• Health Policy and Management
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• v.32 no.3
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• pp.323-329
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• 2022

Background: This study aimed to identify the characteristics of the referral and return of patients to clinics in the endocrinology and cardiology departments at the National Health Insurance Service Ilsan Hospital to evaluate the "referral and return of patients to clinics" program and reduce the rate of returning patients. Methods: From May 2018 to December 2020, we identified the number of visits to referral hospitals and hospital usage status at Ilsan Hospital after returning to clinics. We also identified the patients who returned to Ilsan Hospital within 6 months, defined as "failure to transport," among those recommended to be transported to clinics of the Medical Cooperation Center. Additionally, we evaluated the characteristics of the "failure to transport" patients. Results: Among the returning patients, the rate of visiting Ilsan Hospital within 6 months was higher in cardiology than in endocrinology (25.1% vs. 16.7%). Older age, more severe disease, and more number of visits to the department were associated with a high rate of failure to transport. The rate of failure to return was low in cases diagnosed with hyperlipidemia/lipoprotein metabolism disorder. With respect to diabetes, the rate of failure to transport differed according to each type of diagnosis of diabetes. Conclusion: The success rate of the "referral and return of patient to clinics" program differed based on each patient's characteristics, department of visit, and diagnosis. Individualizing according to the visit department and diagnosis is required to ensure successful transfers, and infrastructure expansion and institutional arrangements must be facilitated.

• Health Policy and Management
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• v.3 no.1
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• pp.124-145
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• 1993

General practitioners, internists, pediatricians, and family physicians are classified as so-called primary care physicians in the United States. We carried out this study for the purpose of answering the following question; "Who are the primary care physicians in Korea\ulcorner" We analyzed the 663, 154 claims which were drawn from the health insurance processing file made during the period of one month, April 1992 on the basis of systemic random sampling technique. The 663, 154 cases were matched with the doctor's file registered at the National Federation Medical Insurance by using the indivisual physician code number and analyzed according to the kind of specialty. If we follow the Geyman's definition of primary care physician in the United States, this study shows that they can take care of 43.2% of the total private clinic's claims in Korea. Provided that general practitioners and family physicians are considered the same way as in the United Kingdom, they could with only 8.3% of the total claims in Korea. The most frequent diseases are those which rank first to 46th in the total private clinic's claims. The proportion of the most frequent diseases was highest for pediatricians(90.4%) and followed by internists(81.4%), otolaryngologists(78.7%) and family physicians(76.5%). The proportion of the most frequent diseases in the most common 46 diseases was highest for radiologists(80.4%) and the next was as follows : general practitioners(78.3%), family physicians(67.4%), and internists(67.4%). We classified the most common 20 diseases of each specialty into 17 categories of ICD-9 and compared it with those of general practitioners. The specialists who had managed a similar disease pattern to those of general practitioners were identified as anesthesiologists, family physicians, general surgeons, and internists. Some specialists practicing at private clinics managed the diseases which were not quite appropriate for their specialties. After we evaluated each specialty by the most common diseases, the most frequent diseases, and the most frequent 20 diseases of each specialty in terms of the 17 categories of ICD-9, a tentative assumption is made that the primary physicians in the Republic of Korea are general practitioners, anesthesiologists, family physicians, internists, and general surgeons. This study has concluded that the categories of the primary care physicians are so diverse that their roles and distributions are distorted accordingly. Vigorous health policy efforts in correcting the malcomposition need to be made for the better provision of primary health care in Korea. in Korea.

• Journal of Korean Academy of Nursing Administration
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• v.19 no.5
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• pp.565-577
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• 2013

