• Health Policy and Management
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• v.32 no.1
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• pp.45-52
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• 2022

Background: There are regional variations in the incidence of coronavirus disease 2019 (COVID-19), which means that some regions are more exposed to the risk of COVID-19 than others. Therefore, this study aims to investigate regional variations in the incidence of COVID-19 in Korea and identify risk factors associated with the incidence of COVID-19 using community-level data. Methods: This study was conducted at the districts (si·gun·gu) level in Korea. Data of COVID-19 incidence by districts were collected from the official website of each province. Data was also obtained from the Korean Statistical Information Service and the Community Health Survey; socio-demographic factor, transmission pathway, healthcare resource, and factor in response to COVID-19. Community risk factors that drive the incidence of COVID-19 were selected using a least absolute shrinkage and selection operator regression. Results: As of June 2021, the incidence of COVID-19 differed by more than 80 times between districts. Among the candidate factors, sex ratio, population aged 20-29, local financial independence, population density, diabetes prevalence, and failure to comply with the quarantine rules were significantly associated with COVID-19 incidence. Conclusion: This study suggests setting COVID-19 quarantine policy and allocating resources, considering the community risk factors. Protecting vulnerable groups should be a high priority for these policies.

• Journal of Society of Preventive Korean Medicine
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• v.25 no.2
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• pp.1-11
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• 2021

Objective : The purpose of this study is to analyze Korean patients' characteristics, who were concurrently treated with both Korean herbal medicines and Western chemical medicines using nation-wide database. Method : Using the patients sample data (HIRA-NPS 2018) provided by Health Insurance Review and Assessment Service, a group of patients who co-administered Korean herbal and Western medicines was selected, and their basic characteristics, diagnosis, and prescribed chemical medicines were analyzed. Results : Out of the 1,481,921 sample population, 17,629 patients (1.2%) were selected as a concurrent medication group. Compared to the whole sample, the concurrent medication group was composed of more women (65.8% vs. 51.1%), the more elderly people (65 or older years old) (44.5% vs. 14.6%), and the higher prevalence of chronic diseases (49.1% vs. 22.2%). The most frequent diagnosis treated with Western medicines was mental and behavioral disorders, musculoskeletal and circulatory disorders. Frequently used drugs among concurrent medication group were anti-anxiety drugs, gastric ulcer treatment drugs, and senile diseases treatment drugs. Conclusion : The evidence reported in this study is expected to provide herb-drug interaction researchers with important reference to set the priorities of research topics in the future.

• Journal of Korean Clinical Health Science
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• v.4 no.2
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• pp.582-592
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• 2016

Purpose. For more effective hospital management, it analyzes the trend through general characteristics, balance sheet, income statement, and financial ratio analysis, grasps the causes of the problems, and analyzes management of the hospital in order to use the result as baseline data for development of the hospital in the future. Methods. The collected data of 3 years from 2011 to 2013 about 3 tertiary hospitals in metropolitan cities from Alio (provider of public institution information; www.alio.go.kr), Health Insurance Review & Assessment Service (www.hira.or.kr), and the website of the Ministry of Health and Welfare (www.mw.go.kr) were analyzed and general characteristics, balance sheet, income statement, and financial ratio, analysis are used as data. Results & Conclusions. From the result of data analysis from 2011 to 2013, general characteristics, balance sheet, income statement, financial ratio analysis, and pie charts could lead to conclusions as follows. In the result of comprehensive analysis, the 3 tertiary hospitals showed increase of fixed expense due to extension of the buildings and so did the scale of fund and asset. Although medical revenue increased, the margin of increase for medical expense was greater than that of medical revenue, which consequently led to loss. In prediction for the 3 tertiary hospitals based on characteristics so far, it is expected to see improved revenue structure after building extension is completed, but it is necessary to exert management effort to maintain its optimal level by enhancement in stability of management and inventory turnover through management of inventories.

