• 대한한의학회지
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• 제44권1호
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• pp.1-15
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• 2023

Objectives: National health insurance herbal prescription of Korean medicine has been serving important role in public healthcare in spite of continuous demand on revision of system. However, the categories of insurance herbal prescriptions are not equally distributed throughout the KCD-based major disease categories. We analyzed statistical database of claimed national health insurance classified as major disease categories by years. We classified all 56 herbal prescriptions as per their total medical indications into 22 major disease categories to analyze their distribution. Significant increase of M and S-T code claims were found, whereas decrease of U code claims by years. We figured out that the 56 prescriptions were unequally distributed along with enrichment of certain codes such as K and J. Meanwhile, the insurance claim of each prescription was positively correlated with number of code types of their indications. As a result, we believe that the reform of national health insurance herbal prescription list is necessary to promote use of it in clinic.

• 의료법학
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• 제20권3호
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• pp.3-45
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• 2019

건강보험은 국민의 건강을 보장하는 헌법적 과제를 실현하는 주축 수단이다. 건강보험의 과제를 살펴보기 위해서는 역사적으로 형성된 우리 건강보험의 특성, 건강보험 자체의 급여와 관련된 특성 및 규범적 특성을 이해하여야 한다. 우리 건강보험은 낮은 수준의 보편적 평등을 지향하였다. 이는 역설적으로 건강보험을 보편화하는 데 유리한 상황이 되었다. 건강보험의 과제는 포괄적이며, 적극적·개방적이다. 그러나 건강보험은 평균적 진료와 재정안정성을 유지하기 위하여 어느 정도 정형화된 진료의 종류와 내용 및 방법을 규범화하여야 한다. 건강보험은 한편으로는 이를 벗어나는 진료를 통제하여야 하지만, 다른 한편 진료의 필요성과 효과성을 기준으로 이를 보충하여야 한다. 그런데 이러한 두 요청은 일치할 수 없다는 구조적인 한계가 있다. 이 글은 위와 같은 건강보험의 특성을 기준으로 건강보험의 역사를 정리하고, 앞으로 남겨진 과제를 분석하고 개선과제를 제시하는 목적을 갖는다. 건강보험이 처한 새로운 상황에서 건강보험의 보장성을 부분적으로 강화하는 문제, 건강보험의 제도 및 재정위기의 구조적 문제, 건강보험에 특유한 거버넌스와 관련된 현재의 문제 및 개선방향을 제시하였다.

• 보건행정학회지
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• 제17권2호
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• pp.1-17
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• 2007

Limited coverage for health care services of National Health Insurance(NHI) in Korea has been ongoing policy issue but additional NHI financing through raising contribution or taxes in order to improve coverage faces substantial obstacles. Private health insurance(PHI) is often considered as an alternative financing source to improve coverage. Recent reform that attempted to stretch the role of PHI allowed life insurance companies to provide complementary PHI, indemnity plan which will pay for uncovered services by NHI and out-of-pocket spending for covered services. Although complementary PHI may relieve financial burden of patients, it may significantly raise NHI spending as well as total health expenditure since little out-of-pocket spending may increase utilization of health care. So far, there has not been enough discussion about concerns of potential adverse effect resulting from extended role of PHI. This study investigated potential increase of NHI spending followed by extension of complementary PHI through sensitivity analysis. The amount of NHI spending for services that would be covered by complementary PHI was calculated using 2005 NHI statistics and expected complementary PHI enrollment rate by age and sex. Expected utilization increases were obtained based on price elasticities$(-0.2{\sim}-0.5)$ from previous studies and expected coverage rate$(50{\sim}80%)$ of complementary PHI and then converted to monetary figures. Because coverage rate of complementary PHI has not been determined yet, we employed the sensitivity analysis using coverage rate of $50{\sim}80%$. Findings demonstrate that additional spending for health care services is expected to be $426{\sim}1,702$ billion won, corresponding amount payed by NHI $298{\sim}1,192$ billion won. In conclusion, since complementary PHI may raise NHI spending significantly, there should be an agreement whether this additional cost would be accountable and acceptable in our society. Potential inefficiency resulting from extended role of complementary PHI should be considered since public and private financing do not operate in isolation and there should be more discussion on proper role of PHI in Korea.

