• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.11
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• pp.7463-7473
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• 2015

This study aims to analyze the effect of long-term care utilization on health care utilization of the national health insurance elderly. This study is a secondary data analysis of the long-term care insurance data that comprised of total 21,213 long-term care insurance with the level 1 elders who received either service or non-service. This study evaluated the impact of long-term care service on the probability of health care utilization experience and costs of health care utilization. The total medical cost, geriatric hospital's medical cost, inpatient day and geriatric hospital's inpatient day by 2007-2009 were significant factor influencing the long-term care utilization. This study suggests long term care system should proper medical service linkage system. The current long-term care insurance system should more resource allocation on long-term care utilization to increase the efficiency of insurance system.

• Journal of The Korean Ophthalmological Society
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• v.59 no.11
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• pp.1039-1048
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• 2018

Purpose: To evaluate the effects of anti-vascular endothelial growth factor (VEGF) treatment on the healthcare-related finances of patients with age-related macular degeneration. Methods: Changes in health care financing due to newly introduced benefit standards were predicted over the coming 5-year period (2018-2022). We also analyzed the financial impact of scenarios in which agents similar to anti-VEGF, such as the over-licensed drug bevacizumab, were introduced. For this purpose, the future number of patients receiving anti-VEGF treatments was estimated for various scenarios based on National Health Insurance Corporation claims data followed by an estimate of the financial burden. Results: In the case of age-related macular degeneration, the current standard of care (14 times in a lifetime) was maintained in scenario 1. In 2018, the insurance budget for the coming 5-year period was estimated at approximately 440.3 billion won. The insurance cost for that period was estimated at approximately 560.1 billion won under the revised standard of December 2017 (scenario 2). For scenarios wherein, after 2020, similar treatments (scenario 3) and bevacizumab (scenario 4) were introduced, the estimated health insurance costs were 521 billion won and 419.7 billion won, respectively. Conclusions: Health insurance costs are projected to increase substantially due to the elimination of the 14 time pay standard; however, the actual budget will only moderately increase, due to new limitations of visual acuity ${\leq}0.1$ or in case of scarring/atrophic lesions. Clinically similar agents and bevacizumab could be considered as alternatives to anti-VEGF treatment for age-related macular degeneration.

• 한국노년학
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• v.31 no.4
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• pp.871-884
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• 2011

Standard Long-term care(LTC) Utilization Plan is a kind of care plan, which aims to help beneficiaries and their family choose services to meet their care needs. The objective of this study is to determine the relationships among family caregivers' perceived quality, overall satisfaction and utilization in Standard LTC Utilization Plan. Data were gathered from family caregivers with beneficiaries who have used community service in long-term care insurance system. A national cross-sectional descriptive survey was conducted in December 2008, using proportionate quota sampling. Finally, 351 family caregivers completed questionnaires which included demographic characteristics, perceived quality(9 items), overall satisfaction(1 item) and utilization(2 items). Path analysis was conducted to find a causal relationship. This study shows firstly, the quality of Standard LTC Utilization Plan was categorized into three dimensions, that is, assessment of care needs, recommended care plan, and management of monthly benefits. Secondly, reliability and validity of quality items were satisfied. Finally, in the effect of perceived quality and satisfaction for utilization, assessment of care needs(indirect effect, path coefficients=0.077) and overall satisfaction(total effect, path coefficients=0.324) were statistically significant. The findings of this study would be helpful in developing the strategies, which is needed to improve the role of Standard LTC Utilization Plan.