• Journal of Korean Academy of Nursing Administration
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• v.20 no.1
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• pp.10-21
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• 2014

Purpose: This study was done to identify determinants of registered nurse (RN) skill mix and staffing level focused on hospital characteristics. Methods: Data were obtained from health insurance claims data and hospital reporting system in the Health Insurance Review and Assessment Service (HIRA) for the year 2010. Data from 2,998 hospitals were analysed using t-test, ANOVA, Pearson correlation, and regression analysis. Results: The RN skill mix and staffing level were positively related to hospital size and the percentage of inpatients to total patients. RN skill mix and staffing level were statistically different across regions. Including nursing aides (NA), however, there was no difference in staffing levels across regions. Medically vulnerable regions, bed operation rate, and the number of patients per doctor were also related to RN skill mix and staffing level. Conclusion: The statically significant determinants of RN skill mix and staffing level included hospital size, region, bed operation rate, percentage of inpatients, doctor-patient ratio. Further study needs to be done to investigate factors including RN supply and wages.

• Knowledge Management Research
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• v.11 no.5
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• pp.25-36
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• 2010

It is widely known that KMS (Knowledge Management System) plays a role of facilitator that contributes to upgrading the organizational performance. Despite this widespread belief, actual operation of KMS has been stalled at the level of being used only for the plain knowledge administration, not reaching the level of utilizing KMS strategically. In this sense, this case study suggests three successful KMS operation strategies-personalization strategy, socialization strategy, and technological strategy. Cases adopted in this study include HIRA(Health Insurance Review & Assessment Service) and KORAIL (Korea Railroad) where KMS has been successfully utilized to improve their organizational innovation and performance as well. Through scrutinizing the two cases, it was concluded that the proposed three KMS operation strategies have potentials of being generally applied to other KMS operation cases.

• Korean Journal of Clinical Pharmacy
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• v.20 no.1
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• pp.39-49
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• 2010

The present study was aimed to examine the occurrence and influencing factors therapeutic duplication (TD) of medications for anxiety disorders by analyzing the relevant prescription data. In this study, the prescription data issued on March 19, 2008 in domestic medical institutes were utilized. TD was defined as more than two medications under the same therapeutic classification per prescription based on the Anatomical Therapeutic Classification (ATC) code. The assessment of TD was performed based on the number of cases and on the ratio determined. To identify the influencing factor of TD, the variables related to the differences in the TD ratio were analyzed based on the results of the Chi-Square test conducted with the variables; patients, medical institutes, diseases, and treatments. The number and ratio of TD were determined to be 1,333 out of the total of 19,219 anxiety disorder cases, and 6.94%, most cases involving benzodiazepine derivatives, respectively. The TD ratio was found to be higher in relation to males than to females. Patients with national health insurance benefits have a higher TD ratio compared to the medical-aid beneficiaries. The TD ratios were highest in clinics, psychiatry divisions, and Gyeongsang district. The TD ratio of the cases with more than two anxiety disorders was found to be higher than that of the cases with only one anxiety disorder. As the number of medications per prescription increased, the TD ratio was shown to have become gradually higher. In conclusion, in order to prevent TD, the concurrent DUR system should be implemented. The prescribers and pharmacists must be educated regarding duplicated medications to promote the safe and effective use of medicines, without unnecessary TD.

• Korean Journal of Clinical Pharmacy
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• v.28 no.1
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• pp.57-64
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• 2018

Background: Patients experience significant differences in aspects of mortality, quality of life, and costs between during the year of receiving liver transplant (LT) and the subsequent years (post-LT). This study aimed to estimate the medical utilization and cost of LT for patients compared to post-LT patients by using a recent National Patient Sample (NPS) data provided by the Korean Health Insurance Review and Assessment Service (HIRA). Methods: This study used a subset of the 2015 HIRA-NPS. Patient claims data that included Z944 (Korean Standard Classification of Diseases code for LT status) were selected. Within the selected data, LT patients were identified based on whether the national health insurance number code of Q80 (procedure code for LT surgery) was included, and they were compared to post-LT patients. Results: In the analysis, 330 patients were included. The average cost per patient was $90,066{\pm}36,959$ thousand KRW and $10,557{\pm}9,668$ thousand KRW for LT and post-LT patients, respectively. Especially, LT patients' costs for injection/procedure, surgery/treatment, and examination were higher than other costs, being $35,983{\pm}18,115$ thousand KRW, $28,246{\pm}9,408$ thousand KRW, and $12,131{\pm}6,604$ thousand KRW, respectively. For inpatients, the average number of hospitalized days was $63.5{\pm}66.0$ days for LT patients and $22.3{\pm}35.1$ days for post-LT patients. Conclusion: Compared to post-LT patients, LT patients had higher costs, especially for injection/procedure, surgery/treatment, and examination. Additionally, the LT group had longer hospitalization duration and higher costs for their hospital admission, whereas they did not show a significant difference in number of visits and medical costs for outpatient-care.

