• Journal of Korean Academy of Nursing
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• v.42 no.7
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• pp.928-935
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• 2012

Purpose: The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. Methods: Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. Results: Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. Conclusion: The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.

• Korean Journal of Clinical Pharmacy
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• v.18 no.2
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• pp.124-131
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• 2008

The impacts of guideline for digestives on physicians' prescription of GI medication Clinical practice guidelines provide benefits to physicians, patients, and researchers. It also helps doctors to make decisions in medical services. In many countries, practice guidelines lead to activities of quality improvement and are developed using evidence based methods. This research was to assess the impacts of Korean Medical Association's guideline for digestives on the change of physicians' behavior. This study was progressed as one-group pre-test post-test quasi-experimental design using health insurance claims data. The unit of analysis was institution. Data was analyzed using paired t-test for change of prescription rate before and after the distribution of practice guidelines. And the multiple regression analysis was performed to examine the independent impact of the guideline on the prescribing rate of GI medication. Prescription rates of GI medication per claim by medical institution increased significantly, 1.98%point (from 50.27% to 52.25%) and multivariate regression analysis showed significant increase in the prescription rate of GI medication after the distribution of guideline (p<0.001). In conclusion, the distribution of guideline for digestive might not have the effects on the change in provider's behavior. Furthermore, to activate the use of practice guideline, it would be necessary to educate the contents to physicians as well as to develop practice guideline.

• Research in Community and Public Health Nursing
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• v.18 no.4
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• pp.593-600
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• 2007

Purpose: This research was carried out to present an ideal cooperative model between the public and private health sectors for the management of community dementia patients. Method: In this study a public-private cooperative council was formed, basic data for dementia patients and their families were collected, and a dementia service program was carried out in cooperation between the two sectors. Results: The survey data shows the majority of the registered patients were undergoing a chronic diseases which would make the dementia health service inefficient. The cooperative public-private council adopted the reinforcement of medical service to the public enrolled dementia patients. The intensive medical service program showed effects on the health status of the dementia patients. Conclusion: The results of this study pointed out that change of the health insurance program supportive to the private sectors to be made; a referral system for the public health sector to the private sector should be established; and expanding the capacity of the visiting health program in the public health sector is needed.

• Health Policy and Management
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• v.30 no.2
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• pp.192-198
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• 2020

Background: Korea National Health Insurance Service (NHIS) is operated as a social insurance system in which people pay a portion of their monthly income as insurance premiums and receive benefits when they experience illness or injury. Since 2005, the national health insurance remained surplus accumulating cumulative reserves each year. However, as of 2018, NHIS revenue recorded 62.11 trillion won and spending of 62.29 trillion won. The deterioration of NHIS finances is expected to accelerate with the aging population, income growth, new medical technology development, and enhanced security policies. Methods: To examine the financial health and sustainability of NHIS, we estimated the future revenue and spending until 2030 using the data from Korea Health Insurance Review and Assessment Service statistical yearbook. 2004-2018 average percentage change in NHIS revenue and spending was calculated. We estimated the future NHIS financial status using two methods. In the first method, we calculated the revenue and spending of the future NHIS by applying the 2004-2018 average percentage change to the subsequent years consecutively. In the second method, we estimated the future NHIS financial status after adjusting for the predicted demographic changes such as the aging population and declining birth rate in South Korea. Results: The estimates from this study suggest that the NHIS's cumulative reserves will run out by 2024. Conclusion: In terms of spending on current health insurance, there should be a search for ways of more efficient spending and funding options.

• Korean Journal of Health Education and Promotion
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• v.24 no.1
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• pp.127-138
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• 2007

Objectives: This study aims to examine if the follow-up management service by National Health Insurance (NHI) for person at health risk leads to significant modification of the lifestyle and change of health status. Methods: Of persons who underwent health screening and were classified as having health risks after periodic health screening by NHI in 2003, persons who took the follow-up management service were selected as case group and persons who took no service were selected as control group. The DW database of NHI was used to explore the effect of the follow-up management service on the modification of health status and lifestyle. Chi-square tests were conducted with SAS 9.1 to examine the differences of health promotion effect between case vs. control group. Results: It was shown that of lifestyle behaviors, only exercise was significantly improved for case group compared with control group as the effect of the follow-up management service by NHI (2.98%p) (p<.0001). Further, morbidity rate for control group was 2% higher than that of case group (p <.0001), which indicates that persons who received the follow-up management service better maintained their health significantly than persons who did not. Conclusions: The present study shows that the appropriate follow-up management services need to be provided for maximizing potential effect of periodic health screening by NHI.

