• 보건행정학회지
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• 제18권3호
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• pp.90-109
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• 2008

Government has extended the benefit coverage and reduced out-of-pocket (OOP) payment for cancer patients in 2005. This paper intends to examine the impact of the above policy on the equity in health care utilization. This paper analyzed the national health insurance data and compared the health care utilization of cancer patients before and after the policy change for people with 10 different income levels. For the equity in health care utilization, we examined the change in concentration index (CI) for visit days, inpatient days, and health expenditure. In the case of outpatient care, CI of visit days and health expenditure were positive(favoring the rich) in both regional and employee health insurance members and both 'before' and 'after' the policy change. CI values rarely changed after the policy change, and the policy change seems to have little impact on the equity of outpatient care utilization except expenditure of regional subscriber. In the case of inpatient care, CI of inpatient days was negative and CI of health expenditure was positive in both regional and work subscriber and both 'before' and 'after' the policy change. After the policy change, CI of inpatient expenditure in both groups of members decreased. CI of inpatient days changed in the direction favoring the poor in regional insurance members, but it rarely changed in employee insurance members. These results suggest that the policy of reducing OOP payment has a positive impact and reduced the inequity particularly in the utilization of inpatient care of cancer patients.

• 보건행정학회지
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• 제17권3호
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• pp.26-49
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• 2007

The purpose of this study is to analyze the equity of health care utilization by income groups in terms of both quantity and quality of care, which is measured by expenditure, type of care, and type of health care institutions. Equity in health care utilization is measured by HIwv index, based on the survey of 1,480 Gwangju-Jeonnam residents. Health care utilization in terms of the probability and quantity of outpatient and inpatient care show equitable or pro-poor inequitable distribution, whereas the distribution of health care expenditure, which can account for the quality of care, is pro-rich inequitable, implying that the better off tend to use more expensive medical care. In terms of the types of care, simple visits for basic care show equitable distribution, whereas the distribution of the utilization of traditional tonic medicine, comprehensive health examination, CT, MRI, and ultrasound is pro-rich inequitable. Utilization of general hospitals and traditional health institutions show pro-rich inequitable distribution, hospitals and dental care institutions equitable, and physician clinics and public health centers pro-poor inequitable.

• 보건행정학회지
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• 제24권3호
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• pp.228-241
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• 2014

Background: The purpose of this study is to evaluate the effect of health insurance coverage expansion for cancer patients on equity in health care utilization and catastrophic expenditure. Methods: To analyze the causal relationship between the policy to expand benefit coverage and the change in health care utilization and out-of-pocket payments of cancer patients, this study employed a difference-in-differences (DID) method. In the DID model, the change in health care utilization, such as health care expenditure, visit days and length of stay, of cancer patients was compared with that of liver disease patients, using Korea Health Panel Data in 2009 and 2010. Results: The policy of reducing cost sharing from 10% to 5% for cancer patients did not have significant effects on equity in health care utilization. The results of this study were different from those of the previous study that showed that the reduction of cost sharing from 20% to 10% significantly improved the equity in health care utilization of cancer patients. In addition, the result of catastrophic expenditures analysis showed the policy did not change the probability of catastrophic expenditures. Conclusion: The results of this study imply that payment for non-covered services account for high out-of-pocket payments, and the reduction in cost sharing for covered services alone may have a limited effect on total financial burden on patients.

• 보건교육건강증진학회지
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• 제15권2호
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• pp.217-233
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• 1998

This paper analyzed four different perspectives on health care reform in Korea in terms of the basic values, formulated problems and reform plans, implementation methods, and supporting groups. The medical security plan was insisted by social security specialists and social activists focusing on the integration of medical insurance coops in order to enhancing equity and right of the people. However, its perspective was limited to promoting security instead of reforming health care system. The government proposed the health care reform plans in 1994 and in 1997, focusing on promoting efficiency by remedying many problems in health care delivery system. However, its implementation was not successful due to the lack of organizational and financial supporters. Recently, two opposite proposals were issued. The market reform plan paid attention to revitalizing the market function to promoting efficiency by allowing hospitals to treat private patients instead of applying the medical insurance regulation. The government reform plan focused on intensifying governmental planning and intervention in the health care sector in order to removing inefficiency and promoting equity with the supports of social activists and labor unions. Finally, this paper proposed an alternative plan to promote harmonious social relationship between actors in the health care system.

