• Health Policy and Management
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• v.13 no.2
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• pp.125-143
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• 2003

This study was conducted to estimate the future government budget in medical expenditures using for the low-income handicapped, because medical expenditures to the low-income handicapped is escalating in these days. It became a big problem not only to the central-government but also to the district-government because they have to subsidize a part of co-payment. This study was designed to project the future government budget using structural model. For the short-term projection, the structural model is stronger than the regression model. The data used for this study were the population projection data based on National Census Data(2000) of the National Statistical Office, the data of Ministry of Health & Welfare, and the data of National Health Insurance Corporation from November 2m to June 2001. The results of the study are summarized as follows: The future government budget in medical expenditures using to the low-income handicapped will be 15-18 billion Won in the year 2003, 16-23 billion Won in 2004, 18-30 billion Won in 2005, 19-38 billion Won in 2006 and 21-49 billion Won in 2007. It is predicted that they would be increasing rapidly. Therefore, the government budget in medical expenditures using for the low-income handicapped must be enlarged.

• Health Policy and Management
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• v.25 no.4
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• pp.295-306
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• 2015

This study aims to examine the performance of public municipal hospitals through the analysis of data envelopment analysis, efficiency, profitability, and publicness by using panel data during period from 2006 to 2010. The main findings of the study are as follows. First, as a result of efficiency analysis during the period from 2006 to 2010, it was revealed that the number of staff by each job category, labor cost ratio, the number of operating beds need to be decreased. Second, the performance data represented by the indicators of efficiency, profitability and publicness were complementary and showed a tendency of being increased or decreased in same direction. Third, from the result of panel analysis, the efficiency was mainly influenced by the structural factors, while the profitability was influenced by managerial factors, and the publicness by medical environment. In conclusion, in order to enhance the performance of public municipal hospitals in Korea, it is important to harmonize the effort for efficiency, financial and policy support by central and local government, and the continuous participation of community residents.

• Health Policy and Management
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• v.27 no.1
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• pp.80-83
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• 2017

The proportion of people who reported unmet healthcare needs is an important indicator to measure the access problem in healthcare service. To examine current status and trends of unmet needs in Korea, we used data from four sources: the Korea National Health and Nutrition Examination Survey (KNHNES, '2007-2015); the Community Health Survey (CHS '2008-2015); the Korea Health Panel Survey (KHP '2011-2013); the Korean Welfare Panel Study (KOWEPS '2006-2015). The proportion of individual reporting unmet healthcare needs as of 2015 was 12.6% (KNHNES), 11.7% (CHS), and 16.3% (KHP, as of 2013). Annual percent change which characterizes trend for follow-up period was -9.4%, -3.4%, and 7.6%, respectively. The proportion of individual reporting unmet healthcare needs due to cost was 2.8% (KNHNES), 1.7% (CHS), and 4.6% (KHP). The proportion of household reporting unmet healthcare needs due to cost was 1.2% (KOWEPS). Annual percent change was -9.0%, -14.9%, 9.4%, and -18.2%, respectively. Low income population reported about 5 times more unmet needs than high income population. Therefore for decreasing the unmet healthcare needs, strategies focusing on low income population were needed.

• Health Policy and Management
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• v.27 no.1
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• pp.84-87
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• 2017

Catastrophic healthcare expenditure refers to out-of-pocket spending for healthcare exceeding a certain proportion of a household's income and can lead to subsequent impoverishment. The aim of this study was to investigate the proportion of South Korean households that experienced catastrophic healthcare expenditure between 2006 and 2015 using available data from the Korea Health Panel, National Survey of Tax and Benefit, and Household Income and Expenditure Survey. Frequencies and trend tests were conducted to analyze the proportion of households with catastrophic healthcare expenditure. Subgroup analysis was performed based on income level. The results of the Household Income and Expenditure Survey revealed that around 2.88% of households experienced catastrophic healthcare expenditure in 2015 and that this proportion was highest in the low income group. Results also showed a statistically significant increasing trend in the number of households with catastrophic healthcare expenditure (annual percentage change= 0.92%, p-value < 0.0001). Therefore, the findings infer a need to strengthen public health care financing and to particularly monitor catastrophic healthcare expenditure in the low income group.

• Health Policy and Management
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• v.14 no.4
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• pp.21-47
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• 2004

There is general agreement that the Korean health care delivery system has two basic structural problems. One is the limited capacity and role of public hospitals, and the other is the absence of functional differentiation and referral arrangement between the clinics and hospitals of various technological sophistication levels. This study is intended to make an empirical observation of the system's growth process from the viewpoint of the population ecology model of organizations so as to understand the background of these problems and to find out ways of approaching them. As predicted from the population ecology model of organizations, all the types of medical care facilities have expanded in response to the environmental changes for the past three decades or so, and the differences in the extent and pattern of expansion among the types are related to what have taken place in the environment. These findings suggest that the efforts for reforming the health care delivery system should be directed not only to medical care institutions but also to the environmental context under which they function. It is believed that the usefulness of the population ecology perspective on organizations for studying the health care delivery system has been demonstrated. Thus further studies along this line based upon more strict design would improve systematic understanding of the system that is needed for developing policy approaches needed to increase its effectiveness.

