• Health Policy and Management
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• v.27 no.4
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• pp.273-275
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• 2017

It has been forty years since the implementation of National Health Insurance (NHI) in South Korea. Following the 1977 legislature mandating medical insurance for employees and dependents in firms with more than 500 employees, South Korea expanded its health insurance to urban residents in 1989. Resultantly, total expenses of the National Health Insurance Service (NHIS) have greatly increased from 4.5 billion won in 1977 to 50.89 trillion won in 2016. With multiple insurers merging into the NHI system in 2000, a single-payer healthcare system emerged, along with separation policy of prescribing and dispensing. Following such reform, an emerging financial crisis required injections from the National Health Promotion Fund. Forty years following the introduction of the NHI system, both praise and criticism have been drawn. In just 12 years, the NHI achieved the fastest health population coverage in the world. Current medical expenditure is not high relative to the rest of the Organization for Economic Cooperation and Development. The quality of acute care in Korea is one of the best in the world. There is no sign of delayed diagnosis and/or treatment for most diseases. However, the NHI has been under-insured, requiring high-levels of out-of-pocket money from patients and often causing catastrophic medical expenses. Furthermore, the current environmental circumstances of the NHI are threatening its sustainability. Low birth rate decline, as well as slow economic growth, will make sustainment of the current healthcare system difficult in the near future. An aging population will increase the amount of medical expenditure required, especially with the baby-boomer generation of those born between 1955 and 1965. Meanwhile, there is always the problem of unification for the Korean Peninsula, and what role the health insurance system will have to play when it occurs. In the presidential election, health insurance is a main issue; however, there is greater focus on expansion and expenditure than revenue. Many aspects of Korea's NHI system (1977) were modeled after the German (1883) and Japanese (1922) systems. Such systems were created during an era where infections disease control was most urgent and thus, in the current non-communicable disease (NCD) era, must be redesigned. The Korean system, which is already forty years old, must be redesigned completely. Although health insurance benefit expansion is necessary, financial measures, as well as moral hazard control measures, must also be considered. Ultimately, there are three aspects that we must consider when attempting redesign of the system. First, the health security system must be reformed. NHI and Medical Aid must be amalgamated into one system for increased effectiveness and efficiency of the system. Within the single insurer system of the NHI must be an internal market for maximum efficiency. The NHIS must be separated into regions so that regional organizers have greater responsibility over their actions. Although insurance must continue to be imposed nationally, risk-adjustment must be distributed regionally and assessed by different regional systems. Second, as a solution for the decreasing flow of insurance revenue, low premium level must be increased to an appropriate level. Likewise, the national reserve fund (No. 36, National Health Insurance Act) must be enlarged for re-unification preparation. Third, there must be revolutionary reform of benefit package. The current system built a focus on communicable diseases which is inappropriate in this NCD era. Medical benefits must not be one-time events but provide chronic disease management. Chronic care models, accountable care organization, patient-centered medical homes, and other systems that introduce various benefit packages for beneficiaries must be implemented. The reimbursement system of medical costs should be introduced to various systems for different types of care, as is the case with part C (Medicare Advantage Program) of America's Medicare system that substitutes part A and part B. Pay for performance must be expanded so that there is not only improvement in quality of care but also medical costs. Moreover, beneficiaries of the NHI system must be aware of the amount of their expenditure through a deductible payment system so that spending can be profiled and monitored. The Moon Jae-in Government has announced its plans to expand the NHI system; however, it is important that a discussion forum is created so that more accurate analysis of the NHI, its environments, and current status of health care system, can take place for reforming NHI.

