• Health Policy and Management
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• v.14 no.2
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• pp.58-77
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• 2004

Cost containment has become high political issues since financial crisis of the Korean Health Insurance fund in 2000. Korean Government has developed and implemented several measures to reduce the pharmaceutical expenditures. Pharmaceutical economic evaluation can be a tool in decision to allocate scare resource efficiently. In order to increase the quality of economic evaluation for pharmaceuticals, the Korean Health Insurance Review Agency(HIRA) is considering the development of a guideline for economic evaluation. It mandates that pharmaceutical companies could submit the result of an economic evaluation when demanding reimbursement of new pharmaceutical drugs. The purpose of this study is to provide a critical review of the economic evaluations of health care technologies published in the Korean context whether they have been performed according to current guidelines and therefore whether their results are directly useful for decision making. We found there exist important problems and deviation from, good practice' both in the general features of the studies, like the study design and perspective, and in terms of cost measurement and valuation. There are needs to develop clear guidelines and to educate and train researchers in performing economic evaluations.

• Health Policy and Management
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• v.16 no.1
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• pp.17-40
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• 2006

With the prospect of rapidly growing health insurance expenditures, particularly spending for ambulatory care, the introduction of a case-based payment method is discussed as an alternative to the current fee-for-service based method. A system to measure case mixes of providers is a core component of such payment systems. The objective of this study were to develop a classification system for ambulatory care, Korean Ambulatory Patient Group (KAPG) based on the U.S. APG version 2.0 and to evaluate the classification accuracy of the system. A database of 64,258,386 records was constructed from insurance claims submitted to the Health Insurance Review Agency (HIRA) during three months from August 2002. A total of 41,347,307 records with a single visit was used for the development and 7% random sample of the database was used for the evaluation. Additional groups were defined to include both physician and hospital fees in the classification, age splits were added to classify the entire population as well as the population older than 65, and the definition of medical groups used by the HIRA was adopted. The variance reduction in charges achieved by KAPGs was computed to evaluate the accuracy of classification. A total of 474 KAPGs was defined compare to 290 groups in the U.S. APG. The variance reduction for charges of all visits ranged from 20% to 37% depending on the type of provider, and ranged from 22% to 42% for non-outliers, that were better than those achieved by the system currently used by the .HIRA for its internal review purpose. Although further study is required to improve the classification for complicated care in larger hospitals, the results indicated that KAPGs could be used for better management of costs for ambulatory care.

• Human Ecology Research
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• v.57 no.1
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• pp.143-157
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• 2019

This study analyzed per capita expenditure (food expenses, housing expenses, health care costs, and cultural & entertainment expenses) by the consumption quintile for middle and older elderly households in addition to personal characteristics, household characteristics and economic factors affecting it. A sample collected from the 6th KLoSHA in 2016, was 2,983 households. First, among each per capita expenditure, the largest expenditure was food expenses, followed by housing expenses, health care costs and cultural & entertainment expenses. Compared with the first quintile of personal consumption expenditure, the largest increase in the fifth quintile was food expenses, followed by cultural & entertainment expenses, housing expenses, and health care costs. Second, compared to the fifth quintile of per capita food expenses, all other quintile had negative effects, and only the first quintile showed a negative effect compared to the fifth quintile of per capita housing expenses. The first, the second, and third quintile had a negative effect compared to the fifth quintile of per capita health care costs. Compared with the fifth quintile of per capita cultural & entertainment expenses, only the third quintile showed a negative effect. Third, in all quintile of per capita food expenses, the most influential variable from the first quintile to the third quintile was marital status, while in the fourth and fifth quintile included household income. In all quintile of per capita health care costs, health status was the most influential variable from the first quintile to the fourth quintile, and residence was in the fifth quintile.

• Journal of Preventive Medicine and Public Health
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• v.46 no.3
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• pp.147-154
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• 2013

Objectives: Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. Methods: Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. Results: Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p= 0.021) after adjustment for residence, socioeconomic status, and morbidity. Conclusions: Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.

