• 보건행정학회지
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• 제33권3호
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• pp.325-337
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• 2023

Background: While there are many studies estimating the effects of private health insurance on various types of health care utilization, few have examined how such effects change in conjunction with important policy reforms in national health insurance (NHI). This study examined how the effect of private health insurance (supplemental and fixed cash benefit) on high-cost outpatient imaging test utilization changed following the expansion of magnetic resonance imaging (MRI) coverage in 2018, which is a key example of the NHI benefit expansion policy in recent years. Methods: Data from the 2017 and 2019 Korea Health Panel Survey, which contained information about healthcare utilization before and after the expansion of MRI coverage in 2018, were used. The incremental effect of private health insurance on high-cost outpatient imaging test utilization for each period were quantified and compared, with special attention given to the type of private health insurance. Results: While people with supplemental private health insurance were more likely to use high-cost outpatient imaging tests than those without, both before and after the expansion of MRI coverage, the incremental effect increased from 1.6% points in 2017 to 2.5% points in 2019. Conclusion: Benefit expansion in NHI does not necessarily reduce disparities in the use of health care between private health insurance subscribers and non-subscribers. The results of our study also suggest that the path through which private health insurance affects healthcare utilization may not be limited to the price mechanism alone but can be more complex.

• 보건행정학회지
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• 제24권3호
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• pp.205-218
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• 2014

Background: Most studies on the national health insurance benefit expansion policy have focused on policy tools or decision-making process. Hence there was not enough understanding on how policies are actually implemented within the specific policy context in Korea which has a national mandatory health insurance system with a dominant proportion of private providers. The main objectives of this study is to understand the implementation process of the benefit coverage expansion policy. Unlike other implementation studies, we tried to examine both the process of implementation and decision making and how they interact with each other. Methods: Interviews were conducted with the ex-members of the Health Insurance Policy Review Committee. Medical doctors who implement the policy at the 'street-level' were also interviewed. To figure out major variables and the degree of their influences, the data were analyzed with Winter's Policy Implementation Model which integrates the decision making and implementation phases. Results: As predicted by the Winter model, problems in the decision making phase, such as conflicts among the members of committee, lack of applicable causal theories application of highly symbolic activities, and limited attention of citizen to the issue are key variables that cause the 'implementation failure.' In the implementation phase, hospitals' own financial interests and practitioners' dependence on the hospitals' guidance were barriers to meeting the policy goals of providing a better coverage for patients. Patients, the target group, tend to prefer physicians who prescribe more treatment and medicine. To note, 'fixers' who can link and fill the gap between the decision-makers and implementers were not present. Conclusion: For achieving the policy goal of providing a better and more coverage to patients, the critical roles of medical providers as street-level implementers should be noted. Also decision making process of benefit package expansion policy should incorporate its influence on the implementation phase.

• 보건행정학회지
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• 제27권3호
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• pp.191-198
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• 2017

Moon Jae-in Government announced the Government's 5-Year Plan on July 19, 2017, President Moon directly announced the Government's Plan for Benefit Expansion in National Health Insurance on August 7, 2017. The main contents of the announced expansion include benefit coverage for all medically necessary services with control over non-covered service occurrence, a decrease in the cost-sharing upper limit, and monetary support for catastrophic medical costs. Although past governments have been continuously striving for benefit expansion in the last 15 years, this plan has its breakthrough aspect in that all medical services will be covered by the National Health Insurance. In alignment, there are important tasks to solve: attaining a proper fee schedule, reforming the healthcare delivery system, and improving healthcare quality. This plan is a symptom oriented action in that it is limited in reducing patients' out-of-pocket money, unlike the systematic approach of the National Health Insurance. The sustainability of the National Health Insurance is being threatened due to South Korea's low birth rate, rapidly aging society, and low economic growth, in addition to the unification issue of the Korean Peninsula, medical utilization of the elderly, management of non-communicable diseases, and so on. Therefore, the Government needs to plan the National Health Insurance system reformation including actions addressed toward medical consumers.

• 한국사회정책
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• 제20권2호
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• pp.195-232
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• 2013

2009년 7월부터 도입된 양육수당은 보육시설을 이용하지 않고 가정 내에서 양육되는 아동에 대한 형평성 차원에서 양육수당이 제공되는 것으로 보육시설을 이용하지 않는 국민기초생활수급자와 차상위 계층 2세 미만 영아에 대해 월 10만 원을 아동양육수당으로 제공하면서 시작되었다. 그러나 2013년에는 소득에 관계없이 만 0~2세의 아동을 대상으로 만 0세 20만 원, 만 1세 15만 원, 만 2~5세 10만 원의 지원금을 제공하기로 개정되었다. 2013년의 이러한 정책변화는 전년도인 2012년의 양육수당 정책과 비교해 볼 때, 760%의 재정 증액이 이루어진 것으로 그 지원의 확대 정도가 이례적으로 매우 큰 것을 알 수 있다. 본 논문에서는 이러한 양육수당의 급격한 확대에 주목하며 양육수당 정책형성과정에 대한 정책네트워크 분석을 시도하였다. 분석 결과, 지방선거, 총선 및 대선이 정책형성 과정 행위자들의 상호작용 및 네트워크 구조 등에 즉각적인 영향을 주었는데, 즉 정당 행위자들은 양육수당의 확대가 정당 행위자들의 이익(선거결과)에 직접적인 영향을 준다고 판단하고 있었다. 이러한 정책경쟁 과정에서 정부부처들과의 예산과 관련된 갈등은 오히려 논의를 다양화시켜 양육수당 논의는 활성화 되었다. 또한 총선 이후 새누리당의 공약에서 시작된 양육수당의 확대는 비슷한 복지 공약 등을 내세운 박근혜 후보가 대통령에 당선되면서 구체적으로 정책채택 단계로 접어들어 정책형성과정과 정책채택과의 밀접한 관계도 확인하였다.