• Journal of the Korean Society of Radiology
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• v.14 no.6
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• pp.801-810
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• 2020

In this study, the health insurance application of PET and the change in the pay standard were examined, and the amount of health insurance use over the past 10 years was analyzed. Positron tomography was applied as health insurance in 2006, and after ¹⁸F-FDG was first applied as health insurance, positron tomography tests using various radioactive isotopes have been applied as health insurance. As of 2019, the number of positron emission tomography tests was 198,651 cases, and the treatment amount was about 88.3 billion won, and the number of tests according to general characteristics was higher in men than in women, and by age, the number of tests was the highest in 60s. The number of outpatient examinations was higher than that of inpatient examinations, and the number of examinations in tertiary hospitals(68.2%) was significantly higher than that of general hospitals and hospitals. As for the test site, torso test was the most common at 86.6%, and radioisotope was the most at 93.6% using ¹⁸F-FDG. The change in the use of PET for 10 years increased steadily from 2010 to 2014, but the amount of use decreased sharply afterwards as the recognition of asymptomatic long-term follow-up tests was deleted due to the government's change in health insurance application standards in 2014. As changes in health insurance standards have a great influence on changes in health insurance usage, continuous monitoring will be required in the future.

• Health Policy and Management
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• v.32 no.2
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• pp.137-153
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• 2022

In the process of promoting policies to strengthen health insurance coverage, the relationship between public health insurance and private health insurance, along with the management of non-benefit, is also emphasized as a policy issue. First, the concept and scope of non-benefit were comparatively analyzed by country. Second, the interaction between the public and private health insurance was classified as 'large or small,' and the government's regulation and management policy on private health insurance was classified as 'strong or weak.' Korea has relatively smaller benefits covered by public health insurance, higher copayment expenses, and more areas and scope of non-benefits. In countries where the interaction between public and private health insurance is small, private health insurance-related policies are weak. And in countries with large interactions had public-private partnerships and the government's management policies were also strong. On the other hand, Korea has a large interaction, but the actual structure of cooperation between public and private insurance and management policies were weak. Because the non-benefit sector in Korea is relatively wide, it is difficult to manage compared to other countries where the concept of non-benefit is limited. In addition, the health authorities rarely perform the role of supervision over private health insurance, and they have so few linkages and cooperation for public-private insurance. Therefore, practical policy enforcement is necessary to achieve the easing of the burden of national medical expenses through linkage and cooperation of public-private health insurance with reference to relevant other countries' cases.

• Health Policy and Management
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• v.33 no.3
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• pp.295-310
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• 2023

Background: The long-term care (LTC) group has higher rates of chronic disease and disability registration compared to the general older people population. There is a need to provide integrated medical services and care for LTC group. Consequently, this study aimed to identify medical usage patterns based on the ratings of LTC and the characteristics of benefits usage in the LTC group. Methods: This study employed the National Health Insurance Service Database to analyze the effects of demographic and LTC-related characteristics on medical usage from 2015 to 2019 using a repeated measures analysis. A longitudinal logit model was applied to binary data, while a linear mixed model was utilized for continuous data. Results: In the case of LTC ratings, a positive correlation was observed with overall medical usage. In terms of LTC benefit usage characteristics, a higher overall level of medical usage was found in the group using home care benefits. Detailed analysis by medical institution classification revealed a maintained correlation between care ratings and the volume of medical usage. However, medical usage by classification varied based on the characteristics of LTC benefit usage. Conclusion: This study identified a complex interaction between LTC characteristics and medical usage. Predicting the requisite medical services based on the LTC rating presented a challenge. Consequently, it becomes essential for the LTC group to continuously monitor medical and care needs, even after admission into the LTC system. To facilitate this, it is crucial to devise an LTC rating system that accurately reflects medical needs and to broaden the implementation of integrated medical-care policies.

• The Journal of the Korea Contents Association
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• v.20 no.2
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• pp.435-450
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• 2020

How do Korean people recognize major welfare policies of the Moon Jae-in government? Using a survey of 1,000 adults conducted in December 2018, this study examines what the public thinks about major issues related to welfare policies and what factors are related to variations in their opinions regarding the welfare policies. Results show that the public recognized the roles of government in providing welfare in a positive way. The positive opinion on expanding the coverage of National Health Insurance was the highest. Regarding the resolutions of fiscal problems of the National Pension Plan, there were substantial oppositions to reforms such as insurance premium increase, benefits cut, and increase in the age of receipt of pension benefits. Both efficiency and equality were perceived as important when government makes decision for allocating budgets. Only one-third of respondents agreed Korean government contributed to promoting the happiness of Korean people. Based on these findings, implications for developing welfare policies were discussed.

