• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.17
• /
• pp.7981-7986
• /
• 2015

Background: As coverage of public insurance is not sufficient to cover diagnosis or treatment of cancer, having private health insurance is important to prepare for unexpected expenses of cancer. The purpose of this study was to assess factors associated with having private cancer insurance, considering gender among the socio-demographic factors and health behavior. Materials and Methods: We used data from the 2011 Korea Health Panel, which included 10,871 participants aged 20 years and older. Socio-demographics, health behavior, and perceived cancer risk were the independent variables and having private cancer insurance was the dependent variable. Multivariable logistic regression analysis was used to identify factors associated with having private cancer insurance. Results: The variables relating to middle age, higher education, higher household income, married men, and the perceived cancer risk groups of 1-10% and 11-30% were significantly associated with having private cancer insurance. Additionally, females who had private non-cancer health insurance were positively associated with the dependent variables (OR=1.36; 95% CI=1.17-1.57). Education, smoking status, exercise, and perceived cancer risk possibility were significantly associated with having private cancer insurance only among women. The men lowered the overall percentages of those having private cancer insurance (OR=0.53, 95% CI=0.45-0.63). Conclusions: We found that there were significant differences between men and women who had private cancer insurance. Women with private cancer insurance are more likely to follow precautionary health behavior than men. This could be interpreted as resulting from masculine ideologies. It is important to make males recognize the seriousness of the cancer risk. In general, household income was highly associated with private cancer insurance. These results reveal an inequity among the buyers of private cancer insurance in terms of economic status level, education level, and health condition.

• The Korean Journal of Health Service Management
• /
• v.11 no.1
• /
• pp.43-53
• /
• 2017

Objectives : In this paper, we proposed a method to comprehensively examine the roles of medical insurance review nurses' by analyses of task importance and task performance. Methods : For the analyses, we used the responsesof 268 nurses who completed a questionnaire for members of the Medical Insurance Review Nurses Association in 2015, and analyzed task importance and task performance using the IPA method and the standard task guide. Results : There were significant differences in task importance and task performance according to task position. In the category of 'Keep up the good work,' 'Calculate benefit standard' was indicated only in administrative positions, and in the category of 'Concentrate here,' 'Manage hospital resources' and 'Process after appeal results' was demonstrated only in general positions. There were differences in the 'Low priority' and 'Possible overkill' categories by task performance according to task position. Conclusions : Our results indicate the necessity of a new education system and task reassignment according to task importance and task performance as perceived by medical insurance review nurses.

• Health Policy and Management
• /
• v.28 no.2
• /
• pp.138-144
• /
• 2018

Background: Diagnostic imaging fee had been reduced in May 2011, but it was recovered after 6 months because of strong opposition of medical providers. This study aimed to analyze the behavior of medical providers according to fee changes. Methods: The National Health Insurance claims data between November 2010 and December 2012 were used. The number of exams per computed tomography was analyzed to verify that the fee changes increased or decreased the number of exams. Multivariate regression model were applied. Results: The monthly number of exams increased by 92.5% after fee reduction, so the diagnostic imaging spending were remained before it. But medical provider decreased the number of exams after fee return. After adjusting characteristic of hospitals, fee reduction increased the monthly number of exams by 48.0% in a regression model. Regardless type of hospitals and severity of disease, the monthly number of exams increased during period of fee reduction. The number of exams in large-scaled hospitals (tertiary and general hospital) were increased more than those of small-scaled hospitals. Conclusion: Fee-reduction increased unnecessary diagnostic exams under the fee-for-service system. It is needed to define appropriate exam and change reimbursement system on the basis of guideline.

• Journal of Korean Academy of Nursing Administration
• /
• v.15 no.2
• /
• pp.264-274
• /
• 2009

Purpose: This study is to develop job standards in order to propose proper job level of the advanced nurse practitioners and apply the results to the work and enhance the expertism. Method: This study is a methodical study. The validity was examined by using the content validity index(CVI). Result: The pre-items of job standards for advanced health insurance review nurses were established and the final job standards comprising of 12 standards, 46 criteria, 92 indicators, 418 activities were determined after the examination by the advisory group. The validity of the job standards were examined for two times by the seven professionals. The relevance of the modified job standards was examined by the working level employees above the assistant manager position working in the general hospitals and the result was 93.14% relevance. The job standards comprising of 12 standards, 46 criteria, 89 indicator and 409 activities were developed. Conclusions: By the development of the job standards, it is expected to prove that advanced health insurance review nurses are the most suitable professionals for dealing with medical affairs such as management and propriety evaluation of medical expenses while defining the roles of advanced health insurance review nurses.