• Health Policy and Management
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• v.15 no.1
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• pp.30-56
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• 2005

This paper used two threshold approaches to measure the equity in urban households' out-of-pocket payments for health care from 1997 to 2002, which developed by Wagstaff and van Doorslaer. One approach used catastrophic health expenditure, which means that payments exceed a 'pre-specified proportion' of total consumption expenditures or ability to pay and the other used impoverishment that they did not drive households into poverty. Indicies for 'catastrophic expenditure' captured intensity as well as its incidence and also the degree of which catastrophic payments occur disproportionately among poor households. Measure of poverty impact also captured both intensity and incidence. The methods applied with data on out-of-pocket payments from the Urban Household Expenditure Survey Incidence and intensity of catastrophic payments - both in terms of total household consumption as well as ability to pay - increased between 1997 and 2002, and that both incidence and intensity of 'catastrophic expenditure' became less concentrated among the poor, but more concentrated in 2001 than in 1997. The incidence and intensity of the poverty impact of out-of-pocket payments increased between 1997 and 2002. Health security system may not have provided financial protection against catastrophic health expenditure to low-income households, because of high user fee policy not considering income level. The policies alleviating catastrophic health payments among the poor need to be more developed, and two threshold approaches further evaluated on our policy context.

• Health Policy and Management
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• v.20 no.1
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• pp.137-154
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• 2010

This study empirically analyzed the effects of the Top Management Team (TMT) on organizational performance. We verified whether the age heterogeneity, job heterogeneity (core career, core function and major), and process (communication and integration) of the TMT affect organizational performance (management performance and healthcare service quality evaluation level). We collected data about 473 members of the 2006 TMT in 81 medical institutions. We also utilized statistics of organizational performance from the Ministry for Health, Welfare and Family Affairs and the Korean Institute of Hospital Management. Results of the study showed that the age heterogeneity of TMT exerted a negative effect on the healthcare service quality evaluation level, while the process exerted a positive effect. However, the age heterogeneity, job heterogeneity, and process had no influence on management performance. We discussed the implications of such outcome of the investigation in comparison with the former studies on TMT and organizational performance, and presented its restrictions and future plans.

• Health Policy and Management
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• v.23 no.1
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• pp.78-89
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• 2013

This study empirically analyze efficiency and productivity changes of public hospitals of Korea using data envelopment analysis/Window model and global Malmquist indices model. We use the ten-year data from 2001 to 2010 of 30 regional public hospitals listed database from the Association of Korean Regional Public Hospitals. The main focuses are to reveal whether the technical inefficiency are improved as time goes by, and efficiency and productivity are affected by environmental factors. The results can be summarized as follows. First, the efficiencies of public hospitals rise in trend as time passes. Second, regional public hospitals show the different average efficiencies according to their regional type, hospital type, operational type, medicaid type, and demand and supply conditions by Mann-Whitney U-tests. Third, technical efficiency changes mainly contribute to 4.4% annual average growth rate of productivity of regional public hospitals during that period. Our findings have some policy implications. It is confirmed that there exist some environmental inefficiencies, and those inefficiencies can not be overcome through just improving the inner management system. Thus, policy and institutional changes are necessary for regional public hospitals to improve efficiency and productivity overall.

• Health Policy and Management
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• v.28 no.2
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• pp.138-144
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• 2018

Background: Diagnostic imaging fee had been reduced in May 2011, but it was recovered after 6 months because of strong opposition of medical providers. This study aimed to analyze the behavior of medical providers according to fee changes. Methods: The National Health Insurance claims data between November 2010 and December 2012 were used. The number of exams per computed tomography was analyzed to verify that the fee changes increased or decreased the number of exams. Multivariate regression model were applied. Results: The monthly number of exams increased by 92.5% after fee reduction, so the diagnostic imaging spending were remained before it. But medical provider decreased the number of exams after fee return. After adjusting characteristic of hospitals, fee reduction increased the monthly number of exams by 48.0% in a regression model. Regardless type of hospitals and severity of disease, the monthly number of exams increased during period of fee reduction. The number of exams in large-scaled hospitals (tertiary and general hospital) were increased more than those of small-scaled hospitals. Conclusion: Fee-reduction increased unnecessary diagnostic exams under the fee-for-service system. It is needed to define appropriate exam and change reimbursement system on the basis of guideline.

• Health Policy and Management
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• v.30 no.3
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• pp.277-285
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• 2020

Chronic diseases as well as a growing population of older adults are currently the leading cause of ill health and economic burden worldwide. Managing those diseases in one-on-one medical consultations poses substantial challenges due to limited time and resources in the current health care system. Various approaches have been taken to manage these conditions, most with limited success. Shared medical appointments (SMAs) are an innovative care delivery option to make the testing of alternative care modalities a prime concern. SMAs are individual medical consultations carried out in a group of patients with similar diseases by providing education, medication management, and disease monitoring. SMAs, since their initial conceptualization in 1998, have gained much popularity and adopted as one of the standard processes in many countries. Accumulated evidence-based studies show outcomes for increasing access to care, behavioral change facilitated through self-management education, maintained/better outcomes, physician productivity, and enhanced resource management. This review summarizes current evidence regarding the existing status of SMAs abroad. An extensive literature search was conducted on major electronic databases including PubMed and Google Scholar. This study suggests to explore and exploit the SMAs which have unique potential as a healthcare delivery innovation in Korea.