• 보건행정학회지
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• 제17권3호
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• pp.106-128
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• 2007

The Korean health care system is under great controversy. Over the last 30 years, main goal of health policies was to pursue equal access of health care services. However, another goal of health policies laid on efficiency and Quality of care, it had lower priorities. Superficially, controversy stems from priority setting among goals of health care system, equity, efficiency and quality. At a deeper level, arguments arise from disagreement and confusion about the values of Korean health care system. One of the value spectrums believes that health care is the basic right of human beings, therefore it should be produced and distributed on need approach, and needs are known to be decided by professionals. If we accept need approach, health care is a pubic good. Another value of spectrums considers that health care should be distributed on demand approach. Demand approach means that health care is a consumption good on the positive economics, while normative judgement believes that health care is a public good. In equity aspect, health care is considered as a public good. Over the last several years, some of scholars proposed health care reform based on the principle of competition which is based on demand approach. Others argue that the competition principle based on demand approach is not appropriate for the reform proposal, because health care has to be approached on need base. If we do not make explicit values we should adopt, consensus building for reform is nearly impossible. From this perspective, this article will review an ideology and reality in health policies in Korea.

• 보건행정학회지
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• 제27권4호
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• pp.304-314
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• 2017

Background: This study aimed to analyze effects of postpartum care services to women after birth, identify the factors affecting their use, and examine the extent of income-related inequality in the postpartum care services utilization and expenditures using Korean Health Panel data between 2010 and 2013. Methods: The panel data of the year 2010-2013 of the 247 women after birth were used. First, EuroQoL-5D was used to evaluate the effects of postpartum care service to women's quality of life. Second, multinominal logistic regression analysis was used to identify determinants of the use of the postpartum care services. Finally, concentration index and HIwv (horizontal equity) index were used to find that the concentration index for the inequality in the use of postpartum care services showed negative sign, which implied pro-rich. Results: The estimation results showed that utilization of the postpartum services has a positive effect on women after birth. Also age, area of residence, and number of household members turn out to be the factors of using postpartum services. And there are inequality in the use of postpartum care services whose HIwv index showed positive sign, which implied pro-rich. Conclusion: Therefore, the government's policy of the postpartum care service is necessary to be expanded and diversified considering the personal characteristics and equity of the women after birth.

• 보건행정학회지
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• 제5권2호
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• pp.155-172
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• 1995

This study is an empirical analysis on the equity in the delivery of heatlh care under the Korean Medical Insurance Corporation System. The purposes of this study are to find out effects of income on the health care utiliztion and measure the income-related inequity in the distribution of health care. This study was carried out based on the fact that the health insurance program has been organized to achieve the equity objective, "equal treatment for equal needs". Of 41, 828 insured persons who had been diagnosed in the 1993 Health Screening Test and utilifzation data from 1, January 1993 through 31, December 1993 were derived from the Benefit Managment File. Inequity was measured by means of I) share approach, ii) standardization concentration curve approach, iii) inequity index, iv) test for inequity. The major findings were as follows : 1. The expenditure shares of the top two quintile groups exceeded their morbidity shares, whereas the opposite was true of the bottom three quintile groups, Which showed a positive HI$_{LG}$ inequity index, suggesting the presence of some inequity favoring the rich group. 2. Compared with other residential areas, the rural area showed the highest positive HI$_{LG}$ irrespective of need indicatior applied. 3. Standardized expenditure concentration indices adjusted by age, gender and need structure were also found to be positive, and therefore still indicated that there has been inequity favoring the rich after the standardization. 4. The Loglikelihood Ratio (LR) test for the statistical significance of income-related inequity of medical care utilization was carried out using the logistic regression model. The resulting loglikelihood ratio test statistic value was 176, which did exceed the 0.5 percent critical value of the chi-square distribution with 28 degrees of freedom, which is 50.993. Therefore, the null hypothesis of no income-related inequity of medical care utilization was rejected at the 99.5 percent confidence level. 5. The Regression based F-test has been carried out for analyzing the income-related inequity of medical expenditure in terms of age, gender, morbidity indicators as explanary variables. The hypothesis of the absence of income-relate inequity was rejected for all need indicators at the 95% confidence level.nce level.

