• Journal of Preventive Medicine and Public Health
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• 제24권2호
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• pp.211-220
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• 1991

Finances of health insurance can be explained by factors determining benefit expense and premium collection. This study was conducted to analyze factors contributing to the financial status of rural health Insurance. Nationwide 134 health insurance associations except the six pilot project counties were analyzed and obtained the followings. 1. In univariate analysis, statistically significant variables that explain 1) outpatient benefit expenditures include public health center utilization, proportion of pregnant women. premium and collection rate of premium 2) inpatient benefit expenditures include public health center utilization, Proportion of old age, proportion of pregnant women, premium and collection rate of premium 3) profits include public health center utilization, proportion of old age, proportion of pregnant women and collection rate of premium. 2. In multiple regression analysis, statistically significant determinants in 1) outpatient benefit include premium and public health utilization 2) inpatient benefit include premium 3) profit include public health center utilization, premium and collection rate of premium.

• 보건의료산업학회지
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• 제6권2호
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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.

• 보건행정학회지
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• 제31권3호
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• pp.364-373
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• 2021

Background: This study aims to examine the regressiveness of national health insurance (NHI) premium burdens for local subscribers. The government has established a restructuring of health insurance contributions in 2017. Therefore, insurance premium reform began in 2018 and the second national health insurance premium reform will be carried out in 2022. We will analyze local subscribers before and after the policy reform of 2018. Methods: This study used data from 'local premium imposition elements' in the health insurance statistics annual reports (2017-2019) on National Health Insurance Service (NHIS). This study was calculated contribution rates according to levels of income and property for local insured by the method of comparing. Simulations of primary and secondary reforms were conducted in the study to determine regressiveness. Results: Insurance premiums for local subscribers were analyzed separately by income and property insurance premiums. In the income premium analysis, the higher the income, the lower the premium rate, and then the fixed rate was maintained from a certain section. The regressiveness of income insurance premiums has been eased in part. On the other hand, the property insurance premium burden was found to be regressive still by income class. Conclusion: Regressiveness analysis showed that a decrease in income contributions was achieved to local insured in the first phase of reform. But in the second phase of reform, more consideration should be given to reductions of property premium portions of local subscribers. Based on the results, the author suggested policy discussions to reorganizing the new systems of NHI contribution of local Insured.

• 의료법학
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• 제15권1호
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• pp.185-209
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• 2014

While the local health insurance and the employment-based insurance were integrated in July 2000, the insured is divided into employment-based insured and the local insured and the relevant premium has been applied to both groups. The health insurance premium having the feature of social solidarity has to be determined depending on income, that is, the ability to pay in accordance with the principles of social insurance. While employment-based insurance premium has been determined depending on the earned income, the local insurance premium for the local insured has been determined by scoring gross income(evaluated income), property and possession of automobiles. A variety of improvement approaches has been implemented including introduction of the employment-based insurance premium ceiling system (2002) and the change of property scoring system for the local insured (2006). However, the health insurance system which was merged in 2000 has been implemented up to now without significant change even though there were lots of socio-demographic change including increase of income level and the population structure such as low birth and aging. In other words, it is required to implement the premium rating system securing the income-based equity. Nevertheless, it was inevitable to apply the diverse rating standards in the early stage because it was very difficult to verify the income of the self-employed. Although the income verification rate was significantly increased from 23% in 1989 to 44% in 2010, the irrational standards including property, automobiles, living standard and activity rate have been still applied to the local insured because it is difficult to secure the validity of insurance premium rating system and it severely lacks of security. This paper investigated whether the current insurance premium rating system for the local insured imposing the premium on the basis of 'gender' and 'age' complies with the basic human rights secured by the current Constitution of the Republic of Korea with respect to the practical and theoretic irrationality of insurance premium rating system and standards for he local insured. In accordance with the analysis results, this paper proposed the approach to improve the system.

• 한국콘텐츠학회논문지
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• 제14권8호
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• pp.277-286
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• 2014

