• 보건행정학회지
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• 제18권4호
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• pp.23-48
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• 2008

Although the universal health insurance, National Health Insurance (NHI), have improved access to health care and financial burden of health care costs for Koreans, limited coverage of the NHI leads to high out-of-pocket payment for health care. This study examines financial burden of household health expenditures by income level. Data from the Urban Household Expenditure Survey from 1985 through 2005 is analyzed and household expenditure is used as a proxy measure for income. Health expenditures include spending for inpatient care, ambulatory care and pharmaceuticals. If a household spends health expenditure above 40% of household consumption except for foods, that is defined as catastrophic health expenditure. Access to health care for the lowest income group had been improved for two decades relative to other income groups as well as in absolute term. However, both financial burden of health expenditures and the proportion of households that experienced catastrophic health expenditure had been increased in the lowest income group. Study findings have several policy implications. First, in terms of financial burden of health expenditures. the differences among income groups decreased until 2000 but it was worsen in 2005. This suggests that recent policies for extending NHI coverage are not enough to improve the disparity by income level. Second, a differential catastrophic coverage by income level would be an effective strategy that relieves financial burden for low income group. Third, since the catastrophic coverage is applied to only covered services by the NHI, additional strategy for uncovered services should be considered.

• 보건행정학회지
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• 제18권4호
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• pp.170-184
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• 2008

Objectives: The aim of this analysis was to investigate factors associated with dental visits in terms of getting diagnosis and receiving care for diagnosed dental diseases among Korean adults. Methods: Data used in this analysis were from the 2005 Korean National Health and Nutrition Examination Survey which involved a representative sample of 25,487 adults nineteen years of age and older who resided in Korea. This analysis used data of adults who had completed health interview survey (n = 25,215). Uni- and bi-variate analysis, Chi-square test, and logistic regression analyses. were conducted using SAS. Results: The percentages of people diagnosed (treated) dental canes, periodontal disease. and temporomandibular joint disorder were 70.4(77.1), 16.1 (55.7), and 0.6(37.4), respectively. The reception of treatment for diagnosed dental caries and periodontal disease was significantly associated with older age, high monthly household income, and high education attainment. Logistic regression model indicated that age, monthly household income, education attainment, type of health insurance, and chewing problem were significantly associated with getting diagnosis and treatments of dental diseases. Most frequently answered reason for non - or delayed treatments of diagnosed dental diseases during the last one year was cost of treatments. Conclusions: The findings indicated that socio-economic-status still significantly affected reception of needed dental treatments among Korean adults despite the national health insurance system. Oral health policy and programs should be augmented to provide further support to adults of low socio-economic-status who are more prone to dental diseases yet lack resources for needed dental treatments.

• 보건행정학회지
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• 제8권1호
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• pp.1-14
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• 1998

Analysis of practice variations has been one of important issues in trying to contain costs as well as to manage quality in health care. This study was conducted to provide statistical model for analysing variations in inpatient costs by type of hospitals. Four K-DRGs including Cesarean section, appendectomy, cataract extraction, and pediatric pneumonia with CC class 0 were selected, and means and dispersions of inpatient procedure and operation costs were simultaneously compared between type of hospitals. The results indicated that joint modelling of means and dispersions by gamma distribution was a very useful analytic tool for identifying factors which might have relationship with variations in inpatient costs. This model can be expanded to test the significance of several independent variables in analysing cost variations. In surgical conditions, means and unit variations of procedure and operation costs showed consistent pattern which was tertiarty hospital, general hospital, and hospital in descending order. Different findings were identified in pediatric pneumonia, from which mean and unit variation of procedure and operation cost was the highest in general hospital. The practical implication of this difference could not be drawn from this study. It will be done by further sophisticated researches. In order to develop health policy for cost containment and quality management in Korea, it is essential to find out manageable factors affecting variations in practice patterns which include characteristics of population, providers, regions, and so on. The statistical model presented in this study will give health services researchers useful insights for future investigations in analysing cost variations.

• 보건행정학회지
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• 제8권1호
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• pp.232-265
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• 1998

