• Journal of Korean society of Dental Hygiene
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• v.12 no.4
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• pp.751-758
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• 2012

Objectives : This study aimed to seek the national health insurance coverage and the efficient direction of toothbrushing instruction and to contribute to establishing policy as auxiliary data, targeting 373 dental hygienists who are working in some areas of Jeonnam. Methods : A research method was questionnaire survey by individually self-administration method. Results : It was indicated to agree to the national health insurance coverage of toothbrushing instruction in the better understanding and cooperation level with toothbrushing instruction, in case of carrying out toothbrushing instruction, and in the higher age group. Conclusions : There will be a need of allowing the national health insurance coverage to be formed in the direction at which the dental service providers and the dental service consumers can be satisfied, by being performed a comprehensive and sufficient research for this.

• The Korean Society of Law and Medicine
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• v.12 no.2
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• pp.189-217
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• 2011

According to the current law of national health insurance, the Minister of Health and Welfare can impose a suspension of business or license, and a fine with medical institutions who violate the law. In case that medical institutions raise an action for ity with each penalty, they ask for replacing the suspension of business with a fine during the pendency of the action. But there is a long gap of time between an offense and administrative measures. One violation cause several types of administrative measures (suspension of business or fine, suspension of license etc.) and different government departments impose these penalties. It takes a lot of time to organize their opinions and they are liable to impose penalties after considerable space of time because of overwhelming tasks. Then the medical institutions can sustain a loss by getting unexpected administrative measures after their offense against the law. Thus, this article review whether extinctive prescription apply to the right of imposing fine on the law of national health insurance or not. Meanwhile, we have no regulations imposing a same fine to co-representatives of medical institution who infringe the law of national health insurance. On this point, this study review whether they have equal duty on that or not.

• Health Policy and Management
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• v.30 no.2
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• pp.192-198
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• 2020

Background: Korea National Health Insurance Service (NHIS) is operated as a social insurance system in which people pay a portion of their monthly income as insurance premiums and receive benefits when they experience illness or injury. Since 2005, the national health insurance remained surplus accumulating cumulative reserves each year. However, as of 2018, NHIS revenue recorded 62.11 trillion won and spending of 62.29 trillion won. The deterioration of NHIS finances is expected to accelerate with the aging population, income growth, new medical technology development, and enhanced security policies. Methods: To examine the financial health and sustainability of NHIS, we estimated the future revenue and spending until 2030 using the data from Korea Health Insurance Review and Assessment Service statistical yearbook. 2004-2018 average percentage change in NHIS revenue and spending was calculated. We estimated the future NHIS financial status using two methods. In the first method, we calculated the revenue and spending of the future NHIS by applying the 2004-2018 average percentage change to the subsequent years consecutively. In the second method, we estimated the future NHIS financial status after adjusting for the predicted demographic changes such as the aging population and declining birth rate in South Korea. Results: The estimates from this study suggest that the NHIS's cumulative reserves will run out by 2024. Conclusion: In terms of spending on current health insurance, there should be a search for ways of more efficient spending and funding options.

• Journal of Korean society of Dental Hygiene
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• v.18 no.5
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• pp.771-783
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• 2018

Objectives: This study aimed to identify methods that help medical consumers to be aware of relevant information regarding changes in dental health insurance policy. Methods: The following results were obtained from a survey regarding awareness and satisfaction with dental health insurance policy among the general public aged 20 years or older in Seoul, Gyeonggi Province, and other areas from August 1, 2017 to August 23, 2017. Results: The correlation between adults' awareness of and satisfaction with dental health insurance was 0.471, where satisfaction with dental health insurance was enhanced with increasing awareness of dental health insurance (p<0.001). Factors that significantly affected awareness of dental health insurance were marriage (married p<0.05), medical service (dental university hospital, p<0.01), and satisfaction with dental health insurance (p<0.001); these factors explained 29.2% of the variance. Factors that significantly affected satisfaction with dental health insurance were final education (high school graduation, p<0.05), medical service (dental hospital, p<0.05), and awareness of dental health insurance (p<0.001); these factors explained 27.8% of the variance. Conclusions: Importantly, awareness of the government's operation of dental health insurance and the benefits of such dental health insurance were low, suggesting that the government and national health insurance agency should improve the level of transparency in dental health insurance operations and continuously promote dental health insurance benefits to the public.

• Korean Journal of Head & Neck Oncology
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• v.39 no.1
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• pp.15-18
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• 2023

A plunging ranula is a pseudocyst caused by mucus secreted from the sublingual glands, and it is mainly observed on the mouth floor. Nowadays, sclerotherapy using picibanil has been performed instead of invasive surgical treatment, and studies are reporting safe and effective outcomes. In our study, more than 92% of the 25 patients had marked response after picibanil sclerotherapy, and no serious complications were observed. Picibanil sclerotheraphy can be considered as the primary treatment of plunging ranula for patients who refuse surgery under general anaesthesia.