• Journal of dental hygiene science
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• v.17 no.4
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• pp.323-332
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• 2017

This study aimed to investigate the factors influencing the decision on whether to receive regular oral check-ups among the national health insurance beneficiaries with income and aged over 20 years in Korea. This was a cross-sectional study, using the data from the 2014 6th Korea National Health and Nutrition Examination Survey (KNHANES VI-2), conducted by the Korea Centers for Disease Control and Prevention. The final sample included 2,843 subjects who participated in the health examination survey and oral check-ups. The IBM SPSS Statistics ver. 20.0 was used for the statistical analysis, based on the complex sampling design. The Rao-Scott chi-square test was used to verify the difference in the distribution of independent variables with regard to oral check-ups. The binary logistic regression analysis was used to determine the influencing factors. The ratio of beneficiaries who received oral check-ups was less than half of those who received medical examinations. The Rao-Scott chi-square test, revealed significant differences in the age group (p<0.05) of the predisposing factors, toothache within a year (p<0.001), untreated dental caries (p<0.001) of the need factors, personal income level (p<0.001), educational level (p<0.001), type of medical insurance (p<0.001), and private health insurance (p<0.01) of the enabling factors. In the binary logistic regression analysis, factors influencing oral check-ups were age group, personal income level, educational level, toothache within a year, and untreated dental caries. These findings show a variety of factors influencing the utilization of regular oral check-ups.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.5
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• pp.1897-1904
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• 2010

The administration data of the national health insurance and health insurance bills were utilized in this study. The data of 432,915 patients who were at the age of 30 and up and used the out-patient departments of every medical institution located in some regions involving two southern and northern provinces once or more during a 184-day period from July to December. As a result of analyzing their prescription compliance and factors affecting it, the following findings were given: The average rate of the prescription compliance of the patients stood at 61.5 percent. It denoted that they were prescribed to take medicine for approximately 113 days during the six-month(184 days) period of time, and the rate of the patients who complied with the prescriptions just stood at 13.0 percent. They used out-patient department for 4.3 days on the average due to hypertension and they visited 1.1 medical institutions on the average. 94.9 percent just used a medical institution. The largest group (11.6%) suffered from diabetes as co-morbidity, and 23.3 percent of the hypertensives had co-morbidity. Concerning the relationship between their characteristics and prescription compliance, those who were male, who were beneficiaries of the national health insurance, who mainly used general hospitals and who suffered from co-morbidity complied better with the prescription they got. Their prescription compliance got better at the age of 65 to 74 and got worse afterwards. As for factors affecting their prescription compliance, the patients who were male, who were aged between 55 and 64 and who were beneficiaries of the national health insurance, who mainly used specialized general hospitals, general hospitals and public health centers and who had heart diseases and diabetes as co-morbidity complied better with the prescriptions. The above-mentioned findings of the study suggested that it's needed to make a factor analysis of the poor prescription compliance of patients from diverse angles, and that existing hypertension care plans should carefully be reviewed to improve the prescription compliance of patients and to find a feasible alternative. As hypertensives are easily likely to develop co-morbidity like diabetes, systematic health education should be provided for them to get into the right life habits such as taking low-salt meals or quitting smoking. In addition, the development of health care programs is required.

• Journal of agricultural medicine and community health
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• v.36 no.4
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• pp.238-250
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• 2011

Objectives: This study was performed to investigate the service needs of the beneficiaries who had enrolled in home-based management programs for cancer patients. Methods: From March to May 2009, 676 cancer patients who were registered in home-based cancer patient management programs were selected as subjects for this study. The data were collected using a questionnaire along with a face-to-face interview performed by officers in charge of the home-based care programs of 47 regional health centers. Fifteen patients were excluded due to incomplete data, leaving 661 subjects who were ultimately enrolled in the study. Results: The mean age of subjects was $64.0{\pm}2.5$ years, and males comprised 45.1% (298/661) of the sample. The results of factor analysis for service needs showed that there were five main categories and Cronbach's alpha ranged from 0.593 to 0.890 for each factor. The service needs categories in order of importance were social support, information and education, psychological problems, physical symptoms and household chores. The service needs scores were significantly different when subjects were stratified by age, habitation, religion and disease classification. When we divided the subjects into complete remission, under treatment and terminally ill groups, the needs scores of the terminally ill patient group were significantly higher than those of the other groups (p<0.001). Conclusions: Service provision based on patient and beneficiary needs could be an effective intervention to reduce the economic burden of cancer management and to improve the quality of life of cancer patients receiving home-based care. Therefore, it is recommended that individual cancer patient care programs be developed and administered according to patient age, habitation and disease severity.