Taiwan has experienced rapid economic growth during the past two decades. As a result, the demand for health care in Taiwan has increased rapidly. To meet the rising demand, Taiwan implemented a National Health Insurance (NHI) program on March 1, 1995. This program now covers more than 96 percent of Taiwan's citizens. Implementation of the NHI in 1995 represents fulfillment of a primary social and health policy goals of Taiwan. The goals of the NHI program is to eliminate financial barriers of health care for the citizens, to improve the quality of care. To achieve these goals, the NHI was designed on the following principles: 1. All Taiwan citizens are compul내교 joined the NHI program by law; 2. The NHI program provides comprehensive services; 3. The NHI is run by one single govt' subsidy; 5. The NHI adopt fee-for-services scheme to pay medical expenses and copayment to avoid abouse of medical services. However, the scheme did not bring in the efficient use of health care C. National Health Council, 1986 NARC, Aging in Japan, International Publication Series 1991;2 Kahana EF. Kiyak HA. Attitude and behavior of staff in facilities for the aged, 1984 Naoki I, John CC. Health polic report japan's medical care system, New England Joumal of Medicine 1995; 333(19) National Economic Research Associates, The Health CAre System in Japan, NERA, 1993. National Federation of health Insurance Societies (KEMPOREM), Health Insurance and Health Insurance Societies in Japan, 1995. Owe Ahlund, Aging and housing in sweden, Paper presented at the International Symposium, Long term Care Facility, 1993. Statisitics Jahrbuch, Statistisches Bundesamt, 1992. Stein S. Linn, MIW. and Stein EM. Patient's anticipation of stress in nursing home care, 1985. U. S. Senate Special Committee on Aging, A Report of the special Committee on Aging, Washing D. C, 1992. U.S. Bureau of the Census, 1994.

• 보건행정학회지
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• 제6권1호
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• pp.110-143
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• 1996

The purpose of this study is to assess the extent of inequality in health outcomes and the distribution of health services according to health need under National Health Insurance System in Korea. For the empirical analysis, data were collected through an interview survey during one month of October, 1994. Interview were conducted with a total of 10, 875 of the employees and the self-employed selected through cluster, systematic sampling. The major findings of this research are as follows: 1. The analysis of the differentials in morbidity rates by socio-economic group showed that health inequality in the pro-higher groups existed in all self-reported morbidity indicators. 2. The findings of the conventional use measures showed that the lower socio-economic groups had more ambulatory and inpatient services than the higher groups. In contrast to the level of the medical care utilization, however, the higher socio-economic groups were more likely to use the high-quality source of care in terms of their treatment place compared to the lower groups. 3. By using the need-based use measures, the results were different from each use-disability ration indicator. Using the use-disability ration measured by physician visits per 100 restricted-activity days in the population, it was found that there was no evidence favoring the higher socio-economic groups. In contrast, the use-disability ration based on physician visits per a chronic patient in one year displayed that there was remarkable relative difference by income group as well as the evidence of the pro-higher income groups. 4. The results of logistic regression analysis and two-stage estimation method indicated that although the utilization is significantly affected by type and duration of insurance coverage, the use or nonuse of service and the volume of physician care consumed is determined by health need and demographic characteristics rater than economic status. In sum, these findings suggest that physician service is equitably distributed according to health need under national health insurance system in Korea. As there were some evidences of inequality including the differential in physician visits of chronic patients by income group, however, the government should strengthen the activities to guarantee the equity of health services utilization.

• 보건행정학회지
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• 제15권4호
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• pp.110-135
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• 2005

The objectives of this study were (1) to describe doctors' perception and attitudes toward patient safety culture and medical error reporting in their working unit and hospitals, (2) to examine whether these perception and attitudes differ by doctors' characteristics, such as sex, position, and specialties, and (3) to understand the relationship between overall perception of patient safety in their working unit and each sub domain of patient safety culture. A survey was conducted with 135 doctors working in a university hospital in Korea. After descriptive analyses and chi-square tests of subgroup differences, a multivariate-regression of overall perception of patient safety in their unit with sub-domains of patient safety culture was conducted. Overall, a significant proportion of doctors expressed negative perception of their working units' patient safety culture, many reporting potentials for patient safety problems to occur in their unit. They also negatively viewed their hospital leadership's commitment on patient safety. Regarding the patient safety in their working unit, doctors were most worried about staffing level and observance of safety procedures. Most doctors did not know how and which medical error to report. They also perceived that medical errors would work against them personally and penalize them. About 22 percent of respondents believed that even seriously harmful medical errors were not reported.

• 보건행정학회지
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• 제23권4호
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• pp.387-396
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• 2013

Background: The purpose of this study was to analyze the association between areas of Korea Train Express (KTX) region and external medical service use in Korean society using spatial statistical model. Methods: The data which was used in this study was extracted from 2011 regional health care utilization statistics and health insurance key statistics from National Health Insurance Corporation. A total spatial units of 229 districts (si-gun-gu) were included in this study and spatial area was all parts of the country excepted Jeju, Ulleungdo island. We conducted Kruskal-Wallis test, correlation, Moran's I and hot-spot analysis. And after, ordinary linear regression, spatial lag, spatial error analysis was performed in order to find factors which were associated with external medical service use. The data was processed by SAS ver. 9.1 and Geoda095i (windows). Results: Moran's I of health insurance patients' external medical service use was 0.644. Also, population density, Seoul region, doctor factors positively associated with health insurance patients' external medical service. In contrast, average age, health care organization per 100 thousand were negatively associated with health insurance patients' external medical service use. Conclusion: The finding of this study suggested that health insurance patient's external medical service use correlated for seoul region in korea. The study results imply the need for more attention medical needs in the region (si-gun-gu unit) for health insurance patients of seoul region. It is important to adapt strategy to activation of primary health care as well as enhancing public health institution for prevent leakage of patients to other areas.

