• Journal of dental hygiene science
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• v.23 no.2
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• pp.154-168
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• 2023

Background: Legal regulations and fees have been established in Korea to provide visiting oral health care services to individuals with long-term care insurance (LTCI). However, beneficiaries of this service are very limited. Therefore, to improve the Korean system we propose a comparative analysis with the Japanese system. Methods: This study is a descriptive analysis based on secondary data, such as statistics, laws, and service record forms from Korea and Japan. The most recent institutional documents were obtained through a Google search. The variables investigated were financial resources of LTCI, co-payment structure, monthly limit of LTCI benefits, care levels of LTCI, service providers, service costs, contents of service, and the number of cases of service. Results: In both Korea and Japan, LTCI is financed through a combination of taxes and insurance premiums. However, the monthly limit for receiving LTCI services in Japan is about 2.4 times higher than in Korea. Visiting medical and dental treatment is also possible in Japan. Furthermore, nursing staff can provide daily oral health care services according to dental hygienists' instruction unlike Korea. Oral health care services in Korea are focused on oral hygiene and prevention of oral diseases, while Japan additionally provides oral function screening, patient education for oral health management, and training for nursing staff to enhance oral function, eating, and swallowing of the patients. Conclusion: We concluded that the possibility of visiting dental treatment, differences in monthly limit of LTCI benefits, oral function assessment and guidance, as well as collaboration with other healthcare professionals contributed to the difference in the frequency of utilization of visiting oral health care services between Korea and Japan.

• Korea Journal of Hospital Management
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• v.5 no.1
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• pp.129-155
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• 2000

This empirical study, activity-based costing, a newly introduced approach that has proved to be an improvement over the conventional costing system in product or service costing, is applied at department of clinical pathology in K university hospital. The study subjects were 233 test procedures done in clinical laboratory of K university hospital. Activity analysis was done by interview, questionnaires, and time study, and the amount of resources consumed by each activity and their costs are then traced and applied to the laboratory tests. The main purpose of this study were to compare the test costs of activity-bases costing with those of conventional costing, and test fees of medical insurance, and to provide accurate cost informations for the decision makers of hospital. The major findings of this study were as belows. 1. The cost drivers for application of activity-based costing at clinical laboratory were cases of sample collection, case of specimen, cases of test, and volume-related allocation bases such as direct labor hours and total revenue of each test. 2. The profits of each clinical laboratory fields analyzed by conventional costing were different from the profits analyzed by activity-based costing, especially in the field of Urinalysis(approximately over estimated 750%). 3. The standard full costs by conventional costing were quite different from the costs computed by using activity-based costing, and the difference is most significant with the tests of long labor time. 4. From the comparison between costs computed by using activity-based costing and medical insurance fees, some test fees were significantly lower than the costs, especially in the non-automated fields. As described in this study, activity-based costing provides more accurate cost information than does conventional costing system. The former approach is especially important in the health care industry including hospitals in which planning and controlling the costs services provided are the key to maintaining a healthy financial status for the organization. Despite the contribution of activity-based costing the economic as well as technical feasibilities of implementing such a cost accounting system in an organization must be evaluated. In the development of activity-based costing systems, an activity analysis has to be conducted to identify activities that consume resources. This involves a detailed study of the organization's logistics and accounting information systems, and it is an expensive project in itself. Besides, it can be quite difficult and time consuming to identify and trace resource consumption to a specific activity. Thus the activity-based costing system should be implemented only when the decrease in cost of error far exceeds the increase in cost of measurement. By combining activity-based costing with standard costing, health care administrators can better plan and control the costs of health services provided while ensuring that the organization's bottom line is healthy.

• Journal of Korean Academy of Nursing
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• v.23 no.1
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• pp.68-89
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• 1993