• 도시과학
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• 제8권1호
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• pp.51-58
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• 2019

본 연구의 목적은 노인들의 응급의료이용에 영향을 주는 요인들을 알아보고 의료접근의 형평성을 조사하는 데 있다. 2014년 한국의료패널조사 자료를 사용하여 기술분석과 로지스틱회귀분석이 행하여졌으며 인터뷰에 참여했던 1,313명의 노인들이 표본으로 선정되었다. 연령, 성별, 교육수준 등의 인구변수들이 응급의료이용의 중요한 결정요인이었다. 의료요구는 노인 계층 간 응급의료이용의 차이를 충분히 설명하지 못한 걸로 나타났으나 건강상태는 응급의료서비스를 사용하는 노인들의 중요한 결정요인이었다. 의료비지출은 응급의료서비스이용의 계층 간 차이를 개선하지 못했으나 응급의료이용의 중요한 예측요인으로 남았다. 한국에서 의료개혁은 의료요구를 가진 노인들이 효과적인 진료혜택을 받을 수 있도록 전국민 응급의료 보장을 확대하는 방향으로 계속 이루어져야 한다. 앞으로 연구도 75세 이상의 교령노인과 여성 및 교육수준이 낮은 노인, 그리고 높은 의료비 지출을 하는 노인과 같은 인구계층들에게 혹시 있으지 모르는 의료접근의 장애들을 허무는 방향으로 이루어질 필요가 있다.

• 보건행정학회지
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• 제13권3호
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• pp.104-128
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• 2003

Equity in health care has taken priority in the Korean government's policy agenda after the government-led national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiary. The purpose of this study is to examine the extent to which there exists difference or inequality in the utilization of health care, especially cancer inpatient services among income classes. We analysed the utilization of cancer inpatient services of residents in Jeju Island for a year of 2000, using the national health insurance data for qualification of beneficiaries and utilization of health care. The independent variable are 10 income classes based on the national health insurance fee imposed on each household for a year of 2000. The dependent variables of this study are an amount of cancer inpatient health care utilization measured by cancer admission days and cancer treatment costs. Also, cancer inpatient health care utilization is analysed by three categories divided into utilization in medical care institutions (1) within Jeju Island, (2) outside Jeju Island, and (3) all within and outside Jeju Island. We measured concentration index of cancer inpatient health care utilization. This analysis showed negative concentration index within Jeju Island and positive outside Jeju Island, and positive in all within and outside Jeju Island. This results suggest inequality against the relatively poor income groups in utilization of cancer inpatient health care services. Especially, inequity of cancer inpatient health care would be more serious in Jeju Island of Korea, considering that lower income groups reportedly have higher incidence rates in most of cancer and thus use more health services.

• 보건행정학회지
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• 제32권3호
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• pp.258-271
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• 2022

The rapidly aging trend of Korea is a major factor that threatens the sustainability of the long-term care insurance system. Therefore, looking at how Japan and Germany mitigated the financial burden when they managed similar long-term care insurance systems will provide important implications for improving the Korean system in the future. The study was conducted using the literature review method, and the "country" was set as a unit for the case analysis. The three countries selected are Korea, Japan, and Germany. Recently in Korea, the insurance premium rates of all subjects have been rapidly rising, which can exacerbate the issue of intergenerational equity. On the other hand, Japan has responded to the aggravating finances for long-term care insurance due to aging by raising coinsurance for selected groups like the wealthy elderly. Germany is selectively raising the insurance premium rates by additionally increasing the premium rate for childless recipients. A more preventive and quality-oriented care service plan can be promoted by referring to the recent changes in Japan and Germany. In addition, a more effective and selective increase in payment burden in Japan and Germany could be considered in response to a recent equity issue in Korea.