• Journal of Preventive Medicine and Public Health
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• 제49권2호
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• pp.118-128
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• 2016

Objectives: The purposes of this study were to examine the status of children and adolescents with regard to enrollment in private medical insurance (PMI) and to investigate its influence on their utilization of medical services. Methods: The present study assessed 2973 subjects younger than 19 years of age who participated in five consecutive Korea Health Panel surveys from 2009 to 2012. Results: At the initial assessment, less than 20% of the study population had not enrolled in any PMI program, but this proportion decreased over time. Additionally, the number of subjects with more than two policies increased, the proportions of holders of indemnity-type only ('I'-only) and of fixed amount+indemnity-type ('F+I') increased, whereas the proportion of holders with fixed amount-type only ('F'-only) decreased. Compared with subjects without private insurance, PMI policyholders were more likely to use outpatient and emergency services, and the number of policies was proportionately related to inpatient service utilization. Regarding outpatient care, subjects with 'F'-only PMI used these services more often than did uninsured subjects (odds ratio [OR], 1.69), whereas subjects with 'I'-only PMI or 'F+I' PMI utilized a broad range of inpatient, outpatient, and emergency services relative to uninsured subjects (ORs for 'I'-only: 1.39, 1.63, and 1.38, respectively; ORs for 'F+I': 1.67, 2.09, and 1.37, respectively). Conclusions: The findings suggest public policy approaches to standardizing PMI contracts, reform in calculation of premiums in PMI, re-examination regarding indemnity insurance products, and mutual control mechanisms to mediate between national health insurance services and private insurers are required.

• 보건행정학회지
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• 제30권3호
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• pp.270-276
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• 2020

Entering the fourth industrial revolution era, health technology is rapidly developing and the people's needs for medical services are gradually increasing. Establishing a life cycle management of health technology has emerged as a new policy agenda to cope with these changes. However, the management of health technology have been conducted without continuity and with several problems pointed out. Therefore, we suggest the reform agendas by stages to establish system for a life cycle management of health technology in the fourth industrial revolution era as follows. In the stage of development, it is important not only to provide research funding, but also consulting by professional about whole cycle of health technologies. In the phase of market entry, there are needs for enhance the system that would expand the early adoption for innovative technology and increase its effectiveness. After the spread of health technology to clinical settings, a reassessment and post management system should be established that have an institutional framework with strong price adjustment and exit mechanism. Furthermore, we hope that discussions will be brisk in macro perspective on the balancing of development in healthcare industry, health of people and national health insurance finance.

• 보건의료산업학회지
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• 제12권4호
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• pp.59-72
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• 2018

Objectives : This study was performed to investigate health care system recognition and influential factors using the data from the "2017 Health Care Experience Survey". Methods : Data on 7,000 participants in the Health Care Experience Survey were drawn and statistically examined using a t-test, ANOVA, and multiple regression analysis. Results : First, the significant factors of health care service satisfaction were education, income, region, chronic diseases, unmet medical needs, satisfaction with doctors and institutions, and the health care system's reliability and importance. Second, the influential factors of willingness to pay additional health insurance premium were age, occupation, income, health status, chronic diseases, unmet medical needs, satisfaction with health care institutions, limit to utilization of medical services, necessity of health care reform, and the health care system's reliability, satisfaction, importance. Conclusions : Since the additional burden for improving the health care has been negative to the socially disadvantaged, there should be efforts to provide stable health care funding for financial stability of the health insurances by considering public opinions and reaching social consensus.

• 대한한방부인과학회지
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• 제20권1호
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• pp.239-257
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• 2007

Purpose : In the part of Ob & Gy disease, the health insurance application is very limited. This study has been performed for gaining the basic data of enlargement of insurance coverage and reform of the insurance system corresponded with real clinical conditions. Methods : The survey has been practiced twice, the subjective questionnaire was used at the first survey. Then the questionnaire written using the results of first survey was distributed to the Korean medical doctors(KMD) who participated in the autumn symposium of the society of Oriental Obstetrics & Gynecology. Results : 1. The main Ob & Gy disease that the acupuncture treatment has been used actually or thought be positively necessary on the clinic were Dysmenorrhea(including premenstrual syndrome), Climacteric syndrome, Menstrual disorder, Postpartum Pain syndrome. Amenorrhea, Low back pain with pregnancy, JingHa(pelvic tumor), Infertility etc. 2. The main additional complex the sick and wounded names given to visiting patients for Ob & Gy disease as the limits of acupuncture items of insurance coverage were Low back Pain(J10), Qi-stasis(B13.0), SimHwaHangYeom(C2l.1). 3. Suitable the sick and wounded name of Ob & Gy disease thought be added in BokGangNae(Intra-abdominal acupuncture: CV13 ${\cdot}$CV16${\cdot}$CV10). TuJa(Puncture each adjoining acu-points in one insertion : SP6-GB39), TuJa(PC6-TE5) among acupuncture items of insurance coverage were Dysmenorrhea(K05). Menstrual disorder(K02) and Dysmenorrhea(K05), Hyperemesis(K16.0). 4. Climacteric syndrome(K04) and Dysmenorrhea(K05) should be added as suitable the sick and wounded name of TuJa(SP6-GB39), and Postpartum pain syndrome(K29) as KwanJeolGangNea(Intra-articular acupuncture: S35, LE201). Conclusion : Standing on this study, additional survey to general KMD should be continued. And the academic verifications through the oriental medical literatures and RCT papers on acupuncture should be also required.