• The Korean Journal of Health Service Management
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• v.6 no.2
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• pp.165-177
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• 2012

This study examined market size of private health insurance premium and individual characteristics associated with the market size change in Korea, using wave 1 (2008) and wave 2 (2009) of Korea Health Panel. The market size was 24.4 trillion Korean won in 2008 and 26.9 trillion in 2009. The increase rate of private health insurance premium among those who were the elderly, single, or the poor was higher than that among their counterpart respectively. Health status and utilization were insignificant in determining the increase rate of private health insurance premium. These findings were more obvious among the uninsured in 2008 than among the insured in 2008. The increase of private health insurance premium in Korea imply the increase of willingness-to-pay for health risk through private sector. The authors suggest policy intervention for accessability to health care for the underprivileged and weak through enlargement of Korean social health insurance benefit.

• Journal of Preventive Medicine and Public Health
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• v.24 no.1 s.33
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• pp.16-28
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• 1991

Service diversification is recognized as an important strategy against turbulent environmental change. This study is designed to find out the trend of service diversification in Korean health care organizations and also to identify factors associated with the degree of service diversification. Data were collected from 69 hospitals out of 71 hospitals with over 300 beds. Important findings are summarized below. 1. Types of diversification are closely related to hospital size. Large hospitals have a tendency to provide sophisticated services requiring specialized skills and equipment, while small hospital have concentrated their efforts on health screening programs. 2. The more competitive and bigger hospitals are, the greater number of services that provide. Also, hospitals operating rational management information systems provide more services. Contrary to the expectation hospitals with a low performance during last 3 years showed more service diversification. 3. A trend of more diversification was observed in hospitals whose chief executive officer used a prospector strategy. 4. A multiple regression analysis revealed that bed size, competitive environment, degree of rational management, and the growth pattern were significantly associated with the service diversification.

• Korean Journal of Health Education and Promotion
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• v.26 no.3
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• pp.75-83
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• 2009

Objectives: This study aims to examine if the follow-up management service by National Health Insurance (NHI) for obesity persons leads to significant modification of the lifestyle and change of health status. Methods: Of persons who underwent health screening and were classified as obesity after periodic health screening by NHI in 2004, persons who took the follow-up management service were selected as case group and persons who took no service were selected as control group. The DW database of NHI was used to explore the effect of the follow-up management service on the modification of lifestyle and health status. Chi-square tests and t-tests, pairs t-tests were conducted with SAS 9.1 to examine the differences of health promotion effect between case vs. control group. Results: It was shows that of lifestyle behaviors, only exercise is significantly improved for case group compared with control group as the effect of the follow-up management service by NHI (2.11%p) (p=0.0435). Further, morbidity rate for control group was 2.05% higher than that of case group (p=0.0002). These results indicate that persons who received the follow-up management service better maintained their health significantly than persons who did not. Conclusion: The present study shows that the appropriate follow-up management services need to be provided for maximaizing potential effect of periodic health screening by NHI.

• The Korean Journal of Health Service Management
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• v.12 no.1
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• pp.1-11
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• 2018

Objectives : The purpose of this study was to identify the relationship between decision-making types, public entrepreneurship, and performance management of local public hospital directors. Methods : A questionnaire survey was carried out to assess the dependent variables of directors' decision-making types and public entrepreneurship. The analysis of management performance was carried out through a comparison between 2016 results of, data of variation rate on medical revenue and change rate on medical profit and results in 2015. Results : Results indicated that local public hospital directors who used rational decision-making showed better performance management. The analysis showed that enterprise had a greater positive effect (+) on variation rate of medical revenue than that of innovation. However, innovation had a higher positive effect (+) on change rate of medical profit than that of enterprise. These results suggest that innovation and enterprise have a major influence on performance management. Conclusions : The survey used for this study suggests that an education and training program is needed to improve public hospital directors' ability for rational decision-making, public entrepreneurship and performance management. Additionally, the policy change guaranteeing autonomy within the proper range is demanded that Local Public Hospital Director having spirit of innovation and enterprise achieves peak capacity and have responsibility for management.

• Journal of Preventive Medicine and Public Health
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• v.47 no.4
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• pp.230-235
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• 2014

Objectives: The aim of this study was to investigate whether the health status of Republic of Korea Air Force (ROKAF) soldiers changed after one year of military service. Methods: We selected 483 ROKAF soldiers from the 11 749 recruits who participated in the 2011 physical examination. The selected soldiers underwent another physical examination in 2012 for advancement to senior airman. Data from 2011 and 2012 were merged. To collect data on lifestyle, a questionnaire was sent to all included subjects via the military intranet e-mail service. Results: The percentage of recruits with an abnormal alanine transaminase level (normal range <40 IU/L) decreased from recruitment (13.7%) to the following year (2.7%). Moreover, the percentage of obese soldiers (body mass index ${\geq}25kg/m^2$) decreased from recruitment (20.5%) to the following year (10.4%). There was a significant change in mean duration of exercise carried out each day before ($0.8{\pm}1.3$ hours) and after ($1.0{\pm}0.7$ hours) joining the ROKAF service. Conclusions: These ROKAF soldiers were generally in good health before and after joining the armed service. After one year of military service, the health status of most soldiers improved, especially with respect to body mass index and alanine transaminase level.