This study was conducted to develop a model of a fee schedule for nursing services.'Regardless of the demand for skilled and professional nursing service today, the Korean health insurance system does not furnish a chapter for the nursing service fee schedule. A nation-wide survey of hospital nursing service fee schedules was to provide practical and realistic data about how the variety of nursing services are being charged. From September 1990 to April 1991, data from the fee schedule used by twenty hospitals located in eight large cities which are designated large medical regions in the Korea Health Care and Patient Referral System were collected. Nursing services and the fees charged for them were analyzed. The nursing services were subjected to a secondary analysis with referrence to reports on “nursing services to be charged in Korea”. The total number of nursing services recommended by the literatures was 177 : finally 141 types of nursing services were selected by investigator as chargable nursing services. In addition, data on managerial characteristics of the hospitals were collected to discover influential variables for a nursing fee schedule model. Under the assumption that all the managerial characteristics of the hospitals influenced the fee schedule, the following model was tested : Fee of nursing services (C) = f(A₁, A₂, A₃, A₄, A/sub 5/, A/sub 6/, A/sub 7/, A/sub 8/,) When, A₁ = number of nurses A₂ = the first salary of a nurse educated in a four year A₃ = scale of nursing management division A₄ = location of the hospital A/sub 5/ = the type of hospital management (profit / non-profit) A/sub 6/ = number of hospital beds A/sub 7/ = years of hospital operation A/sub 8/ = number and kinds of clinical divisions The results showed that the model should be built as follows : C = f (A₁, A/sub 4/, A/sub 5/) Each nursing service was applied to the fee schedule with consideration for the professional level and time-taken to provide the services. Detailed fee schedules were presented in the related tables. Of the 141 kinds of nursing services, 24.8% were chargeble to the Korea Health Insurance, 32.6％ of the nursing services were being paid directly by the patienty. The rest of nursing services (42.6％) were not being charged to any source. It was recommened that the Korea Health Insurance Reimbursement system should add a classification system for nursing services that can be used in the national health care program. Further study is needed about how to include 32.6% of the nursing services now being paid for directly by the patients in the health insurance system.

• Korea Journal of Hospital Management
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• v.20 no.3
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• pp.36-44
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• 2015

The Activity Based Costing(ABC) means the process that makes clear how the actions and input resources have changed into service to calculate medical services costs. These days, the number of hospital which is using the ABC system is increasing to make their policy decision making efficient and run the hospitals more resonable. This study analyzes the unbalance in the level of health insurance service fee and the improvement plans based from 8 hospitals(ABC system) and 95 clinics(ABC survey). The cost recovery ratio has shown different levels according to each service type. A surgery service type recorded 76.8% and an evaluation & management service type is 84.6%, a treatment procedure type(85.8%), a function test type(91.6%) and health insurance fee even did not reach to the original cost. Meanwhile, a laboratory test type and imaging test type show high level of cost recovery ratio. they recorded 188.3% and 158.8%. Resultingly now of unbalance in the level of health insurance service fee accelerates supply of every test. so there is a need to make laboratory test type and imaging test type lower to keep balance with the surgery and medical service. These methods should be performed gradually with monitoring the unbalance fee ratio and for this, a panel medical institution have to be established for generalizations of studying result, fairness of selecting researching sample.

• Korean Medical Education Review
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• v.24 no.1
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• pp.10-17
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• 2022

South Korea is not a wasteland of publicly funded health care-instead, it has a good medical social security system known as the national health insurance (NHI). The NHI of Korea has three unique features; (1) low premiums, low insurance fees, and low coverage; (2) obligatory designation of medical institutions; (3) and allowance of non-benefit services. These features have made hospitals and doctors interested in profit-seeking. However, the commercialization of medical institutions has taken place in both private- and public-established sectors. A basic problem of commercialization is the co-existence of the obligatory designation of medical institutions and non-benefit services. The problem became worse in the Kim Dae-Jung government because it officially permitted non-benefit services. Since 2000, the Korean government has consistently pursued benefit extension policies, but the coverage rates of the NHI have stagnated. In addition, premiums and current medical expenses have markedly increased because policy-makers have emphasized accessibility to the NHI, while ignoring important principles of medical social security such as a needs-based approach and patient-referral system. In order to resolve the commercialization problem, the obligatory designation of medical institutions to the NHI should be changed to a contract system, and non-benefit services should be prohibited at NHI institutions. We must re-establish the patient-referral system via a needs-based approach. We also need to build a primary healthcare system and public health policies. We should make a long-term plan for healthcare reform.

• Korea Journal of Hospital Management
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• v.28 no.1
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• pp.37-51
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• 2023

Purposes: There exist many non-covered services that the National Health Insurance does not cover, and thus, their prices are set by individual health care providers. However, little study has been done to investigate how hospitals set prices for those services. The purpose of this study is to examine the relationship between ownership, profitability, and prices of those services for a sample of general hospitals. Methodology/Approach: Data regarding the prices of major non-covered services (e.g., upper-level hospital room fees, MRI, Da 7inci robot surgery, and LASIK) were obtained from the Health Insurance Review and Assessment Service and the financial information, as well as other characteristics, were derived from the financial reports from the Korea Health Industry Development Institute. Descriptive statistics, t-tests, and multiple linear regression analyses were used to test the relationship between the independent variables and the dependent variables. Findings: Hospitals owned by private universities appeared to have higher prices for non-covered services while regional public hospitals tend to have lower prices. Profitability, measured by operating margin, was not significantly related to the prices. Hospitals that charge higher prices were more likely to be located in the capital area (Seoul, Incheon, and Gyeonggi), and to employ larger number of personnel. Practical Implications: Public hospitals tend to charge lower prices for non-covered services. Relative market power appears to be related to pricing. Further research is needed to investigate whether such a relationship varies over time and its effects on the quality and access.

