• Health Policy and Management
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• v.22 no.2
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• pp.207-224
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• 2012

This study estimates the total health expenditure of ambulatory dental care and explores the factors related to disbursements. The study used two waves of a 2008 Korea Health Panel (KHP) survey, of which each wave is composed of 7866 households and 24,659 persons. The KHP includes missing expanses of reimbursement data of the National Health Insurance (NHI), such as out-of-pocket, drugs, and private health insurance. The study estimates total monthly ambulatory dental expenditure and the sub-special categories of dental care. For influential factors analyses, the study exploits log-linear model with age, gender, education, job, equivalence income, the status of chronic diseases, means-tested benefit recipients, private insurance, and the composite deprivation index as independent variables. The total monthly outpatient health spending is estimated to be 102,468 won per household, and for dental, each household spends 31,115 won per month. Older age, means-test recipients, non-regular workers are more likely to spend less money on dental care, whereas private insurers, high income, and those who live in less deprived areas are more likely to spend more money for dental services. From the study we found that the KHP data are more suitable to estimate the total amount of health care markets, especially when the NHI coverage is low, such as for dental care in Korea.

• Health Policy and Management
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• v.24 no.3
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• pp.228-241
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• 2014

Background: The purpose of this study is to evaluate the effect of health insurance coverage expansion for cancer patients on equity in health care utilization and catastrophic expenditure. Methods: To analyze the causal relationship between the policy to expand benefit coverage and the change in health care utilization and out-of-pocket payments of cancer patients, this study employed a difference-in-differences (DID) method. In the DID model, the change in health care utilization, such as health care expenditure, visit days and length of stay, of cancer patients was compared with that of liver disease patients, using Korea Health Panel Data in 2009 and 2010. Results: The policy of reducing cost sharing from 10% to 5% for cancer patients did not have significant effects on equity in health care utilization. The results of this study were different from those of the previous study that showed that the reduction of cost sharing from 20% to 10% significantly improved the equity in health care utilization of cancer patients. In addition, the result of catastrophic expenditures analysis showed the policy did not change the probability of catastrophic expenditures. Conclusion: The results of this study imply that payment for non-covered services account for high out-of-pocket payments, and the reduction in cost sharing for covered services alone may have a limited effect on total financial burden on patients.

• Health Policy and Management
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• v.26 no.4
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• pp.343-351
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• 2016

Background: This study aims to analyze the effects of insurance types on the medical service uses for heart failure inpatients using propensity score matching (PSM). Methods: 2014 National inpatient sample based on health insurance claims data was used in the analysis. PSM was applied to control factors influencing the service uses except insurance types. Negative binomial regression was used after PSM to analyze factors that had influences on the service uses among inpatients. Subjects were divided by health insurance type, national health insurance (NHI) and medical aid (MA). Total charges and length of stay were used to represent the medical service uses. Covariance variables in PSM consist of sociodemographic characteristics (gender, age, Elixhauser comorbidity index) and hospital characteristics (hospital types, number of beds, location, number of doctors per 50 beds). These variables were also used as independent variables in negative binomial regression. Results: After the PSM, length of stay showed statistically significant difference on medical uses between insurance types. Negative binomial regression provided that insurance types, Elixhauser comorbidity index, and number of doctors per 50 beds were significant on the length of stay. Conclusion: This study provided that the service uses, especially length of stay, were differed by insurance types. Health policy makers will be required to prepare interventions to narrow the gap of the service uses between NHI and MA.