• 한국직업건강간호학회지
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• 제16권2호
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• pp.222-231
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• 2007

Purpose: This study aims to suggest political alternatives for nursing care costs for PCAs to provide qualitative medical benefit for patients with occupational disease by investigating present situation and problems of the nursing care cost system of Korea's Industrial Accident Compensation Insurance. Methods: Data was collected from 6 workers' accident medical corporation and 275 nurses affiliated with Korea labor welfare corporation using self reported questionnaire. Result: Research results were as follows; Character of nursing care cost of the Korea's Industrial accident Compensation Insurance changed as if it aims to support for living expenses for the family; As possible problems which could be caused under current system, administrative problems, decrease of service quality were made as objects of criticism. Some patients did not make every effort in rehabilitation to be beneficiaries continuously. Some patients were supplied with whole one PCA or all-night PCA even though they did not need as much caring as such. Conclusion: The research suggested that PCAs payment system improvement is necessary, and the presented nurses' opinion for the improvement method could be applied for policy making.

• 보건행정학회지
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• 제14권2호
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• pp.17-33
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• 2004

The present study attempts to examine the progressivity of health care financial sources based on the income approach, for which it decomposes redistributive effects into vertical, horizontal, and re-ranking components. The study data include Korean Household Expenditure Survey (2000) conducted every 5 year by Korea National Statistical Office. The data were sampled from the national population by the multistage probabilistic sampling method, and amounts to 23,270 households. For the better application of the income approach, the study employs household total expenditure in Korea instead of total income, because the former data source is more reliable and less fluctuated over time. Progressivity of health care financing was measured by Kakwani index. Aronson's decomposition equation was used in case of the analysis where differential treatment of health care expenditure needs to be considered. Despite the progressivity of Korea's governmental contributions, total expenditure of health care showed regressive pattern, which may largely be attributable to the higher regressivity in out-of-pocket money. With the result of negative Kakwani index, differential treatment increased income redistribution biased for better-off. It is worth to note that social insurance displays not only negative Kakwani index, but also horizontal inequality, suggesting that the first step of health care financing reform should be the revision of social insurance premium rates toward effective and equable way.

• 동남아시아연구
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• 제28권1호
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• pp.173-218
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• 2018

본 연구는 지속가능개발목표(Sustainable Development Goals) 하에 보편적 건강보장(Universal Health Coverage) 달성을 목표로 전 국민의 건강보험 가입을 추진하고 있는 베트남의 보건의료 부문에 주목하여 보건의료 체계와 건강보험법의 개혁 과정에서 나타난 특징을 역사 문화적 맥락을 통해 파악해보고 개발의 관점에서 그 함의를 살펴보고자 한다. UHC의 세 가지 차원, 즉 인구 집단에 대한 보장성 확대, 다양한 의료서비스 제공, 그리고 재정적 보호를 기준으로 베트남 보건의료 부문의 현황을 요약하면 다음과 같이 정리할 수 있다. 첫째, 2015년 발효된 개정 건강보험법에서 가구 단위의 의무 가입과 그에 따른 건강보험료 정산 방식이 새로운 제도로 시행되고 있다는 점이다. 둘째, 1차 의료시설, 즉 사($X{\tilde{a}}$, Commune)급 단위의 보건소를 중심으로 예방 및 건강관리 서비스를 제공할 수 있는 의료 네트워크가 구축되어 있다는 점이다. 셋째, 의료보험법 및 다양한 제도 시행 이후 공공 지출이 증가하고 민간 지출이 감소하고 있지만 여전히 본인부담 의료비 지출(Out-of-Pocket Expenditure)이 많은 비중을 차지하고 있다는 점이다. 베트남의 사회건강보험 개혁은 현재 과도기이다. 따라서 베트남은 보건의료 체계와 건강보험 제도를 어떻게 구축해 나갈 것인가에 대한 문제가 더욱 중요할 수밖에 없는 시기적 상황에 당면해 있다. 제도와 체계에 대한 개발은 효율성보다는 그것을 고스란히 감당해내야 하는 주체, 즉 해당 사회의 구성원들에게 적절하고 정당한 방식으로 설계되어야 한다. 본 연구는 제도와 문화, 즉 제도를 공유하는 사회적 가치, 가족 문화 그리고 비공식적인 제도 등과의 상호작용 등으로부터 그 함의를 이끌어내고자 하였다.