• 의료법학
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• 제8권2호
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• pp.9-35
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• 2007

The Health care program in Korea has now been systemized after 30 years of declaring the inauguration of the national health insurance system by the current government. The national health care covering all Korean citizens was achieved after 12 years of implementing the national health insurance and the health care program since 1977. Hundreds of multiple operational agencies managing the insured individually had undergone the amalgamation process from 1998 to 2000, and had been restructured as one agency, the National Health Insurance Corporation. In 2003, the community/area based financial management was also merged together with the employment based financial management. The National health care system of Korea offer various merits, compared with that of other countries, such as health care provision covering all Koreans, low insurance premium, accessibility of medical services/facilities etc. However, there are still some weak features which need to be addressed for improvement; below expectation insurance cover system, mistrust on the medical services, low medical charges resulted from excessive restrictions, and unstable financial status of the national health insurance etc. Therefore, the National health care system should continue to evolve to re-establish itself as more effective national health care system by further strengthening its merits, and by improving its weaknesses; with adopting the positive system to optimize the costs of prescribed medicines/drugs, applying simpler insurance coverage system to calculate the optimum medical charges, promoting private medical insurances, and increasing insurance premium etc.

• 한국산학기술학회논문지
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• 제19권2호
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• pp.247-260
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• 2018

본 연구는 우리나라 장기요양보험 인정자들의 연령대(70대군, 80대군 및 90세 이상 군)별 정신적 건강상태(우울, 인지기능장애 및 치매)를 알아보고, 정신적 건강상태에 관련된 요인을 규명해 보고자 시도하였다. 조사대상은 2011~2014년도에 국민건강보험공단에서 장기요양 인정자로 판정받았던 70세 이상 노인 1,488명(남성 740명, 여성 748명)으로 하였다. 자료 수집은 국민건강보험공단으로부터 생활습관 등이 기재된 문진표, 검사항목별 건강검진 및 장기요양자료를 연구목적으로 제공받아 수집하였다. 연구결과, 조사대상자들의 연령대별 정신적 건강상태를 나타내는 우울, 인지기능장애 및 치매 수준은 연령대가 증가할수록 유의하게 높아지는 경향을 보였다. 다중 로지스틱 회귀분석 결과, 정신적 건강상태를 나타내는 우울, 인지기능장애 및 치매가 나타날 위험비는 각 연령대별로 큰 차이 없이 남성보다 여성에서, 과체중군보다 저체중군에서, 비흡연군보다 흡연군에서, 비음주군보다 음주군에서 유의하게 증가하였다. 이상과 같은 연구결과는 조사대상자들의 정신적 건강상태(우울, 인지기능장애 및 치매)는 연령이 증가할수록 저하됨을 시사하며, 특히 흡연, 음주 및 규칙적인 운동 등과 같은 건강관련행위특성이 좋지 않은 군이 좋은 군보다 정신적 건강상태가 저하되고 있음을 시사하고 있다.

• 보건행정학회지
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• 제19권2호
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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.

• 보건행정학회지
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• 제22권3호
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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.

• Journal of Preventive Medicine and Public Health
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• 제39권5호
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• pp.438-446
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• 2006

Objectives: We developed the predictive model for the incidence of colon cancer by utilizing the health screening data of the National Health Insurance in Korea. We also explored the characteristics of the high risk group for colon cancer. Methods: The predictive model was used to determine those people who have a high risk for colon cancer within 2 years of their NHI health screening, and we excluded the people who had already been treated for cancer or who were cancer patient. The study population is the insured of the NHI, aged 40 or over and they had undergone health screening from the year 2000 to 2004, according to NHI health screening formula. We performed logistic regression analysis and used SAS Enterprise Miner 4.1. Results: This study shows that there exists a higher rate of colon cancer in males than females. Also, for the population in their 60s, the incidence rate of colon cancer is much higher by 5.36 times than that for those people in their 40s. Amongst the behavioral factors, heavy drinking is the most important determinant of the colon cancer incidence (7.39 times in males and 21.51 times in females). Conclusions: Our study confirms that the major influencing factors for the incidence of colon cancer are drinking, lack of exercise, a medical history of colon polypus and a family history of colon cancer. As a result, we can choose the group that is at a high risk for colon cancer and provide customized medical information and selective management services according to their characteristics.

• 대한두경부종양학회지
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• 제17권2호
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• pp.216-220
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• 2001

There are many approaches in surgery of posterior hypopharyngeal wall cancer according to location, extent, and invasion depth of primary cancer. And many reconstruction methods have been used in reconstruction of surgical defect remaining after wide resection of primary cancer. Posterior hypopharyngeal wall cancer is relatively rare, so its surgical experiences are fewer than those of pyriform sinus cancer and there have been few reports of surgical approaches and reconstruction methods of posterior hypopharyngeal wall cancer. Recently, we experienced a case of posterior hypopharyngeal wall cancer reconstructed with longus colli flap and skin graft after failure of radial forearm free flap in a 72-year -old man and report it with the review of the literatures.