• Health Policy and Management
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• v.16 no.2
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• pp.117-134
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• 2006

Korean health care system introduced the reform for separation between prescribing and dispensing of drugs (SPD reform) in the latter part of the year 2000. The objective of this paper is to look at what change this reform has brought about in the financial situation of Korean public health insurance scheme, particularly in terms of insurance benefit outlay. Since the inception of the reform is a development of more than five years ago, its impact on the finance situation would now start to become apparent. Hypothesis is set in this study for each of three components of drug reimbursement in health insurance, i.e. average price level, composition of drugs and their overall volume. In terms of the classification of health care services by mode of production, the impact of the SPD reform is confined mainly to the last two among three drug reimbursement fields including inpatient department, out-patient department and pharmacy. Pure impact of the SPD reform was estimated to be more or less than 1.7 trillion won, 13.1% of the total outlay of the Nation Health Insurance in 2001, and more than 2.0 trillion won, 14.9% of the total outlay of the Nation Health Insurance in 2003. Both dispensing fees for the pharmacists, which had been newly introduced on occasion of the SPD reform, and larger share of expensive drugs in the medicines prescribed by doctors were confirmed to be main drivers of the augmentation of drug reimbursement.

• Journal of Korean Academy of Nursing
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• v.41 no.3
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• pp.302-312
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• 2011

Purpose: The purpose of this study was to develop a resource-based relative value scale (RBRVS) and its conversion factor for advanced nursing practices carried out by critical care nurse practitioners (CCNP) in intensive care units. Methods: The methodology was developed by calculating CCNP's RBRVS for 32 advanced nursing services based on CCNP's workload and time spent in the context of national health insurance. A cost analysis was performed to estimate the conversion factor of CCNP's RBRVS. The share of CCNP's contribution to fee-for-service in intensive care units was also analyzed. Results: Calculation of the RBRVS of 32 advanced nursing practices showed a range of points from 100.0 to 1,181.4 and an average of 296.1 points. The relevant conversion factor for advanced nursing practices in CCNP were estimated at 37.3-48.4 won. The contribution rate of CCNP's advanced nursing practices in the relative value scale of the national health insurance was estimated at 0.1-31.3%. Conclusion: Measuring the economic value of advanced nursing services will be a basis for esta-blishing a reimbursement system for CCNP's practices and thus encourage a social demand for advanced nurse practitioners.

• Journal of Home Health Care Nursing
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• v.29 no.1
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• pp.5-17
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• 2022

Purpose: This study aimed to investigate the role of hospital-based home health nursing in community care by examining the institutional progress of hospital-based home health nursing and the current status of home health nursing in Korea. Methods: Korean research data, national statistical data, government press releases, and related laws were investigated to clarify the role of hospital-based home health nursing in community care. Results: Korean visiting medical care services, including hospital-based home health nursing, was not found to be sufficient nationwide. The supply of home health nursing did not increase due to the nature of the visiting services that required transportation time, poor profitability due to insufficient insurance fees, and increase in acute beds. Conclusion: The nature of the Korean medical environment and visiting medical care makes it challenging to establish a visiting medical supply system for community care. Therefore, hospital-based home health nursing is an important infrastructure for visiting medical care, and will be a valuable resource to link discharged patients returning to the community when moving health care services. Hence, laws and institutional supplementation to expand the role of home health nursing agencies nationwide are needed along with addressing the limitations in the supply of home health nurses.

• Journal of Preventive Medicine and Public Health
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• v.36 no.4
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• pp.325-331
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• 2003

Objectives : To analyze medical service utilization and trends among the elderly in the last year of life. Method : The subjects of this study were People that had died at the age sixty-five and above between January $1^{st}$ and June $30^{th}$ 2000 The names of the deceased and their dates of death were collected from the data of the funeral-expenses-receivers of the National Health Insurance Corporation (NHIC). This data was merged with that of the individual medical expenses of the NHIC. Results : In the first half of 2000, 84.2% of the funeral-expenses-receivers (53,063) utilized medical services during the year prior to their death; 51.0% (27,042) were female and 49.0% (26,021) male. In the last twelve months of life, the medical fees, the number of days receiving medical services and the number of days receiving medicine were 3,107,935 Won, 47.88 and 153.21, respectively, for each person. As the age of the groups increased, the level of medical service utilization decreased; the change was more obvious in female group. The level of medical service utilization during the twelve months prior to death drastically increased around the time of death. Conclusions : This study, from an analysis of the level of medical service utilization prior to death, shows a concentrated volume of medical services during a certain time period prior to death.