• Health Policy and Management
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• v.30 no.1
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• pp.37-49
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• 2020

Background: Unmet healthcare needs have many advantages for measuring inequalities in healthcare use. However, the existing indicator is difficult to capture the reality of unmet healthcare needs sufficiently and is not quite appropriate in comparing regional inequality. The purpose of this study is to critically analyze the utilization of the unmet healthcare need indicator for regional healthcare inequalities research. Methods: We used the level of healthcare accessibility and healthcare need to categorize the regions that are known to cause differences in healthcare utilization between regions and verified how existing unmet healthcare need indicator is distributed at the regional level. Results: Four types of regions were classified according to the high and low levels of healthcare needs and accessibility. The hypothesis about the regional type expected to have the highest unmet healthcare need was not proved. The hypothesis about the lowest expected regional type was proved, but the difference in the average rate of unmet healthcare needs among regional types was not significant. The standard deviation of the rate of unmet healthcare needs among regions within the same type was also higher than the overall regional variation, which also disproved the whole frame of hypothesis. Conclusion: Failure to prove the hypothesis means the gap between the supposed meaning of the indicator and the reality. In order to understand the current state of healthcare utilization of people in various regions of Korea and to resolve inequality, fundamental research on the in-depth structure and mechanisms of healthcare utilization is needed.

• Health Policy and Management
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• v.11 no.1
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• pp.107-130
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• 2001

During the last year, we had a very severe situation with the strike of physicians working in medical facilities. From that time, many politicians and scholars insisted on the expansion of public hospitals to enhance the public role in the medical care sector. They think that private medical facilities work for profit motivation and that the high proportion of private to whole facilities is an obstacle to the public function of medical care under social insurance system. They found that one of the reasons for failing to prevent the physicians' strike was the high proportion of private facilities. Others insisted that the strike was not a good reason for the expansion of public hospitals. The physicians' strike was a very rare case, and it is not a good basis for generalization of the discussion of public hospitals. Last year almost all apprentice physicians in public facilities took part in the strike, and consequently the public hospitals also lost the role of public function. They view this increasing involvement of government in the medical sector as improper and the cause of inefficiencies. In this paper we review the debate over the expansion of public facilities. To clarify the debate, we review traditional criteria for the role of government in a market system and to apply these criteria to medical care. There are two traditional areas where government Is acknowledged to have a role in a market system: market imperfections and market failure. Where market imperfections and market failure exist, there may be a role for government. The justifications for government intervention are consumer protection and the existence of externalities. One of externalities is to provide medical care for the poor. The appropriate measures to provide medical owe to the poor can be sought in both demand and supply side subsidies. National health insurance is a method of demand subsidies and establishment of public hospitals is a method of supply side subsidies. Under the National Health Insurance System, the expansion of public hospitals is not an appropriate subsidy policy.

• Health Policy and Management
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• v.28 no.1
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• pp.35-47
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• 2018

Background: The purpose of this study is to elucidate the context of medical experience and the perception of unmet healthcare of elderly people with chronic diseases based on in-depth interview data. Methods: We carried out in-depth interviews with 10 elderly people with chronic diseases using semi-structured questionnaires based on literature review. The in-depth interview data were analyzed using thematic analysis; one qualitative research methodology, three core meaning categories, and four attributes associated with unmet healthcare were ultimately derived. Results: The context of the medical experience were based on the following three categories: (1) discomfort due to diseases and high medical needs, (2) the poor community medical environment and difficulties in accessing to metropolitan medical institutions, and (3) inconvenience caused by long waiting time and side effects of medicine. In addition, the elderly with chronic disease realized the unmet healthcare as (1) the availability related to the desired medical institutions at the right time, (2) the affordability related to their economic capacity, (3) the effectiveness of the medical services they experienced, and (4) the appropriateness related to receiving medical services in a pleasant environment. Conclusion: The perception of unmet healthcare among the elderly with chronic disease is the result of interaction of multi-level and multi-dimensional factors related with their medical experience.