• Journal of Preventive Medicine and Public Health
• /
• v.56 no.6
• /
• pp.504-514
• /
• 2023

Objectives: This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes. Methods: This study investigated patients with new prescriptions for hypertension and diabetes in Korea in 2019 with using data collected from general health screenings. A multilevel logistic regression model was applied to explore the relationship between patients' first prescribing institution and their medication adherence, defined as a medication possession ratio (MPR) over 80%. Results: The overall adherence rates were 53.7% and 56.0% among patients with hypertension and diabetes, respectively. The intra-class correlation coefficients were 13.2% for hypertension and 13.8% for diabetes (p<0.001), implying that the first prescribing institution had a significant role in medication adherence. With clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes). Among individual-level variables, female sex, older age, higher insurance premium level, and residing in cities were positively associated with adherence in both the hypertension and diabetes samples. Conclusions: This study showed that the prescribing institution had a significant relationship with medication adherence. When the first prescribing institution was a clinic, newly diagnosed patients were more likely to adhere to their medication. These results highlight the important role played by primary care institutions in managing mild chronic diseases.

• Journal of Preventive Medicine and Public Health
• /
• v.50 no.5
• /
• pp.294-302
• /
• 2017

Objectives: The objectives of this study were to investigate the agreement between medical history questionnaire data and claims data and to identify the factors that were associated with discrepancies between these data types. Methods: Data from self-reported questionnaires that assessed an individual's history of hypertension, diabetes mellitus, dyslipidemia, stroke, heart disease, and pulmonary tuberculosis were collected from a general health screening database for 2014. Data for these diseases were collected from a healthcare utilization claims database between 2009 and 2014. Overall agreement, sensitivity, specificity, and kappa values were calculated. Multiple logistic regression analysis was performed to identify factors associated with discrepancies and was adjusted for age, gender, insurance type, insurance contribution, residential area, and comorbidities. Results: Agreement was highest between questionnaire data and claims data based on primary codes up to 1 year before the completion of self-reported questionnaires and was lowest for claims data based on primary and secondary codes up to 5 years before the completion of self-reported questionnaires. When comparing data based on primary codes up to 1 year before the completion of selfreported questionnaires, the overall agreement, sensitivity, specificity, and kappa values ranged from 93.2 to 98.8%, 26.2 to 84.3%, 95.7 to 99.6%, and 0.09 to 0.78, respectively. Agreement was excellent for hypertension and diabetes, fair to good for stroke and heart disease, and poor for pulmonary tuberculosis and dyslipidemia. Women, younger individuals, and employed individuals were most likely to under-report disease. Conclusions: Detailed patient characteristics that had an impact on information bias were identified through the differing levels of agreement.

• Journal of Society of Preventive Korean Medicine
• /
• v.21 no.1
• /
• pp.67-81
• /
• 2017

Objectives : The purpose of this study was to analyze the report conducted in 2014 by the Ministry of Health and Welfares on influences of private insurance coverage on the use of Korean medicine. Methods : We analyzed Ministry of Health and welfares report on the use and consumption of Korean medicine to fit the purpose of this study. Comparison between private insurance holders and non-holders was made in the areas of sociodemographic characteristics, patient distribution by disorders, total number of disorders and existence of complex diseases, general perception of Korean medicine, and medical expenses and visits. Logistic regression analysis was made to verify the private insurance coverage. Results : Among sociodemographic characteristics, significant differences were observed in age distribution, education, professions, income level, and housing factors. But genders, area of residence, and marital status didn't show significant differences. Other significant differences including side effects, experience with Korean medicine, herbal medicine and acupuncture treatments, and main visiting facilities were shown between private insurance holders and non-holders. Majority of disorders treated with Korean medicine were musculoskeletal issues, and criteria of number of disorders, multiple diseases factors, and medical expenses/visits showed significant differences between the two groups. Conclusions : Summarizing above results indicate that holding a private insurance in addition to National Health Insurance contributes significant influences on the use of Korean medicine.