• Journal of Elementary Mathematics Education in Korea
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• v.13 no.2
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• pp.163-192
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• 2009

Currently, our country operates gifted education only as a special curriculum, which results in many problems, e.g., there are few beneficiaries of gifted education, considerable time and effort are required to gifted students, and gifted students' educational needs are ignored during the operation of regular curriculum. In order to solve these problems, the present study formulates the following research questions, finding it advisable to conduct gifted education in elementary regular classrooms within the scope of the regular curriculum. A. To devise a teaching plan for the gifted students on mathematics in the elementary school regular classroom. B. To develop a learning program for the gifted students in the elementary school regular classroom. C. To apply an in-depth learning program to gifted students in mathematics and analyze the effectiveness of the program. In order to answer these questions, a teaching plan was provided for the gifted students in mathematics using a differentiating instruction type. This type was developed by researching literature reviews. Primarily, those on characteristics of gifted students in mathematics and teaching-learning models for gifted education. In order to instruct the gifted students on mathematics in the regular classrooms, an in-depth learning program was developed. The gifted students were selected through teachers' recommendation and an advanced placement test. Furthermore, the effectiveness of the gifted education in mathematics and the possibility of the differentiating teaching type in the regular classrooms were determined. The analysis was applied through an in-depth learning program of selected gifted students in mathematics. To this end, an in-depth learning program developed in the present study was applied to 6 gifted students in mathematics in one first grade class of D Elementary School located in Nowon-gu, Seoul through a 10-period instruction. Thereafter, learning outputs, math diaries, teacher's checklist, interviews, video tape recordings the instruction were collected and analyzed. Based on instruction research and data analysis stated above, the following results were obtained. First, it was possible to implement the gifted education in mathematics using a differentiating instruction type in the regular classrooms, without incurring any significant difficulty to the teachers, the gifted students, and the non-gifted students. Specifically, this instruction was effective for the gifted students in mathematics. Since the gifted students have self-directed learning capability, the teacher can teach lessons to the gifted students individually or in a group, while teaching lessons to the non-gifted students. The teacher can take time to check the learning state of the gifted students and advise them, while the non-gifted students are solving their problems. Second, an in-depth learning program connected with the regular curriculum, was developed for the gifted students, and greatly effective to their development of mathematical thinking skills and creativity. The in-depth learning program held the interest of the gifted students and stimulated their mathematical thinking. It led to the creative learning results, and positively changed their attitude toward mathematics. Third, the gifted students with the most favorable results who took both teacher's recommendation and advanced placement test were more self-directed capable and task committed. They also showed favorable results of the in-depth learning program. Based on the foregoing study results, the conclusions are as follows: First, gifted education using a differentiating instruction type can be conducted for gifted students on mathematics in the elementary regular classrooms. This type of instruction conforms to the characteristics of the gifted students in mathematics and is greatly effective. Since the gifted students in mathematics have self-directed learning capabilities and task-commitment, their mathematical thinking skills and creativity were enhanced during individual exploration and learning through an in-depth learning program in a differentiating instruction. Second, when a differentiating instruction type is implemented, beneficiaries of gifted education will be enhanced. Gifted students and their parents' satisfaction with what their children are learning at school will increase. Teachers will have a better understanding of gifted education. Third, an in-depth learning program for gifted students on mathematics in the regular classrooms, should conform with an instructing and learning model for gifted education. This program should include various and creative contents by deepening the regular curriculum. Fourth, if an in-depth learning program is applied to the gifted students on mathematics in the regular classrooms, it can enhance their gifted abilities, change their attitude toward mathematics positively, and increase their creativity.