• Journal of Preventive Medicine and Public Health
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• v.53 no.3
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• pp.205-210
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• 2020

Objectives: Aging is assumed to be accompanied by greater health care expenditures. The objective of this retrospective, bottom-up micro-costing study was to identify and analyze the variables related to increased health care costs for the elderly from the provider's perspective. Methods: The analysis included all elderly inpatients who were admitted in 2017 to a hospital in Tehran, Iran. In total, 1288 patients were included. The Mann-Whitney and Kruskal-Wallis tests were used. Results: Slightly more than half (51.1%) of patients were males, and 81.9% had a partial recovery. The 60-64 age group had the highest costs. Cancer and joint/orthopedic diseases accounted for the highest proportion of costs, while joint/orthopedic diseases had the highest total costs. The surgery ward had the highest overall cost among the hospital departments, while the intensive care unit had the highest mean cost. No statistically significant relationships were found between inpatient costs and sex or age group, while significant associations (p<0.05) were observed between inpatient costs and the type of ward, length of stay, type of disease, and final status. Regarding final status, costs for patients who died were 3.9 times higher than costs for patients who experienced a partial recovery. Conclusions: Sex and age group did not affect hospital costs. Instead, the most important factors associated with costs were type of disease (especially chronic diseases, such as joint and orthopedic conditions), length of stay, final status, and type of ward. Surgical services and medicine were the most important cost items.

• Korea Journal of Hospital Management
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• v.9 no.2
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• pp.76-101
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• 2004

The primary purpose of this study was to provide the basic information for improving collaborating care of Korean traditional medicine and western medicine by surveying utilization and attitude on it among cerebral apoplexy(CA) patients hospitalized at a general hospital with both the western and Korean traditional medical department in Busan metropolitan city, Korea. The survey was conducted on 170 patients, 80 from Korean traditional medical department, and 90 from western medical department. The major results of this study were as below: First, CA patient's medical utilization patterns including selecting medical institution, term of treatment and type of medical institution at first-aid were significantly variated by their socio-demographic characteristics such as religion and job. Second, the perceptions of collaborating care, such as effectiveness and reduction of treatment period, were better at respondents who were hospitalized at oriental medical department and had been experienced with collaborating care. Third, the major contents of collaborating care which utilized by respondents in side of western medicine were physical therapy, x-ray, pathologic diagnosis, and medication, and in side of Korean traditional medicine were acupuncture, herbal medication, moxa cautery, cupping a boil therapy. Fourth, overall satisfaction on collaborating care was good(3.5 of 5.0) and was significantly variated by age and religion. Fifth, respondents perceived that collaborating care was most helpful for rehabilitation and the major problem of current duplicate medical system was increasement of medical expenditures, and the major obstacle of collaborating care was prejudice against each other medicine. The results of this study imply that effective marketing for collaborative care suitable for age and religion of customers and patient satisfaction strategy is needed to activate collaborating care.

• Korea Journal of Hospital Management
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• v.19 no.4
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• pp.57-68
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• 2014

Since the introduction of National Health Insurance(NHI) in 1977, it has grown rapidly and contributed to extend patient's access to the health care services. However, limited coverage for health care services of NHI has been ongoing challenge and private health insurance(PHI) has been rising as an alternative source of enhancing coverage and saving out-of-pocket(OOP) expenditure for patients. In this study, after controlling for socio-demographic, economic, health related variables, we identified the patients' healthcare utilization and subsequent OOP expenditure depending on their PHI enrollment and their enrollment types(fixed benefit, indemnity, fixed benefit plus indemnity). Data were collected from the 2010 Korean Health Panel. The unit of analysis was a member of household(n=13,324). Of the 13,324 cases, 70.7% of patients held PHI, in detail, fixed benefit(47.0%), indemnity(3.6%), fixed benefit plus indemnity(20.1%). Major findings showd that patients who enrolled in PHI used more outpatient services(outpatient visit, number of physician visit, number of examination) and spent more OOP expenditure than non-PHI patients. There were also differences of healthcare utilization and OOP expenditure among the types of PHI. In addition, PHI patients used more inpatient services(inpatient use, number of hospitalization, LOS), but there was no significant difference between PHI and non-PHI patients with regard to the OOP expenditure. Thus, we could not find any distinct relationship between the types of PHI and patients' tertiary hospital use. Policy-makers should need careful political deliberation for monitoring the effect of PHI on health care utilization and subsequent expenditure not only to improve patients' coverage but also to save their OOP expenditures.