Purpose: This study was done to propose an improvement in the Nursing Fee Differentiation Policy to alleviate polarization of nursing staffing level among hospitals and to rectify the confusion of legally mandated standards between the Korean Medical Law and National Health Insurance Act. Methods: The policy regulation was reconstructed related to nurse staffing standards and nurse-to-patients ratios. Data on nurse staffing grades were obtained from database of the Health Insurance Review & Assessment Service (HIRA) for the third quarter of 2010 for 44 tertiary hospitals, 274 general hospitals, and 1,262 hospitals. A break-even analysis was used to estimate financial burden of the revised policy improvement proposal. An industrial engineering method was used to calculate Nurse-to-Patients ratios per shift. Results: Twelve tertiary hospitals were downgraded. 74 general hospitals and 102 hospitals were upgraded after application of the regulation. Finances for total hospitalization expenditures changed from -3.55% to +3.14%. Conclusion: The results indicate that the proposed policy would decrease polarization between tertiary hospitals and small hospitals, and would not put a major strain on the finances of the Korean National Health Insurance. Therefore, it is suggested that government stake-holders and many interest groups consider this policy proposal and build a consensus.

• Korea Journal of Hospital Management
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• v.23 no.1
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• pp.51-64
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• 2018

Purposes : In February 2014, the government said that the National Health Insurance Service (NHIS) will enforce plan for reducing the financial burden from two major non-covered services including physician surcharges and private room charges, the main causes to increase uninsured, by 2017. The purpose of this study is to analyze the policy effect that performed so far by comparing out-of-pocket payment rates of policy process Methodology: This study analyzed admission medical expenses that occurred from January 2013 to March 2016 at a upper grade general hospitals in Daejeon. Number of study subjects were 134,924 and the data were analyzed with SPSS 22.0 program by using frequency, percentage, mean, standard deviation, ANOVA. The effect of two major non-payment improvement plan on out-of-pocket rates was ascertained via generalized estimating equation. Findings: Out-of-pocket payment rates was statistically significantly declined 2.7 percent than enforcement ago. Also, out-of-pocket payment, physician surcharge, the proportion of out-of-pocket payment of hospital room charge to out-of-pocket payment was statistically significantly declined. However, a further analysis of the cause of the decline in total medical costs is needed. Practical Implications: Physician surcharges and private room charges improvement policy had a positive effect on the decline of out-of-pocket payment rate. The policy of physician surcharges was very effective after the first policy enforcement but it was less effective to medical aids and near poor that was a more greater coverage than national health insurance. Since the policy has not been finalized, we have to continue a research for the successful implementation of the policy.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.13
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• pp.365-387
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• 2000

One of the central and primary doctrine of the law of marine insurance is that the contract of indemnity entered into by assured and insurer is a contract of the utmost good faith. The notion of utmost good faith is a well established doctrine derived from the celebrated case of Carter v. Boehm(1766), decided long before the inception of the Marine Insurance Act(MIA). With the codification of the law, the principle found expression in sections $17{\sim}20$ of the MIA 1906. In section 17 is presented the general duty to observe the utmost good faith, with the following sections introducing particular aspects of the doctrine, namely, the duty of the assured and brokers to disclose material circumstances, and to avoid making misrepresentations. It is somewhat surprising that section 17, being a long founded doctrine, has not attracted the attention of the courts until very recently. Given that the most significant manifestations of uberrimae fidei are non-disclosure and misrepresentations, fulfillment of the obligation of utmost good faith was, not unreasonably, for a long time perceived in terms of the duty to disclose and not to misrepresent. However, Black King Shipping Corporation v. Massie, 'Litsion Pride'(1985) has clarified that the duty of disclosure stems from the duty of utmost good faith, and not vice versa. The duty of utmost good faith is an independent and overriding duty, with the ensuring sections on disclosure and representations providing mere illustrations of that duty. It is now clear that there are important questions with regard to the general doctrine and as to the nature and scope of any duty of good faith continuing after the contract of insurance is made which require separate and fuller discussion. The purpose of this paper is to review the nature and scope of the duty of utmost good faith.

