• Journal of Korean Public Health Nursing
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• v.17 no.2
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• pp.287-298
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• 2003

This study was conducted to identify the health care utilization, health care costs, and potential health care demands of the disabled in the Medicaid Aid beneficiaries. This study focused on the heath care costs not included in the medical aid allowance such as transportation, informal nursing costs, and ambulatory aids etc. Participants were the 864 subjects who were beneficiaries of the National Medical Aid program living in 10 district of Korea. A questionnaires were distributed to the disabled in the Medical Aid beneficiaries during August to September, 2001 through public offices. Data were collected through a home visiting by social workers working in public offices. Direct and indirect medical costs expended for one month by the participating disabled were examined. They expended 110.748 won $({\$}100)$ for heath care costs, which was not included in the medical aid allowance during the month. The disabled with cerebral diseases or who have level 4 disability expended more health care costs compare to those with other diseases. Gradual expansion of medical aid allowance for the disabled is recommended to alleviate economic burden of the disabled and their family.

• 대한예방의학회:학술대회논문집
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• 1994.02b
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• pp.84-86
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• 1994

AS A SOCIETY, we are in conflict with ourselves about the cost of health care. 1 On one hand, we want the best care possible, regardless of cost. On the other hand, we are not willing to pay the cost of the care we want. Our conflict parallels a flaw in the medical marketplace. An essential condition for achieving an equilibrium between cost and value is that the two must be connected through decisions. When people decide what products and services (goods) they want, they must not only see the value they will receive, but they mast also be responsible for the costs. Because of a variety of features of the medical marketplace-most notably third-party coverage, third-party advice, and uncertainty about outcomes-the required connection between value and cost is severed. The result is what we see. One side of our collective mind demands more services while the other side cries that costs are too high. Resolving our conflict will require connecting value to cost. An essential step in accomplishing this will be to incorporate costs in practice policies. 1 As controversial as that thought might seem (the great majority of practice policies currently do not take costs into account except in the most rudimentary way), arriving at the conclusion is the easy part. A more difficult issue is how to implement the goal of connecting value to cost. Suppose we agree that, in principle, costs should be considered when practice policies are designed, and that an activity should be recommended and covered only if its health outcomes (benefits minus hanns) are deemed to be worth its costs. The next questions are, Who should do the deeming? What should the deemers be asked?

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.7
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• pp.3159-3163
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• 2012

Background: For cervical cancer the epidemiological profile is poorly known in Morocco and no data is available concerning the direct medical costs. The purpose of this work is to estimate the direct cost of medical management of invasive cervical cancer during the first year after diagnosis in Morocco. Methods: The estimation of direct costs of medical management of invasive cervical cancer during the first year after diagnosis in Morocco is based on the estimation of individual cost in each stage which covers diagnosis, treatment and follow-up during first year. The cost was estimated per patient and whole cycle-set using the costs for each drug and procedure as indicated by the Moroccan National Agency for Health Insurance. Extrapolation of the results to the whole country was used to calculate the total annual cost of cervical cancer treatments in Morocco. Results: Overall approximately 1,978 new cases of cervical cancer occur each year in Morocco. The majority (82.96%) of these cases were diagnosed at a late stage (stageII or more). The cost of one case of cervical cancer depends on stage of diagnosis, the lowest cost is $382 for stageCis followed by the cost of stageIA1 for young women (< 40 years) which is $2,952. The highest cost is for stageIV, which is $7,827. The total cost of cervical cancer care for one year after diagnosis is estimated at $13,589,360. The share allocated to treatment is the most important part of the global care budget with an annual sum of $13,027,609 whereas other cost components are represented as follows: $435,694 for annual follow-up activity and $126,057 for diagnosis and preclinical staging. Conclusion: This study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of health facilities in Morocco.

