allow face-to-face treatment only. Ultimately, it is necessary to find ways to ensure that non-foce-to-face treatment can be performed in a safe and effective manner. And it should be institutionalized. This is strategically necessary and important. Therefore, we must look over ahead legal issues to be discussed. First of all, the scope, the target disease and the subject of implement have to be clear. Also, structurally, the standards of facilities and equipment must be prepared for non-face-to-face treatment to be implemented. Functionally, communication and information exchange between doctors and patients should be well conducted. In addition, the information protection management system that occurs in the process of non-face-to-face treatment should be materialized. Lastly, the issue of responsibility and cost of non-face-to-face treatment should be decided in detail. When these problems materialize, it can be expected that a safe non-face-to-face treatment environment will be established.

• Clinical and Experimental Pediatrics
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• v.53 no.3
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• pp.307-313
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• 2010

Purpose : Results of the Korea National Health Screening Program for Infants and Children, which was launched in November 2007, were evaluated for future research and policy development. Methods : Data from a total of 2,729,340 cases were analyzed. Five visiting ages, such as 4, 9, 18, 30, and 60 months, were included. Several parameters such as stunting, obesity, and positive rate of developmental screening were also analyzed. Telephone survey was performed in 1,035 users. For the provider survey, 262 doctors participated in our study. Results : The overall participation rate of users was 35.3%. This participation rate showed a decrement tendency to old age and low income. Only 6.9% of users participated in oral screening. Health screening was performed mainly in private clinics (82.6%). The recall rate of 4 months program users at the age of 9 months was 57.3%. The positive rate of screening was 3.1%, and was higher in the low-income group. By telephone survey, users reported that questionnaires were not difficult (94%) and overall satisfaction was good (73%). Longer duration of counseling was related with more satisfied users. Counseling and health education were helpful to users (73.2%). Doctors agreed that this program was helpful to children (98.5%). Conclusion : Korea National Health Screening Program for Infants and Children was launched successfully. Participation rate should be improved, and a quality control program needs to be developed. More intensive support following this program for children of low-income families may lead to effective interventions in controlling health inequality. Periodic update of guidelines is also needed.

• Journal of Preventive Medicine and Public Health
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• v.26 no.2 s.42
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• pp.222-230
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• 1993

Industrial glues, known as 'Bonds' in Korea, contain many kinds of organic solvents, and glue sniffing of youths became one of the social problems in Korea. Mixed exposures to solvents by glue sniffing may induce chronic toxicities different from those by exposures to solvents of single component. To test effects of the glue sniffing on weight gain or central nervous system, two groups of 20 male Sprague-Dawley rats were exposed to air(control group) or vapors of the glues to narcotic status(exposed group), and weight check, tail flick test, hot plate test, rotarod treadmill test were done on the 14th,24th, 36th, 45th, 53rd, 86th, 102nd, 117th, 134th and 151st days after the first exposure. On the 188th day, their brains were excised and examined by a pathologist. Weight gain, controlled against time change, showed significant difference between the groups, but response times in tail flick test, hot plate tests, and rotarod treadmill test didn't. In pathological examination with blind method, no macroscopic or microscopic differences were found between the two groups. These results suggests that organic lesion in central nervous system may not ensue glue sniffing, but, before firm conclusion, more studies in various exposure conditions should be followed.