• Journal of Periodontal and Implant Science
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• 제46권6호
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• pp.405-414
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• 2016

Purpose: This study aimed to evaluate the effects of a policy change to expand Korean National Health Insurance (KNHI) benefit coverage to include scaling on access to dental care at the national level. Methods: A nationally representative sample of 12,794 adults aged 20 to 64 years from Korea National Health and Nutritional Examination Survey (2010-2014) was analyzed. To examine the effect of the policy on the outcomes of interest (unmet dental care needs and preventive dental care utilization in the past year), an estimates-based probit model was used, incorporating marginal effects with a complex sampling structure. The effect of the policy on individuals depending on their income and education level was also assessed. Results: Adjusting for potential covariates, the probability of having unmet needs for dental care decreased by 6.1% and preventative dental care utilization increased by 14% in the post-policy period compared to those in the pre-policy period (2010, 2012). High income and higher education levels were associated with fewer unmet dental care needs and more preventive dental visits. Conclusions: The expansion of coverage to include scaling demonstrated to have a significant association with decreasing unmet dental care needs and increasing preventive dental care utilization. However, the policy disproportionately benefited certain groups, in contrast with the objective of the policy to benefit all participants in the KNHI system.

• Journal of Preventive Medicine and Public Health
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• 제52권1호
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• pp.41-50
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• 2019

Objectives: The aim of this study was to investigate cancer patients' utilization of tertiary hospitals in Seoul before and after the benefit expansion policy implemented in 2013. Methods: This was a before-and-after study using claims data of the Korean National Health Insurance Service from 2011 to 2016. The unit of analysis was inpatient episodes, and inpatient episodes involving a malignant neoplasm (International Classification of Diseases, Tenth Revision codes: C00-C97) were included in this study. The total sample (n=5 565 076) was divided into incident cases and prevalent cases according to medical use due to cancer in prior years. The tertiary hospitals in Seoul were divided into two groups (the five largest hospitals and the other tertiary hospitals in Seoul). Results: The proportions of the incident and prevalent episodes occurring in tertiary hospitals in Seoul were 34.9% and 37.2%, respectively, of which more than 70% occurred in the five largest hospitals in Seoul. Utilization of tertiary hospitals in Seoul was higher for inpatient episodes involving cancer surgery, patients with a higher income, patients living in areas close to Seoul, and patients living in areas without a metropolitan city. The utilization of the five largest hospitals increased by 2 percentage points after the policy went into effect. Conclusions: The utilization of tertiary hospitals in Seoul was concentrated among the five largest hospitals. Future research is necessary to identify the consequences of this utilization pattern.

• 보건행정학회지
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• 제32권2호
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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.

• Journal of Information Science Theory and Practice
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• 제6권2호
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• pp.6-23
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• 2018

Digital Science's Dimensions is envisaged as a next-generation research and discovery platform for more efficient access to cross-referenced scholarly publications, grants, patents, and clinical trials. As a new addition to the growing open citation resources, it offers opportunities that may benefit a wide variety of stakeholders of scientific publications, from researchers and policy makers to the general public. In this article, we explore and demonstrate some of the practical potentials in terms of cascading citation expansions. Given a set of publications, the cascading citation expansion process can be iteratively applied to a set of articles so as to extend the coverage to more and more relevant articles through citation links. Although the conceptual origin can be traced back to Garfield's citation indexing, it has been largely limited, until recently, to the few who have unrestricted access to a citation database that is large enough to sustain such iterative expansions. Building on the open application program interface of Dimensions, we integrate cascading citation expansion functions in CiteSpace and demonstrate how one may benefit from these new capabilities. In conclusion, cascading citation expansion has the potential to improve our understanding of the structure and dynamics of scientific knowledge.

• 보건행정학회지
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• 제24권3호
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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.

• 대한안전경영과학회지
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• 제15권4호
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• pp.417-425
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• 2013

According to industrialization and urbanization the number of increasing cars is attributable to an explosive increase of the vehicle emissions. In this study, in consideration of the population and local transportation characteristics of South Chungcheong Province the environmental and economic cost-benefit analyses are performed to evaluate whether the CNG bus conversion gives what kind of effects. Based on the analysis result the expansion and distribution plan of CNG bus is proposed for South Chungcheong Province, and the local supply policy model is also proposed considering the acquisition and management of the economic situation of CNG charging infrastructure and the small transportation companies.