• Journal of Korean society of Dental Hygiene
• /
• v.16 no.2
• /
• pp.195-204
• /
• 2016

Objectives: The purpose of the study is to investigate the knowledge, attitude, and recognition of health insurance coverage in tooth implant among Korean adults. Methods: A self-reported questionnaire was completed by 420 adults over 20 years lod in Seoul and Gyeonggido from October 1 to December 15, 2014. The questionnaire consisted of general characteristics of the subjects, knowledge, attitude, and recognition of health insurance coverage in tooth implant. Results: The mean of knowledge of regular checkup after implant was 3.05 points, and mean of advantage and disadvantage of implant was 3.03 points. The expectation for the implant treatment was 4.18 points and this was the highest score. There was no significant difference between the knowledge and attitude in age and monthly compensation(p>0.05). Only 45.6% of the adults were aware of the health insurance coverage of tooth implant since July, 2014. Health Insurance meeds to be modified in the beneficiaries age(44.6%), and cost(32.7%). The positive aspects of implant care included medical expenses(37.8%), health care beneficiary(29.1%), and oral health promotion(20.9%). Conclusions: Health insurance coverage of tooth implant is very important to enhance the quality of life in the adults because the proper management and implementation of the health insurance in implant will improve the oral health care in life.

• Health Policy and Management
• /
• v.14 no.3
• /
• pp.20-44
• /
• 2004

The National Health Insurance Expenditure has been increased rapidly since the introduction of the separation of prescription and dispensing in 2000, and this trend of rapid growth in overall spendings rate has been observed predominantly among medical practitioners. This study was conducted to investigate the growth rate and distributional changes in private medical practitioners' expenses from 1999 to 2002 and its determinants using the National Health Insurance claims data. The total increasing rate of all medical practitioners' expenditure paid by the National Health Insurance between 1999 and 2002 was $41.71\%$, which exceeding that of general hospitals by $20\%$p. But the income distribution among each practitioner was improved as the changes in Gini coefficient(from 0.40 to 0.38) and decile distribution ratio(from 0.25 to 0.29) during the same period showed. However, this improvement in distributional patterns is not enough since even in 2002 it turned out that the highest $10\%$ income group earned 33times more than the lowest $10\%$ income group did. Also, higher Gini coefficient was observed in larger cities and some department like plastic surgery, obstetrics and gynecology. The major causes of this differentials in medical practitioners' expenses were factors related to medical demand like proportion of old population, residential economic status in a given area. In addition, providers' economic incentives also played an important role in determining their income distribution. The large income differentials among physicians may imply a skewed distribution of patients and thus long waiting time, inefficient utilization of resources and potential inadequate quality of care. In this sense, unreasonable distributional gaps should be reduced, so effective measures as well as ongoing monitoring would be necessary to correct current distributional problems.

• Health Policy and Management
• /
• v.21 no.4
• /
• pp.527-540
• /
• 2011

Some patients tend to visit tertiary hospitals instead of non-tertiary hospitals for minor illnesses, which is a chronic problem within the Korean health care delivery system. In order to reduce the number of patients with minor severity diseases unnecessarily utilizing the tertiary medical services in Korea, the Ministry of Health and Welfare raised the outpatient co-insurance rate for the tertiary hospitals in July, 2009. Another increase in the prescription drug co-insurance rate by the general and tertiary hospitals is scheduled to take place in the second half of 2011. An increase in copayments may discourage the utilization rate of medical services among the underprivileged or patients who require complicated procedures. This study aims to analyze the diabetic patients' utilization rates of tertiary hospitals according to the Comorbidity score. Diabetic patients' data was gathered from the Health Insurance Claims Records in the Health Insurance Review & Assessment Service between 2007-2009. Comorbidity scores are measured by the Charlson Comorbidity Index and the Elixhauser Index. Chi-square and logistic regressions were performed to compare the utilization rates of both insulin-dependents (n=94,026) and non-insulin-dependents (n=1,424,736) in tertiary hospitals. The higher Comorbidity outcomes in the insulin-dependent diabetic patients who didn't visit tertiary hospitals compared to those who did, was expected. However, after adjusting the gender, age, location, first visits and complications, the groups that scored >=1 on the comorbidity scale utilized the tertiary hospitals more than the O score group. Non-insulin-diabetic patients with higher Comorbidity scores visited tertiary hospitals more than patients who received lower grades. This study found that patients suffering from severe diabetes tend to frequently visit the tertiary hospitals in Korea. This result implied that it is important for Korea to improve the quality of its primary health care as well as to consider a co-insurance rate increase.