본 연구의 목적은 국민건강보험 가입자의 건강보험에 대한 인식수준과 만족도와의 관계를 확인하는 연구이다. 자료의 분석은 SPSS/WIN 14.0 프로그램을 이용하여 기술통계, $X^2$검정, 독립표본 T검정과 일원배치 분산분석(ANOVA)을 실시하였으며, 연구결과는 다음과 같다. 국민건강보험제도에 대한 인식수준과 만족도 관계에서는 국민건강보험의 보장 수준이 높다고 생각하는 집단, 자신이 내고 있는 국민건강보험료를 알고 있는 집단, 평소 국민건강보험에 대한 생각이 긍정적인 집단, 국민건강보험료 부담이 공평하다고 느끼는 집단이 국민건강보험 제도에 대한 만족도가 통계적으로 유의하게 높게 나타났다. 또한 물가인상과 비교한 보험료 인상 수준이 높을수록, 국민건강보험료 부담이 가계에 부담이 더하다고 느낄수록 국민건강보험 제도에 대한 만족도는 통계적으로 유의하게 낮게 나타났다. 본 연구는 국민건강보험에 대한 세부적인 인식수준을 파악하고 이와 국민건강보험제도 만족도의 관계를 확인하였다. 이 결과는 건강보험제도를 다수의 국민이 만족할 수 있는 방향으로 재설정하는데 기초자료를 제공해줄 수 있을 것으로 사료된다.

• 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.

• 의료법학
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• 제20권1호
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• pp.203-242
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• 2019

지방자치단체는 의료보장을 위해 2006년부터 국민건강보험제도 등 의료보장과 관련한 사회보험료를 지원하는 정책이 매월마다 시행되고 있다. 본 연구는 지방정부에서 노인세대 또는 저소득대가구 등의 국민건강보험료 등 공적 보험료를 지원하는 자치법규가 어떠한 내용으로 법규화되어 있는가의 특성 등에 대해 고찰하는 데 목적이 있다. 본 연구의 수행을 위한 방법으로서 국가법령정보센터의 웹사이트에 공표된 자치법규에서 조례와 조례규칙을 '건강보험료'의 검색어를 통해 검색한 결과를 통해 이루어졌다. 2019년5월 현재 제정된 조례는 201건이었는데, 광역지방자치단체는 17개 중에서 8개의 시도에서, 기초지방자치단체는 226개 중에서 193개의 시군구에서 제정되어 있으며, 조례 시행규칙은 전체 37건이 제정된 것으로 조사되었다. 이 중 조례의 경우 목적, 조례 제정시기, 사회보험료의 종류, 사회보험료의 지원 대상, 사회보험료 지원의 금액, 사회보험료 지원의 방법과 과정, 사회보험료 지원의 시기, 사회보험료의 재원 등으로 구성되어 있고, 이러한 조문 내용에 대해 분석하였다. 그리고 이러한 내용을 통해 정책적, 법적인 측면에서 논쟁이 될 수 있는 사안은 무엇인지에 대한 논의와 함께 개선 방향을 제시하였다.

• 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.

• Journal of Preventive Medicine and Public Health
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• 제25권4호
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• pp.399-412
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• 1992

This study was designed to investigate factors relating to fiscal deficit for regional health insurance. The financial statements for the fiscal year 1990 of nationwide 254 regional medical insurance societies were analyzed. Important findings are summarized below: 1. There were differences in the main reason fur the financial deficit among regions when deficit and surplus societies were compared by regions. The total revenue per enrollee, especially revenue from the premium contribution of a deficit society was significantly smaller than that of a surplus society in large cities and counties. On the other hand, the total expenditure per enrollee of a deficit society was larger than that of a surplus society in small cities. 2. Both low premium rate at the beginning of health insurance program and less effort to increase the premium rate were main factors for the smaller revenue from the contribution of a deficit society in large cities and counties. 3. Larger expenditures per covered person of a deficit society in small cities were explained with larger medical expenditures especially for out-patients services rather than larger administrative expenses. 4. A regression analysis showed that utilization rates in out-patient services were significantly associated with income and numbers of total medical care institution per capita within a region where a health insurance society located. Also expenses paid by insurer per visit were associated with the proportion of utilization for tertiary care hospitals as well as the proportion of utilization of public health centers.

• 보건의료산업학회지
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• 제9권1호
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• pp.57-66
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• 2015

This study was performed to provide efficient fund managing plans for hospitals by looking into the management of medical fees for accident insurance. Car insurance, industrial accident insurance and seamen's insurance at a general hospital which is located in Busan during 29 months from January 1, 2009 to May 31, 2011 were assessed. The research data is the total number of 6,293 cases, including 2,251 car insurance cases, 2,350 industrial accident insurance cases, and 1,692 seamen's insurance cases. There were some significant differences found, as car insurance and seamen's insurance, including accident insurance, are types of insurance for which employers or traffic accidents offenders shall be the final premium payer. In addition, medical examination fees or premium payers are applied under their respective related laws. The findings suggest that it is necessary for managers of hospitals to prepare differentiated management schemes based on the characteristics of each insurer and schemes to ensure proper recovery strategies of uncollected medical account receivables.