• Journal of Preventive Medicine and Public Health
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• v.32 no.4
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• pp.546-555
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• 1999

Objectives : To determine the prevalence, pattern. and out-of-pocket expenditure of complementary and alternative medicine (CAM) utilization in Korean adult population. Methods : We conducted a representative telephone survey of 2,042 persons aged 18 or older. Data about any health problem, details of their use of medical doctors(MDs) offices/hospitals/pharmacies services and CAM during the preceding 12 months were collected with structured questionnaire. Results : The utilization rate of CAM among Korean adults was 29% in one year. A total of 231 kinds of CAM was identified from this survey. Annual out-of-pocket expenditure associated with CAM use in 1998 amounted to ${\xi}{\S}1.88$ billion and was comparable to 40.8% of out-of-pocket expenditure paid for MDs offices/hospitals/pharmacies services. Among those(N=424) who paid for both MDs offices/hospitals/pharmacies services an d CAM, 35.8% paid more for CAM. CAM gave more satisfaction than western medicine to those who had experience of both types of therapy. About half of CAM users were willing to recommend CAM to others. Disclosure rate to physician among CAM users was not high(40.6%). Conclusion : CAM became a popular source of health care in Korea, Korean spent a substantial amount of out-of-pocket money on CAM without any public control. Because CAM use is likely to be increased rapidly through lay referral system, health policy makers and health professionals should pay more attention to CAM for making appropriate utilization of CAM.

• Health Policy and Management
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• v.3 no.1
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• pp.53-83
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• 1993

A small number of high cost patients usually spend a larger proportion of scarce health resources. Korea is no exception. Under the national health insurance, 12% of the insured persons have consumed approximately half of the national health insurance expenditures. Therefore, it is necessary to identify the characteristics of the high cost patient group, if we would like to reduce them. This study has defined high cost patients as those who have spent one and half million won and over per 6 months. The study reveals that high cost users are those who have a longer length of stays(LOS), 40days of LOS in the 6 months, have multiple admissions, 2 to 3 admissions per 6 months and are the elderly patients. They have spent 814.126won per on the average, and commonly suffered from malignant neoplasms, circulatory diseases, fracture, diabetes mellitus, etc. Unlike the case of western developed countries, early readmissions are not the major causes of high cost spending in Korea. Undoubtedly, a lengthy admission is the main cause of large spending. Health policies should vigorously be explored to respond appropriately. There are evidences that hospital beds are often misused. As the Korean health care system is lacking in a mechanism of patient evaluation under the fee-for-service remuneration system, an idea of progressive patient care needs to be tested. The Goverment should set up health policy to diversify the role of long-term care facilities and encourage people to establish them. Further studies are needed to identify factors influencing large medical bills necessary for formulating the health policy on cost containment.

• Health Policy and Management
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• v.29 no.3
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• pp.374-378
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• 2019

After the announcement of Moon Jae-in Government's plan (Moon's Care) for Benefit Expansion in National Health Insurance in August 2017, it is necessary to monitor the effects of the policy, especially household out-of-pocket payments (OOP). This paper aims to observe the current status and trend of OOP in Korea. Current health expenditure (CHE) was 144.4 trillion won in 2018, which accounts for 8.1% of gross domestic product (GDP) increased 9.7% from the previous year. Although GDP's share of CHE has been close to the average of the Organization for Economic Cooperation and Development (OECD) countries, the public fund's share was 59.8% of the total in 2018, which was lower than the OECD average of 73.5%. OOP's share was 32.9% in 2018, which decreased from 37.4% in 2008. The share of OOP of non-covered services was 20.0% in 2018, which decreased from 22.9% in 2008. The share of cost-sharing with third-party payers was 12.9% in 2018, which decreased from 14.5% in 2008. The OOP of non-covered services was significantly decreased in hospital and inpatient curative care, but the OOP of non-covered services was significantly increased in the medical clinic. The effect of Moon's Care was not showed in OOP through the results of 2017 and 2018, but further monitoring is needed because the Moon's Care is progressing and the observational period is short.