• Journal of Korean Academy of Nursing
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• v.29 no.1
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• pp.183-195
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• 1999

The purpose of this study is to describe the health care status of Korean Immigrants in New Zealand. The sample consisted of 155 Koreans who were randomly selected from the Korean Immigrants telephone book in Auckland, N.Z. They had health problems that required health management both physically (50.3%) and psychologically(70.3%). During the previous year, the average rate of medical contact with a general practitioner was 1$\pm$1.29 times. Korean immigrants who had health problems first attempted to resolve the problem through self medication rather than utilize health care services. They would only visit a general practitioner if they had severe subjective symptoms or no relief from self medication. Even if they think they need to visit the health care service, 41.9% of the subjects did not go back for follow-up care. Generally, the person who demonstrated positive health care behaviors was male, a college level graduate or higher, lived in N.Z. longer than 2 years, had a high score on health status by self assessment, and he placed few demands on health care services. Barriers to a healthy lifestyle are communication difficulties in expressing subjective symptoms, understanding the physician's treatment and medication plans, difficulty in accessing the appointment system and the high cost of service.

• Health Policy and Management
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• v.22 no.3
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• pp.383-402
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• 2012

The purpose of this study is to investigate the factors affecting family caregiver financial burden of out-of pocket expenses for the nursing home service under Long-term Care Insurance System. We conducted a national cross-sectional descriptive survey from July to September 2010 to collect data based on the long-term care benefits cost specification. Total 1,016 family caregivers completed questionnaires. 185 subjects of total were excluded from the data analysis due to being answered by user(18 cases), or caregivers not to pay for services expenditures(122 cases), having a missing data on family caregivers characteristics(45 cases). Finally, 831 subjects were included in the study. The average financial burden was 3.18(${\pm}0.71$). We divided subjects into two groups by level of burden, high-burden group and low-burden group. In the result of the multiple logistic regression analysis, family caregiver financial burden was significantly higher in family caregivers with ages 40 to 49 compared to less than 40, lower educational level, unsatisfaction for long-term care service, high percentage(more than 50%) of cost-sharing and high total out-of pocket expenses(more than 300,000 won) for long-term care services. Also, Family caregivers who are spouse felt higher financial burden compared to son. This study is meaningful as the first attempt to measure family caregiver financial burden for long-term care service and to identify factors affecting the financial burden. Family caregivers felt financial burden of out-of pocket expenses for the nursing home service. The policy makers, the insurer, and the providers need to pay attention to ease family caregiver financial burden.

• Health Policy and Management
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• v.27 no.2
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• pp.149-156
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• 2017

Background: This study was conducted to evaluate the performance of the Hierarchical Condition Category (HCC) model, identify potentially high-cost patients, and examine the effects of adding prior utilization to the risk model using Korean claims data. Methods: We incorporated 2 years of data from the National Health Insurance Services-National Sample Cohort. Five risk models were used to predict health expenditures: model 1 (age/sex groups), model 2 (the Center for Medicare and Medicaid Services-HCC with age/sex groups), model 3 (selected 54 HCCs with age/sex groups), model 4 (bed-days of care plus model 3), and model 5 (medication-days plus model 3). We evaluated model performance using $R^2$ at individual level, predictive positive value (PPV) of the top 5% of high-cost patients, and predictive ratio (PR) within subgroups. Results: The suitability of the model, including prior use, bed-days, and medication-days, was better than other models. $R^2$ values were 8%, 39%, 37%, 43%, and 57% with model 1, 2, 3, 4, and 5, respectively. After being removed the extreme values, the corresponding $R^2$ values were slightly improved in all models. PPVs were 16.4%, 25.2%, 25.1%, 33.8%, and 53.8%. Total expenditure was underpredicted for the highest expenditure group and overpredicted for the four other groups. PR had a tendency to decrease from younger group to older group in both female and male. Conclusion: The risk adjustment models are important in plan payment, reimbursement, profiling, and research. Combined prior use and diagnostic data are more powerful to predict health costs and to identify high-cost patients.