• Health Policy and Management
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• v.2 no.2
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• pp.221-237
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• 1992

The reasons for cost inflation in medical insurance expenditure are classified into demand pull inflation and cost push inflation. The former includes increase in the number of beneficiaries and utilization rate, while the latter includes increase in medical insurance fee and the charges per case. This study was conducted to analyze sources of increases of expenditure in medical insurance demonstration area by the period of 1982-1987 which was earlier than national health insurance and the period of national health insurance(1988-1990). The major findings were as follows: Medical expenditure in these areas increased by 9.4%(15.1%) annually between 1982 and 1990 on the basis of costant price(current price) and for this period, the yearly average increasing rate of expenses for outpatient care[10.5%(15.8%)] was higher than that of inpatient care [7.3%(12.6%)]. Medical expenditure increased by 6.3%(8.9%) annually between 1982 and 1987, the period of medical insurance demonstration, while it increased by 10.7%(18.9%) after implementing national health insurance(1988-1990). Medical expenditure increased by 35.9%(45.9%) between 1982 and 1987. Of this increase, 115.2%(92.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 61.0%(68.1%) was due to the increase in the charges per case, but the expenditure decreased by 76.2%(60.2%) due to the reduction in the number of beneficiaries. Beteen 1988 and 1990, the period of national health insurance, medical expenditure increased by 21.2%(41.4%). Of this increase, 87.5%(46.4%) was attributable to the increase in the frequencies of utilization per beneficiary and 52.4%(73.4%) was due to the increase in the charges per case, and of the increase in the charges per case, 69.6%(40.8%) was attributable to the increase in the days of visit per case. Medical expenses per person in these areas increased by 78.2%(89.0%) between 1982 and 1987. Of this increase, 76.6%(69.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 23.4%(30.9%) was due to the increase in the charges per case. For this period, demand-pull factor was the major cause of the increase in medical expenses and the expenses per treatment day was the major attributable factor in cost-push inflation. Betwee 1988 and 1990, medical expenditure per person increased by 31.2%(53.1%). Of this increase, 60.8%(37.2%) was attributable to the demand-pull factor and 39.2%(62.8%) was due to the increase in the charges per case which was one of cost-push factors. In current price, the attributalbe rate of the charges per case which was one of cost-push factors was higher than that of utilization rate in the period of national health insurance as compared to the period of medical insurance demonstration. In consideration of above findings, demand-pull factor led the increase in medical expenditure between 1982 and 1987, the period of medical insurance medel trial, but after implementing national health insurance, the attributable rate of cost-push factor was increasing gradually. Thus we may conclude that for medical cost containment, it is requested to examine the new reimbursement method to control cost-push factor and service-intensity factor.

• 한국노년학
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• v.30 no.4
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• pp.1359-1375
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• 2010

Expecting the expansion of the elderly population under long-term home care with the coming of the aged society, this study purposed to propose a prevention and self-reliance support model and to get practical implications for minimizing dependency on care benefits and enhancing the effectiveness of prevention and self-reliance support. Research methods employed for this study were: first, reviewing theoretical literature for clarifying the concept of prevention and self-reliance support in providing long-term care benefits for the elderly; second, identifying factors hindering prevention and self-reliance support through analyzing standard long-term care use plans and documents related to long-term care benefits at elderly welfare centers to which the research subjects belonged; and third, surveying care benefit users on factors hindering their use of prevention and self-reliance support and their needs in the use of care benefits. Based on the results of the three types of qualitative research, we proposed directions for prevention and self-reliance support modeling and suggested practical implications for enhancing the effectiveness of prevention and self-reliance support. For this study, we collected documentary materials and conducted in-depth interviews with the participants with the consents and cooperation of managers and professional social workers at day care centers and elderly welfare centers in D City. According to the results of this study, literature review suggested that long-term care prevention and self-reliance support should be provided in a way of 'strengthening user-centered support systems,' which support elderly long-term care beneficiaries' right to lead a life as the subject of their own life. Document analysis found the absence of benefits related to health and medicine and lack of social support systems for prevention and self-reliance support, and the results of in-depth interviews suggested the necessity to strengthen services related to elderly long-term care beneficiaries' prevention and self-reliance, and the keen needs of the long-term care elders for prevention and self-reliance included: ① loneliness, anxiety, fear; ② missing for and worry about children and people; ③ moving, outing; ④ health and medical services, rehabilitation programs; ⑤ desire to use day care; ⑥ inconvenience of house structure; ⑦desire for meal menus; and ⑧ the occurrence of disuse syndrome. Based on these results, we suggested the base of prevention and self-reliance support modeling with three axes: ① strengthening user-centered support systems; ② strengthening support systems connected to health and medicine; and ③ strengthening social support systems.