• 의료법학
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• 제13권2호
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• pp.45-72
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• 2012

The National Health Insurance Corporation has been retrieving from health care providers the payments made to them by insured patients as a result of the health care providers' arbitrary denial of coverage under the National Health Insurance, and has been disbursing such retrieved monies back to the patients, pursuant to Article 57, Sections 1 and 4 of the National Health Insurance Act. However, such practice is an application of the law that lacks legal exactitude. Another problem with such practice is that there is no legal provision under any laws or notices that expressly prohibits arbitrary denial of coverage. A legislative solution, therefore, is called for to address these issues.

• 보건행정학회지
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• 제18권2호
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• pp.1-18
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• 2008

As medical insurance had been implemented for Magnetic Resonance Imaging (MRI) from January 1, 2005, this study investigated whether there had been any change in the amount of the medical care utilization of patients who undertook MRI before and after the insurance coverage, and was to examine factors affecting the amount of medical care utilization of MRI. Data were collected from patients who undertook MRI before and after the insurance coverage for a year at a general hospital in Kyeanggi-do. $X^2$ and t-test were used for the analysis of their general characteristics, the number of MRI, and its medical costs before and after the insurance coverage, and hierarchical multiple regression analysis for the factors affecting the amount of the medical care utilization of MRI. The results of this study were as follows. First, the number of MRI after the insurance coverage was significantly decreased. Second, there was no significant difference in the total medical costs of MRI after the insurance coverage, but a significant difference was found in patient's share of medical costs. Third, six variables were found to be affecting the amount of the medical care utilization of MRI, and the variables showed to lead the number of MRI decrease after the insurance coverage. These six factors explained 21.4% of the total number of MRI. As MRI had been covered by insurance, the use of MRI and patient's share of the costs were deceased, but the total medical costs were not affected. Reasons for that could be found in that MRI insurance, different from the case of CT insurance coverage, was allowed not to cover some items and the kinds of diseases subjected to the insurance coverage were extremely limited, lowering insurance prescription rate. In addition to that, the average medical cost of MRI was not changed after the insurance coverage. Therefore, as future measures for the MRI insurance, coverage, it should be considered to allow insurance coverage to no coverage items and to expand the scope of benefit coverage, or to lower patient's share of the costs. Furthermore, researches should be done to explore how recipients will act and how suppliers will react if the coverage is expanded, including expanding the scope of coverage and reducing patient's share of the costs, as well as to conduct research on its economic analysis according to case mix.

• 한국직업건강간호학회지
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• 제21권3호
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• pp.247-257
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• 2012

Purpose: This study is designed to identify major factors that affect morale among staff of long-term care insurance in National Health Insurance Corporation. Methods: In order to collect the data, a survey was conducted by using the structured questionnaire based on 161 staff members of long-term care insurance of 50 long-term care operation centers, which were randomly selected by the table of random numbers in the whole centers of National Health Insurance Corporation from September 1 to 30, 2011. As for the data analysis, SPSS 18.0 was used to conduct the descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, mutiple regression, and path analysis. Results: The average point of morale was 3.37, and had a negative correlation with the job stress, while it had a positive correlation with the social support, professional identity, and self-efficacy. Job stress, social support, and professional identity have a significant effect on morale among the independent variables. These variables have significant effects on morale, and also have a positive effect on self-efficacy. The findings show that self-efficacy mediates the process of morale. Conclusion: In this study, the factor which influences the morale was identified. It turned out that the morale could be improved by reinforcing the professional identity, managing the health status as well as rotating the working place. As such, it expects both the improvement of long-term care insurance services outcome and its quality through the morale management.

• 보건교육건강증진학회지
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• 제23권4호
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• pp.13-28
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• 2006

Objectives: This study used the characteristics of the knowledge discovery and data mining algorithms to develop hypertension predictive model for hypertension management using the Korea National Health Insurance Corporation database(the insureds' screening and health care benefit data). Methods: This study validated the predictive power of data mining algorithms by comparing the performance of logistic regression, decision tree, and ensemble technique. On the basis of internal and external validation, it was found that the model performance of logistic regression method was the best among the above three techniques. Results: Major results of logistic regression analysis suggested that the probability of hypertension was: - lower for the female(compared with the male)(OR=0.834) - higher for the persons whose ages were 60 or above(compared with below 40)(OR=4.628) - higher for obese persons(compared with normal persons)(OR= 2.103) - higher for the persons with high level of glucose(compared with normal persons)(OR=1.086) - higher for the persons who had family history of hypertension(compared with the persons who had not)(OR=1.512) - higher for the persons who periodically drank alcohol(compared with the persons who did not)$(OR=1.037{\sim}1.291)$ Conclusions: This study produced several factors affecting the outbreak of hypertension using screening. It is considered to be a contributing factor towards the nation's building of a Hypertension Management System in the near future by bringing forth representative results on the rise and care of hypertension.