• Korean Journal of Social Welfare
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• v.57 no.3
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• pp.5-30
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• 2005

Globalization has conflicting effects on pharmaceutical policies. A change into a 'populist competitive nation' due to globalization strengthens policies to reduce drug manufacturing costs while the WTO's TRIPS Agreement that is affected by multinational pharmaceutical companies increases drug manufacturing costs by bolstering the patent rights on new drugs. Currently, the independency of populist nations' policies to reduce drug manufacturing cost is being compromised because multinational organizations(such as the European Union) which represents the interests of the multinational pharmaceutical companies put restrictions on the pharmaceutical policies of populist nations for purposes of promoting the industrial goals of the multinational companies. Korea is no exception. Up until the late 1990s, the main feature of the pharmaceutical policies in Korea was keeping the drug price at the cost level based on a growth-driven ideology, and this was Korea's unique policy tools as a developing nation. However, the increase in the power of multinational pharmaceutical companies currently infringes on the independency of Korea's pharmaceutical policies. Expensive imported drugs were originally covered by the national health insurance plan, but starting from 1999 such drugs began to be covered by the plan. After separation of medical and pharmaceutical services, the use of expensive drugs was increased, and the Korean government planned to introduce the reference price policy in order to contain the cost of the national health insurance plan. However, due to pressures from the U.S. government as well as multinational pharmaceutical companies, implementation of the policy has been postponed. In addition, due to a pressure from the U.S. government, a working group was created which would affect the health care policy of the Korean government. Discussions so far on globalization was about whether the change into populist competitive nations due to globalization resulted in the reduction of welfare spending. However, this study shows not only the reduction of health care cost through policies to reduce drug manufacturing costs but increase in welfare spending by raising the strengths of multinational pharmaceutical companies that are for-profit providers of welfare service. While focusing on the contradictory effects of globalization on pharmaceutical policies of a nation, this study looked at how these conflicting effects end up promoting the interests of multinational pharmaceutical companies by examining the Korean case.

• The Journal of the Convergence on Culture Technology
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• v.9 no.1
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• pp.443-448
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• 2023

Over the past five years, the number of patients with sleep disorders has increased by about 250,000 from 840,000 in 2017 to 1.09 million in 2021. In addition, sleep disorder is a factor that causes dementia risk factors, and furthermore, the population with sleep disorder is a very important policy issue in terms of stable health insurance financial management in the future in terms of national health management in the super-aging trend. Therefore, this study aims to establish an efficient treatment environment in medical institutions responsible for the current status of polysomnography and effective reimbursement policies for the recently increasing population with sleep disorders, and appropriate sleep management policies for future sleep disorders through correct implementation. We are trying to find out the actual condition and improvement plan through interviews with related organizations and experts.

• Journal of Digital Convergence
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• v.18 no.1
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• pp.257-263
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• 2020

This study was conducted to improve the quality of National Health Policy by analysing the effects of sociodemographic characteristics, Medical institutions characteristics and characteristics of Admission-Discharge on the length of stay in hospital for schizophrenic patients from the data of Health Insurance Review & Assessment Service. The subjects were 4,692 patients who were diagnosed with schizophrenia as main diagnosis from the data records of HIRA-NIS 2016. Regression analysis was performed to evaluate the effect on the length of stay. Sociodemographic characteristics, hospital characteristics and characteristics of Admission-Discharge were used as explanatory variables and length of stay in hospital was used as a dependent variable. The result of study showed that female, age, medical aid, the kind of hospital, gangweon-do and with mental disease were found to be the factors that affect the length of stay. The significance of this study is to use the public data for evaluating factors that affect the length of stay in hospital for schizophrenic patients. But this study did not consider disease severity, so further study is needed for evaluation of the effects of factors on the length of stay according to disease severity.