• Korea Journal of Hospital Management
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• v.8 no.2
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• pp.93-110
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• 2003

Fiscal crisis in the medical insurance has put the pressure upon hospitals by increasing the rate of curtailment, since the implementation of the separation between prescription and dispensing of Drug. The purpose of this study is to analyze the curtailment for antibiotics, injected drug and other drugs expenditure before and after the system of separation between prescribing and dispensing. Data were gathered from 13 general hospitals and used for analysis of trends on antibiotics and injected drug expenditure, and curtailment in 2000-2001 at three months intervals. The results were as follows; The curtailment rate of antibiotics expenditure has been increased in outpatient and inpatient since 2000. The curtailed antibiotics cost and injected drug cost in outpatient under the prescription within the hospital and in inpatient increased. The ratios of curtailment versus expenditure had increased in antibiotics, injected drugs, anticancer drugs, antiulcer drugs, albumine, antiinflammatory drugs. These results suggest that claim review system in social health insurance were over-focused mainly to control the cost and it might to impede the validity of claim review function in health insurance system. Therefore, it's needed to develope the scientific and reasonable parameter & criteria for claim review of drug expenditure.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.1
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• pp.417-425
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• 2020

In this paper, value relevance of the level of dependence on separate accounts in non-life-insurance companies is studied. As noted by Shim et al. (2015), the separate accounts of insurance companies consist of contracts with different attributes from the general accounts, so it is likely that firm value will vary depending on the insurer's dependence on the separate accounts. Thus, in this paper, an empirical analysis has been conducted using quarterly financial data and stock price data from domestic listed non-life-insurance companies from 2011 to 2018. The analysis shows that variables representing the level of dependence on separate accounts have a significant negative relevance to firm value. These results may suggest that changes in the proportion of a non-life-insurer's separate accounts may result in a change to its firm value under the same net assets and net income scales in aggregate accounts. This study provides management implications for the operation of separate accounts from the perspective of maximizing firm value. In addition, this study suggests that disclosure system improvement would be necessary to more directly report the operational performance of the separate accounts.

• Journal of East-West Nursing Research
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• v.30 no.1
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• pp.51-59
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• 2024

Purpose: The purpose of this study was to determine the effect of preoperative guidance and operating room environment experience using virtual reality on increasing satisfaction with information and reducing anxiety in preoperative patients undergoing general anesthesia and local anesthesia. Methods: A non-equivalent control group quasi-experimental design was employed. The participants were 80 surgical patients from 4 wards (40 experimental group and 40 control group) of the general hospital located in Gyeonggi-do. Data collection was conducted from June to November 2023 after completing the control group survey in January 2023. Data were analyzed using Chi-square, t-test, and Mann-Whitney U test using SPSS 23.0 program. Results: Satisfaction with preoperative information was higher in the experimental group than that of the control group. Additionally, anxiety related to surgery in the experimental group was significantly lower than that of the control group. The preoperative state anxiety score in the experimental group was not significantly lower than that of the control group. Conclusions: These results suggest that providing patient education and information using virtual reality technology can not only alleviate patients' anxiety related to surgery, but also have the potential to be used as an effective intervention to improve positive patient experiences.

• Korean Journal of Health Education and Promotion
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• v.7 no.1
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• pp.27-32
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• 1990

Since the medical insurance covered the total population in Korea in July, 1989, the number of patient's visitation to the tertiary care hospital had changed because of referral regulation. In the referred patients through the secondary care hospitals such as out-patients of departments of internal medicine, general surgery, obstetrics and gynecology, pediatrics had decreased as well in-patients in these departments. However, departments of urology, dermatology, dentistry, ophthalmology and ear-nose-throat had more or less similar number of patients after medical insurance implemented for the total population. Contrarily, the number of patients visited emergency clinics and department of family medicine had increased very many. Thus, expansion of emergency clinic department, new special clinic set-ups, establishment of family medicine department in each hospital etc are strongly recommend.

• The Korean Society of Law and Medicine
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• v.14 no.1
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• pp.275-302
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• 2013

The Unites States has been plagued with soaring health care costs and an alarmingly large number of uninsured population. The Patient Protection and Affordable Care Act of 2010 ushered in the most sweeping health care reform in the United States since the introduction of Medicare and Medicaid in 1965 to address these issues. The law's requirement for individuals to purchase health insurance (the so-called "individual mandate"), however, not only caused a political stir but also prompted constitutional challenges. Some questioned whether the federal government, lacking general police power, could require its citizens to buy unwanted insurance based on its enumerated powers under the U.S. Constitution. This paper summarizes the decision of the U.S. Supreme Court on the constitutionality of individual mandate, and explores how the decision relates to Korea's own universal health care.