• Research in Community and Public Health Nursing
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• v.23 no.4
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• pp.415-426
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• 2012

Purpose: This study aimed to investigate trends in home-visit nursing care by agencies' characteristics under the national long-term care insurance system. Methods: Cochran-Mantel-Haenzel tests were conducted, using data drawn from the nationwide long-term care insurance claim database of the Korean National Health Insurance Corporation from 2009 to 2011. Results: The number of home-visit nursing care agencies has decreased continuously since 2009. There were also similar trends in the total amount of service provided by home-visit nursing care agencies, the number of recipients, the number of employees, and payments. This study showed that there were statistically significant differences in the trends in home-visit nursing care by agencies' characteristics. Despite the overall downward trend, there were some increases in the percentage of home-visit nursing care provided by agencies which were established by individuals, located in large cities, and which combined home-visit care with home-visit bathing. Conclusion: Home-visit nursing care agencies are responsible for providing community-based healthcare services. For past three years, however, they have not been utilized to their full potential. Understanding the trends in home-visit nursing care by agencies' characteristics is important to develop utilization strategies for home-visit nursing care.

• Health Policy and Management
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• v.26 no.4
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• pp.333-342
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• 2016

Background: The use of therapeutic materials based on new health technology has increased in recent years in the field of medicine, raising concerns for medical practitioners regarding increased spending on the new therapeutic materials amid the rapid population ageing and increase of chronic diseases in Korea. While therapeutic materials have significant importance in the health care system, they have not been given appropriate attention in the academic world of Korea. The purpose of this study is to identify factors that affect the growth of expenditure on therapeutic materials and to derive implications for an effective management considering the diversity of therapeutic materials. Methods: Using the claims data of the National Health Insurance Services, specific utilization patterns of groups of therapeutic materials in the middle classification level of Health Insurance Review and Assessment Service from 2007 to 2014 were analyzed. Four categories (J5083: drug eluting coronary stent, D0302: nonmetallic anchor, K6014: gauze, K6023: gauze) that exhibit unique patterns with respect to price and volume were selected. Then, decomposition analysis was performed to identify the largest contributor to the spending growth by dividing the products into existing, new, and abandoned products for the period between 2010 and 2013. Results: The effect of new products had larger impact on spending growth than the effect of core items in drug eluting coronary stent (J5083) and nonmetallic anchor (D0302). In addition, existing products in general included items priced relatively lower when compared with another item manufactured by the same company. In the gauze category, however, existing products had the largest impact on expenditure and the effect of volume was greater than that in other categories. Conclusion: This study provides evidence that appropriate management measures classified by the characteristics of therapeutic materials are required for therapeutic materials pricing and reassessment in Korea.

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

• Health Policy and Management
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• v.19 no.2
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• pp.36-50
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• 2009

Korean Government had performed three pilot programs to introduce the long term care insurance system. Persons aged 65 or older who are dependent on others for daily living could use long term care services in the pilot program. The long-term care insurance covered nursing home services, home care services and cash benefits. The cash benefits are included that for elderly at home and for patients in geriatric hospital. This study investigated whether there had been any change in the medical care utilization according to cash benefits for geriatric hospitalization. This study used National Health Insurance claims and Long term Care Insurance claims 2003 through 2006. Data were composed of subjects who undertook both insurance coverage. The subjects was divided into two groups. Case group included participants with the cash benefits of geriatric hospitalization. Control group included persons without the cash benefits selected by random sampling according to the distribution of case group. This study showed that the amount of medical care utilization of the case group is more significantly increased than the control group after adjusted their health condition and functional condition. This result will be helpful for making decisions on whether the cash benefit of geriatric hospitalization can be introduced into long term care insurance system.

• The Korean Journal of Health Service Management
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• v.6 no.2
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• pp.165-177
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• 2012

This study examined market size of private health insurance premium and individual characteristics associated with the market size change in Korea, using wave 1 (2008) and wave 2 (2009) of Korea Health Panel. The market size was 24.4 trillion Korean won in 2008 and 26.9 trillion in 2009. The increase rate of private health insurance premium among those who were the elderly, single, or the poor was higher than that among their counterpart respectively. Health status and utilization were insignificant in determining the increase rate of private health insurance premium. These findings were more obvious among the uninsured in 2008 than among the insured in 2008. The increase of private health insurance premium in Korea imply the increase of willingness-to-pay for health risk through private sector. The authors suggest policy intervention for accessability to health care for the underprivileged and weak through enlargement of Korean social health insurance benefit.