• 보건행정학회지
• /
• 제28권3호
• /
• pp.263-271
• /
• 2018

Health technology assessment (HTA) is defined as multidisciplinary policy analysis to look into the medical, economic, social, and ethical implications of the development, distribution, and use of health technology. Following the recent changes in the social environment, there are increasing needs to improve Korea's healthcare environment by, inter alia, assessing health technologies in an organized, timely manner in accordance with the government's strategies to ensure that citizens' medical expenses are kept at a stable level. Dedicated to HTA and research, the National Evidence-based Healthcare Collaborating Agency (NECA) analyzes and provides grounds on the clinical safety, efficacy, and economic feasibility of health technologies. HTA offers the most suitable grounds for decision making not only by healthcare professionals but also by policy makers and citizens as seen in a case in 2009 where research revealed that glucosamine lacked preventive and treatment effects for osteoarthritis and glucosamine was subsequently excluded from the National Health Insurance's benefit list to stop the insurance scheme from suffering financial losses and citizens from paying unnecessary medical expenses. For the development of HTA in Korea, the NECA will continue exerting itself to accomplish its mission of providing policy support by health technology reassessment, promoting the establishment and use of big data and HTA platforms for public interest, and developing a new value-based HTA system.

• 한국임상약학회지
• /
• 제30권3호
• /
• pp.177-184
• /
• 2020

Background & objective: The Korean government has expanded its benefit coverage to enhance patients' access to orphan drugs and cancer medicines. However, the number of new drugs whose indications were not applied to reimbursement in health insurance was increased. This study aimed to understand the perspectives of experts and various stakeholders on the introduction of a new funding program for cancer treatment and orphan drugs. Methods: We conducted email surveys comprising 19 questions, from September 9 to 26, 2016. We distributed questionnaires to members of the Pharmaceutical Benefit Appraisal Committee and Cancer Assessment Committee. We also conducted a qualitative study through group interviews with stakeholders, including pharmaceutical companies and some patient groups for diseases. Results: A total of 35 survey respondents recommended the introduction of a funding program for orphan drugs, whereas 66% recommended the launch of funding for anticancer drugs. In addition, most pharmaceutical companies and patient groups recommended the introduction of new funding programs targeting patients with cancer and rare diseases. However, some participants asserted that it would be more appropriate to modify the existing reimbursement scheme than launch new funding. Conclusion: This study concluded that introducing new funding needs a social consensus to relieve financial hardships at the patient level.

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

• 한국사회복지학회:학술대회논문집
• /
• 한국사회복지학회 1999년도 추계학술대회
• /
• pp.187-212
• /
• 1999

Parental leave in Sweden is a part of the health insurance in national social insurance system. It has two kinds of benefits. One is parental cash benefit paid for both husband and wife on the occasion of child birth, currently 450days for each child. The other is temporary parental cash benefit when a child under the age of twelve or a caretaker for him is illness, which is six months for a child a year. Parental insurance in Sweden permits parents to take care of their children just after birth at home with the amount of 80% of monthly income for 360 days and 60 Swedish krone each day for 90 days more. It also permits parents with children under the age of eight of part-time work and return to former job at full-time base when they want. It consequently entourage women's economic activity in her whole life and contributes to promotion of equality in sex roles between husband and wife. This insurance scheme is beneficient in that it enhances individual and family welfare and also secures labour force. This case study on Swedish parental insurance offers implication how to resolve the conflict between women's increased demand for economic activity and maternal role.

• 보건행정학회지
• /
• 제5권1호
• /
• pp.31-58
• /
• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• 대한디지털의료영상학회논문지
• /
• 제17권1호
• /
• pp.1-7
• /
• 2015

Recently, dental PACS construction in dental hospital is fairly general. For this reason, inspection request works of dental PACS fee with Health Insurance Review & Assessment Service are more important for the financial stability in hospital and from now on status. But several departments in dental hospital, enforce a incoherent order system so inspection request situation is full of mistakes and omissions. As a result, financial stability in hospital rapidly change for the worse, as the case stands establishment of proper order system and match system is essential to resolve the issue. Consequently, we plan to establish the proposed idealized scheme.

• 한국사회복지학
• /
• 제40권
• /
• pp.68-96
• /
• 2000

Parental leave in Sweden is a part of the health insurance in national social insurance system. It has two kinds of benefits. One is parental cash benefit paid for both husband and wife on the occasion of child birth, currently 450days for each child. The other is temporary parental cash benefit when a child under the age of twelve or a caretaker for him is illness, which is six months for a child a year. Parental insurance in Sweden permits parents to take care of their children just after birth at home with the amount of 80% of monthly income for 360 days and 60 Swedish krone each day for 90 days more. It also permits parents with children under the age of eight of part-time work and return to former job at full-time base when they want. It consequently encourages women's economic activity in her whole life and contributes to promotion of equality in sex roles between husband and wife. This insurance scheme is beneficient in that it enhances individual and family welfare and also secures labour force. This case study on Swedish parental insurance offers implication how to resolve the conflict between women's increased demand for economic activity and maternal role.