• Journal of Korean Academy of Nursing Administration
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• v.19 no.5
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• pp.565-577
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• 2013

Purpose: This study was done to propose an improvement in the Nursing Fee Differentiation Policy to alleviate polarization of nursing staffing level among hospitals and to rectify the confusion of legally mandated standards between the Korean Medical Law and National Health Insurance Act. Methods: The policy regulation was reconstructed related to nurse staffing standards and nurse-to-patients ratios. Data on nurse staffing grades were obtained from database of the Health Insurance Review & Assessment Service (HIRA) for the third quarter of 2010 for 44 tertiary hospitals, 274 general hospitals, and 1,262 hospitals. A break-even analysis was used to estimate financial burden of the revised policy improvement proposal. An industrial engineering method was used to calculate Nurse-to-Patients ratios per shift. Results: Twelve tertiary hospitals were downgraded. 74 general hospitals and 102 hospitals were upgraded after application of the regulation. Finances for total hospitalization expenditures changed from -3.55% to +3.14%. Conclusion: The results indicate that the proposed policy would decrease polarization between tertiary hospitals and small hospitals, and would not put a major strain on the finances of the Korean National Health Insurance. Therefore, it is suggested that government stake-holders and many interest groups consider this policy proposal and build a consensus.

• YAKHAK HOEJI
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• v.55 no.4
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• pp.338-344
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• 2011

This study aimed to identify the changes in the list of drugs covered by national health insurance(NHI) after the introduction of positive list system (PLS) in Korea in December, 2006. Six-year (pre-policy:2004-2006, post-policy:2007-2009) lists of the NHI reimbursable drugs filed from Health Insurance Review and Assessment Service (HIRA) were analyzed. The total number of listed drugs as well as drug ingredients, and the average number of listed drugs per manufacturer decreased annually after the introduction of PLS. More than 8,000 drugs were delisted in the year 2007 right after the policy change. Prescription-only drugs occupied more than 85% of NHI listed drugs. The percentage of oral type of listed drugs has been increased to more than 60% after the policy change. Korean pharmaceutical manufacturers occupied more than 90% of listed drugs than multinational firms. The gap between Korean and foreign manufacturer in terms of the average number of newly listed drugs per manufacturer in each year has decreased two years after the PLS (Korean 7.7 vs. foreign 6.3 in 2009) as the price negotiation power of foreign firms has increased. The total number of listed drugs is expected to decrease in the future as the Korean government makes an effort to delist the unnecessary drugs that do not show cost-effectiveness.

• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.123-164
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• 2014

Under the new system of 'Separation of pharmaceutical prescription and dispensing' in Korea, which was implemented in 2000, physician could not dispense a medicine, and outpatient should have a physician's prescription filled at a drugstore. After pharmacist makes up outpatient's prescription, National Health Insurance Service(NHIS) pay for outpatient's medicine to pharmacist, except an outpatient's own medicine charge. And NHIS only pay for outpatient's prescription fee to physician and, physician doesn't derive profit from dispensing medicine in itself. Nevertheless, if physician writes out a prescription with violation of 'Criteria for the Medical Care Benefits', NHIS clawed back the payment of outpatient's prescription and medicine from the physician or the medical institution which the physician belongs to. In the past, NHIS's confiscation was in accordance with 'the National Health Care Insurance Act, Article 52, Clause 1'. But, since 2006 when the Supreme Court declared that there was no legal basis on the NHIS's confiscation of outpatient's medicine payment, NHIS had put in a claim for illegal prescriptions on the basis 'the Korean Civil law, Article 750(tort)'. So, Many medical institutions filed civil actions against NHIS. The key point of this actions was whether the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits constitute of the law of tort. On this point, the first trial and the second trial took different position. Finally the Supreme Court acknowledged the constitution of the law of tort in 2013. In this paper, the author will review critically the decision of the Supreme Court, and consider the relativeness between the legal effect of Criteria for the Medical Care Benefits and the constitution of the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits as the law of tort.