• Health Policy and Management
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• v.21 no.1
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• pp.115-131
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• 2011

Several common issues are encountered by countries - Germany, Japan, and the United States - that adopted long-term care (LTC) system. First, the demand for LTC and its associated costs have steeply risen following the implementation of the LTC policy. Second, ensuring the quality of services have been difficult. Third, the coordination of services among providers and between LTC and medical care has been inadequate. Learning from their experience, we suggest ways to improve the LTC system in Korea. The basic approach aims for efficiency over equity in the system. This would require promoting provider competition and consumer choice. We propose several policy options according to the major stakeholders. For consumers, cash benefits at fixed rates and personal savings accounts are feasible options to self-contain the demand and cost of services. On the insurer's side, creating an environment of multiple insurers will engender competition, leading to cost savings and quality care. For providers, delivery of quality services through competition, cost-containment through capitated reimbursements, and coordination of services through integrated delivery system can be achieved. From the assessors' perspective, establishing an information system to monitor the activities of insurers and providers would be important, empowering consumers with information to choose cost-effective service providers. In summary, the suggested approach would provide cost-effective LTC services by guaranteeing consumer choice and promoting major stakeholder accountability. Further studies are needed to test the feasibility of this model in ensuring quality LTC in Korea.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.9
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• pp.5049-5054
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• 2013

Background: To assess the treatment pattern and expenditure incurred by cancer patients undergoing treatment at government tertiary hospitals in India. Materials and Methods: A cross-sectional study of 508 cancer patients randomly selected from tertiary cancer hospitals funded by central/state governments located in major cities of five states in India, namely Kerala, Maharashtra, Rajasthan, West Bengal and Mizoram, during March - May 2011 was conducted. Information related to direct costs, indirect costs and opportunity costs incurred on investigations and treatment, major source of payment and difficulties faced by patients during the course of treatment was collected. Results: About 45% of the patients used private health facilities as the first point of contact for cancer related diseases as against 32% in public hospitals. About 47% sought private health facilities for cancer investigations, 21% at district/sub-district hospitals, and about 4% contacted primary health care facilities. A majority of the patients (76%) faced financial problems while undergoing treatment. Conclusions: The results highlight the importance of involving the primary health care system in the cancer prevention activities.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.12
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• pp.4895-4900
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• 2015

Physician recommendation is an important predictor of HPV vaccine acceptance; however, physician willingness and preferences regarding HPV vaccination may be influenced by factors including patient age, vaccine type, and cost. A cross-sectional survey was administered to a convenience sample of health care providers in Da Nang, Vietnam, to evaluate awareness, perceptions about HPV and HPV vaccines, and willingness to vaccinate a female patient. Willingness to vaccinate was evaluated using a full-factorial presentation of scenarios featuring the following factors: vaccine cost (free vs 1,000,000 VND), patient age (12, 16, or 22 years), and HPV vaccine type (bivalent vs quadrivalent). Responses from 244 providers were analyzed; providers had a mean age of $34{\pm}11.9$ years; a majority were female, married, and had children of their own. Thirty-six percent specialized in obstetrics/gynecology and 24% were providers in family medicine. Of the three factors considered in conjoint analysis, vaccine cost was the most important factor in willingness to vaccinate, followed by patient age, and vaccine type. The most favorable scenario for vaccinating a female patient was when the vaccine was free, the patient was 22 years of age, and the HPV4 vaccine was described. In multivariable analysis, older age, being a physician, being married, and having children were all associated with increased willingness to recommend HPV vaccination (p<0.05). Provider willingness is an important aspect of successful HPV vaccination programs; identifying preferences and biases in recommendation patterns will highlight potential areas for education and intervention.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.19 no.2
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• pp.119-126
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• 2012

Purpose: The purpose of this study is to identify clubhouses general characteristics, core services, funding sources and costs in Korean Clubhouse Model, and to compare with Korean and international clubhouses. We explored the annual budget, cost per member, and cost per visit for 1 year. Methods: The data were collected from 14 Korean clubhouses and analyzed using descriptive statistics and Spearman's rank correlation with the SPSS 14.0 program. Results: The average of clubhouse operating period was 8.2 years. There were an average of 40.4 active members; among them, 84.1% were schizophrenia. In addition, there were an average of 5.8 staff and 15.3 services in each clubhouse. Cost estimates were as follows: annual budget (excluding housing) $223.633, cost per member $5,704, and cost per visit $21.35. There were significant difference among the annual budget, number of staff, number of service, and active members, but hours of Work-Ordered Day and social activities hours were not statistically significant. Conclusion: Findings provide a more understanding of operations, programs, and costs of Korean clubhouses.