• Journal of Preventive Medicine and Public Health
• /
• 제22권2호
• /
• pp.223-235
• /
• 1989

To grasp the idea about how drugs are used under Medical Insurance Scheme, the amount and share of drug cost in the total medical fee have been reviewed and analyzed for different types of patients (in-patient out-patient), medical institutions and frequently seen diseases and following findings were revealed. In 1986, drug cost took 32.78% of total medical fee for in-patients and 32.98% for out-patients averaged over 30% share as a whole. When drug cost per case in 1980 be indexed to 100, it has shown steady growth to become 200 for in-patients and about 150 for out-patients in 1986. The contribution of drug cost to the total medical fee is, regardless of patient type-in-patients and out-patients, the highest in University hospitals and followed by General hospitals, Hospitals and Clinics in decending order That for the most frequent 10 diseases came out the highest,79 a with the essential benign hypertension of out-patients in the General hospitals, 61% for the gastric ulcer of out-patients in Hospitals and 33% for the female genital diseases of out-patients in Clinics. The drug cost of oral formula was contributed the most, 7.93% by cardiovascular agents followed by hepatic detoxicants(5.47%) and out-patients(4.93%), and that of injectable formula was contributed the most by antibiotics(24.17%), followed by protein amino-acid preparations(6.19%). The order of drug usage by specialty for the in-patients was the highest with internal medicine followed by general surgery and E.N.T, and that for the out-parients was in the order of Internal medicine, neuropsychology and Ob/Gy. This study revealed that the drug dependency was characteristically different to specialty. In view of the fact that drug cost on average exceeds over 30% of total medical fee, proper drug administration appears to be vitally important for the stabilization of the financial standing of the Medical Insurance Scheme. As a consequence, drug usage guidelines including antibiotics usage shall be established first of all and the voluntary participation for the regulation of drug usage and propagation of the guidelines to medical institutions are strongly coerced.

• 한국임상약학회지
• /
• 제30권2호
• /
• pp.73-80
• /
• 2020

Objective: The Australian Pharmaceutical Benefits Scheme (PBS) is a national drug subsidy program. Given the similarity and comprehensiveness of the Australian PBS and the Korean National Health Insurance (NHI) data, these data are increasingly used for pharmacoepidemiological investigations, as well as international comparative studies. This study aims to introduce the various sources of publicly available PBS data and provide a practical guide to researchers conducting drug utilization studies. Methods: We searched literature and websites to detail and compare the collection, structure, components, and characteristics of each PBS data format. We identified different characteristics of the PBS data from the Korean NHI claims data which are mainly owing to their unique co-payment policies and data collection processes. In addition, the utilization and expenditure of atorvastatin, a widely used treatment for hyperlipidemia, were analyzed using two different sources of PBS data and the different results were interpreted. Results: There exist differences in when data were collected or non-subsidized uses of medicine were included among sources of PBS data. Additionally, two countries have different cost sharing methods inmedicine subsidy scheme; co-payment in Australia and co-insurance in Korea. Therefore, it should be noted that prescriptions under co-payment are not included in some data sources in Australia. Conclusion: Despite several analytical challenges, open access and easy data management are the strengths of the PBS data sources. A detailed knowledge of the PBS data can ensure robust methodology and interpretation of pharmacoepidemiological investigations or international comparative studies.

• Journal of Preventive Medicine and Public Health
• /
• 제42권2호
• /
• pp.135-142
• /
• 2009

Objectives : An appropriate sampling strategy for estimating an epidemiologic volume of diabetes has been evaluated through a simulation. Methods : We analyzed about 250 million medical insurance claims data submitted to the Health Insurance Review & Assessment Service with diabetes as principal or subsequent diagnoses, more than or equal to once per year, in 2003. The database was re-constructed to a 'patient-hospital profile' that had 3,676,164 cases, and then to a 'patient profile' that consisted of 2,412,082 observations. The patient profile data was then used to test the validity of a proposed sampling frame and methods of sampling to develop diabetic-related epidemiologic indices. Results : Simulation study showed that a use of a stratified two-stage cluster sampling design with a total sample size of 4,000 will provide an estimate of 57.04%(95% prediction range, 49.83 - 64.24%) for a treatment prescription rate of diabetes. The proposed sampling design consists, at first, stratifying the area of the nation into "metropolitan/city/county" and the types of hospital into "tertiary/secondary/primary/clinic" with a proportion of 5:10:10:75. Hospitals were then randomly selected within the strata as a primary sampling unit, followed by a random selection of patients within the hospitals as a secondly sampling unit. The difference between the estimate and the parameter value was projected to be less than 0.3%. Conclusions : The sampling scheme proposed will be applied to a subsequent nationwide field survey not only for estimating the epidemiologic volume of diabetes but also for assessing the present status of nationwide diabetes control.