• 한국노년학
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• v.39 no.3
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• pp.517-529
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• 2019

The study was conducted on the impact of employment types middle and old age group of wage earner on life satisfaction and analyzed by dividing it into variables in the employment types and demographic characteristics. Based on the data for the 12th year of the Korea Welfare Panel Study, 1,244 respondents who answered that the main types of economic activities were 'full-time, temporary, daily wage earners' or 'self-help labor, public labor, and elderly empolyment program in public sector.' among 4,341 people over 55 years of age under the age of 75 as of 2017 standard. The survey covered 1,244 people. By age group, 826 people aged 55-64 (middle-age group) and 418 people aged 65-74(old-age group). Middle age group showed that education level, spouse, health condition, beneficiaries of basic livelihood and average monthly income variables were the factors that influence the satisfaction of life. But The type of employment did not significantly affect. Old age group showed that the higher education level, in spouse with-living or spouse death, the better health condition is perceived, the less experience of beneficiaries of basic livelihood, the higher average monthly income, the more satisfied life is. The survey also found that old-aged people who participate in "self-help labor, public labor, and elderly employment program in public sector" are also found to be more satisfied with their lives. According to these results, policy for the old age group should be focused on hunting and expanding of employment program in public sector for the elderly. In order to boost life satisfaction of the elderly, more intensive vocational education and employment training should be provided.

• Journal of Internet Computing and Services
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• v.16 no.4
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• pp.121-130
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• 2015

Technology based start-up is actively encouraged for job creation and economic performance in Korea. The Korean government has implemented a variety of policy for regulatory improvement to vitalize technology based start-up. In order to maximize the effectiveness of the policy for regulatory improvement should be actively reflect the opinions of policy beneficiaries. In this study, The importance of "The progress plan for regulation improvement about vitalization of start-up(25 contents)" published by the government was analyzed using AHP method. The object of study is the beneficiary of the policy(CEO of ICT sector). Analysis showed that the 25 contents were classified into four(1 - expectation of effect, 2 - urgency of system enforcement, 3 - complement of deficiencies, 4 - after careful consideration). This study has a academic significance to quantitative analysis about importance of policy for regulatory improvement. Also, It can be utilized when policy making and practice about technology based start-up.

• Journal of Korean society of Dental Hygiene
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• v.8 no.2
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• pp.1-12
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• 2008

The purpose of this study was to examine the state of visiting oral health programs and the opinions of dental hygienists on the programs in a bid to help boost the efficiency of visiting oral health programs, To meet the goals, 341 dental hygienists in public dental clinics across the nation were asked to join a questionaire survey via e-mail in September 2007, After their views were investigated, the following findings were given: 1. In regard to the management of visiting oral health programs, 44,3 percent of the respondents carried out visiting oral health programs, and 48,3 percent of that group did that in association with visiting health care programs, There were differences among the public dental clinics in beneficiaries of visiting oral health programs, beneficiary selection criteria and the details of oral health programs, which indicated the necessity of the development of standardized models. 2. As to difficulties in fulfilling visiting health care programs, a shortage of professional knowledge was viewed as the greatest hurdle, All their scores were above average, which implied that they were not able to perform the programs successfully. 3. As for the necessity and additional expected effects of visiting oral health programs, the largest number of the dental hygienists who carried them out expected that the programs would serve to change the mind-set of locals about themselves, And the others who didn't placed the most emphasis on cooperation from other departments, and the two groups had a statistically significantly different opinion. 4. Concerning the details of visiting health care programs, the dental hygienists who performed the programs found it most necessary to provide oral health education to employees and families to be visited, The others who didn't considered it most necessary to offer oral health education to people to be visited, The necessity of denture and prosthesis was least stressed by both groups, and they took a significantly different view of treatment for dental diseases, denture and prosthesis. 5. Regarding how to bolster visiting health care programs, the dental hygienist group that carried them out put more emphasis on everything suggested in the survey, Specifically, they attached greater importance to securing sufficient budget, establishing legal foundation, setting up an administration system and determining the directions for the programs in a realistic manner, which signified the desperate need for administrative and institutional backing.