• Korea Journal of Hospital Management
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• v.23 no.4
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• pp.53-64
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• 2018

Purposes: The hospitals needs to generate a minimum profit, in order to perform its own role such as providing high-quality medical services. The demand for hospital management is increasing, as the social demands are diversified and the financial transparency is emphasized. The purpose of this study is to compare hospitals management based on Dupont Identity, by various hospital classification. Methodology: This study is based on '2016 Statistics for Hospital Management' provided by the Korea Health Industry Development Institute. The hospitals were classified according to the scope of care, the type of establishment, the location, and the number of beds. We analyzed the general and financial characteristics of over 337 hospitals using the method of Dupont Identity. Findings: Net profit margin (PM) has the biggest impact on return of equity (ROE). By the number of beds, general hospital with 160-299 beds have the highest return on equity (ROE). By location, hospitals in local municipalities have higher return on equity than hospitals in urban municipalities. According to the type of establishment, public hospitals have lower business performance, and although they invest more than private hospitals. Practical Implications: This study can inspire interest and provide understanding in hospital management and financial structure, by analyzing through an intuitive indicator named Dupont identity. It is possible to provide basic data for hospital management methods for each financial elements, in order to increase the profitability of hospitals.

• Health Policy and Management
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• v.32 no.4
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• pp.389-399
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• 2022

Background: This study aimed to analyze changes in medical utilization and cost before and after long-term care (LTC) implementation. Methods: We used the National Health Information Database from National Health Insurance Service. The participants were selected who had a new LTC grade (grade 1-5) for 2015. Medical utilization was analyzed before and after LTC implementation. Segmented regression analysis of interrupted time series was conducted to evaluate the overall effect of the LTC implementation on medical costs. Results: The total number of participants was 41,726. A major reason for hospitalization in grade 1 was cerebrovascular diseases, and dementia was the top priority in grade 5. The proportion of hospitalization in grade 1 increased sharply before LTC implementation and then decreased. In grade 5, it increased before LTC implementation, but there was no significant difference after LTC implementation. As for medical cost, in grades 1 to 4, the total cost increased sharply before the LTC implementation, but thereafter, changes in level and trend tended to decrease statistically, and for grade 5, immediately after LTC implementation, the level change was decreasing, but thereafter, the trend change was increasing. Conclusion: Long-term care grades showed different medical utilization and cost changes. Long-term care beneficiaries would improve their quality of life by adequately resolving their medical needs by their grades.

• Journal of the Korean Geographical Society
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• v.50 no.3
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• pp.325-338
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• 2015

Telemedicine, which gives or receives medical information via ICT (information and communication technology), is regarded as innovation in a medical field and its application is various according to offline conditions. For example, the utilization of telemedicine in Korea is unfair because of the administrative discretion, which is the basic unit of telemedicine for its practical operation, in spite of the same diagnostic area. With this mind, this study investigates the cause of regional differences of telemedicine through a case of Kangwon province. Furthermore, the crucial matter is that regional differences of telemedicine are associated with digital divide; therefore, this research considers digital divide triggered by telemedicine. The core results are as follows. First, there are little measures such as increase of the staff, economic compensation for public officials, education of telemedicine facilities; accordingly, only regions, where can accept these insufficient conditions, manage the telemedicine system. Second, the interesting of a mayor or a governor and a head of a health center as a highest decision maker has something to do with different utilization of telemedicine. Third, public health doctors play a role as practical operators in telemedicine, but their stance is skeptic about telemedicine somewhat because of the relationship with the medical association opposing the implementation of telemedicine, unimproved regional health care condition, etc. Forth, it seems that the digital divide caused by the regional differences of the present telemedicine utilization does not led to tangible results and is not turned to another disparity so far, the proper measures are required considering that various health care services based on telemedicine will be extended.

• Journal of the Health Care and Life Science
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• v.9 no.1
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• pp.203-211
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• 2021

In this study, we investigated whether the degree of anxiety, depression, stress, and ego resilience in the COVID-19 epidemic situation could affect the quality of life of college students and analyzed the correlation between them. In addition, the causal relationship and mediating effect on ego resilience, stress and quality of life were analyzed and necessary countermeasures were proposed. As a result of analyzing the correlation between each variable, it was found that anxiety, depression, stress, quality of life, and self-resilience all had significant correlations. In particular, stress was found to play a complete mediating role in the effect of ego resilience on quality of life. It is expected that this study will be used as a basis for research on the effect of stress and self-resilience on the improvement of quality of life in the Corona situation.