• 보건행정학회지
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• 제26권3호
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• pp.155-171
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• 2016

Background: In this study, state-owned medical institutes, industrial accident hospitals, veteran hospitals, and private medical clinics including 16 university medical institutes in the Seoul metropolitan area were selected to examine the causality of ethical management, positive psychological capital, and organizational effectiveness. Methods: The study analyzed 1,056 valid questionnaires to which a total of 1,325 nurses, medical technicians, doctors, and administrative staff in 34 healthcare organizations answered over two months from June to August 2015. The study also utilized a 'structural equation model,' and a 'hierarchical linear model' to conduct the analysis. Results: It was first found that ethical leadership, ethical management systems, and organizational ethics values, which are the three factors of ethical management, had significant influence on organizational commitment, and behavior. These are the three factors of employee organizational effectiveness. Second, ethical management, ethical leadership, ethical management systems, and organizational ethics values had significant influence on positive psychological capital. Third, positive psychological capital had significant influence on organizational commitment, turnover intention, and organizational citizenship behavior. Positive psychological capital presented an indirect effect on the relationship between the ethical management and organizational effectiveness of employees. The effect of positive psychological capital consisting of self-efficacy, hope, resilience, and optimism was confirmed in the healthcare organizations. Fourth, in relations among ethical management variables, ethical leadership showed a significant impact on ethical management systems, which had significant impacts on organizational ethics values, which had significant impacts on ethical leadership.

• 보건행정학회지
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• 제26권3호
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• pp.172-184
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• 2016

Background: The objective of this study was to examine the effect of occurrence and reoccurrence of catastrophic health expenditure (CHE) on transition to poverty and persistence of poverty in South Korea. Methods: The data of the year 2008-2011 from the Korea Health Panel were used. CHE was defined as the share of total health expenditure in a household out of a household's total income at various threshold levels (more than 5%, 10%, 15%, and 20%). The effect of catastrophic expenditure on transition to poverty and persistence of poverty was analyzed through multivariate logistic regression. Results: The shares of households facing CHE at various threshold levels have increased gradually with 37.7%, 21%, 13.1%, and 9.5% in 2011. Households facing CHE were more likely to experience transition to poverty at thresholds level of more than 5% and 20% in 2010 set. Households facing CHE seemed to experience persistence of poverty, but it was not statistically significant. About 40% of households facing CHE in 2009 encountered another shock of CHE in 2010. Households without CHE seemed to experience more transition to poverty and persistence of poverty, but it was not statistically significant. For household with multiple CHE, those with medical aid were more likely to experience transition to poverty with statistical significance, but the statistical significance disappeared in case of persistence of poverty. Conclusion: The Korean health system needs to be improved to serve as a social security net for addressing transition to poverty and persistence of poverty due to facing CHE.

• 보건행정학회지
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• 제26권3호
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• pp.185-194
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• 2016

Background: The purpose of this study is to forecast changes in the prevalence of chronic diseases and health expenditure by age group. Methods: Based on the Future Elderly Model, this study projects the size of Korean population, the prevalence of chronic diseases, and health expenditure over the 2014-2040 period using two waves (2012, 2013) of the Korea Health Panel and National Health Insurance Service database. Results: First, the prevalence of chronic diseases increases by 2040. The population with hypertension increases 2.04 times; the diabetes increases 2.43 times; and the cancer increases 3.38 times. Second, health expenditure on chronic diseases increases as well. Health expenditure on hypertension increases 4.33 times (1,098,753 million won in 2014 to 4,760,811 million won in 2040); diabetes increases 5.34 times (792,444 million won in 2014 to 4,232,714 million won in 2040); and cancer increases 6.09 times (4,396,223 million won in 2014 to 26,776,724 million won in 2040). Third, men and women who belong to the early middle-aged group (44-55 years old) as of 2014, have the highest increase rate in health spending. Conclusion: Most Korean literature on health expenditure estimation employs a macro-simulation approach and does not fully take into account personal characteristics and behaviors. Thus, this study aims to benefit medical administrators and policy makers to frame effective and targeted health policies by analyzing personal-level data with a microsimulation model and providing health expenditure projections by age group.