• Korea Journal of Hospital Management
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• v.24 no.1
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• pp.48-56
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• 2019

Purpose: As an interest in the elderly medical expenses increases, elderly people are increasingly purchasing indemnity private health insurance. Authors tried to investigate factors of having the indemnity private health insurance among the elderly people aged 65-75 years. Methods: We conducted panel logit regression analysis on 2,465 subjects as of 2016 using Korean Health Panel from 2010 to 2016. The dependent variable was whether to enroll in the indemnity private health insurance. The explanatory variables included socio-demographic characteristics, economic factors, health status, and health behaviors. Findings: As a result of the analysis of factors of purchasing indemnity private health insurances, it was analyzed that people with larger family, educated, pensioner, high household income or no disability were more likely to have indemnity private health insurance. Practical Implications: Considering the results of this study, the factor of purchasing indemnity private health insurance among elderly people were more likely to be their economic than demographic characteristics such as sex, age, and marital status. Policy makers should make efforts to reduce the burden on the elderly medical expense and to improve equity of medical use through institutional improvement such as raising age limit and lowering premium of indemnity private health insurance and expansion of public health insurance.

• Research in Community and Public Health Nursing
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• v.16 no.4
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• pp.404-414
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• 2005

Objectives: The present study proposed to evaluate 1st-month and 3rd-month health status, depression, self-efficacy and medical expenses of a community-based health promotive self-management program for old Koreans. Method: Participants in the CDSMP were selected from elders in a community health center through convenient sampling. The program included a 3-hour session per week for 14 weeks. Outcomes of evaluation in the 1st month and the 3rd month included modified Self-rated Health Status Scale, Center for Epidemiologic Studies Short Depression Scale, Self-Efficacy for Managing Chronic Disease 6-item Scale, and 1-item Medical Expenses Scale. Results: Self-rate health scores increased significantly just after the intervention (16.22), in the 1st month (17.57) and in the 3rd month (19.04) (x2=32.06. p=.000); Depression scores (reversed) also increased significantly just after the intervention (6.04), in the 1st month (7.75) and in the 3rd month (8.39) ( $x^2=29.92$. p=.000); Self-efficacy score increased significantly just after intervention (12.87) but it decreased in the 1st month (12.73) and in the 3rd month (12.04). But all of the three scores were still higher than those before the intervention (8.65) ($x^2=32.42$. p=.000): Medical expense score decreased at the end of the intervention (1.57) but the cost score increased in the 1st month (2.48) and in the 3rd month (2.39) ($x^2$=7.81. p=.050). Conclusion: CDSMP is effective in increasing self-rate health and self-efficacy and in decreasing depression in the Korean elderly. However, no significant effect of the program was observed in decreasing the medical cost of the Korean elderly.

• Journal of Preventive Medicine and Public Health
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• v.24 no.3 s.35
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• pp.441-458
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• 1991

The objective of this study was to provide basic reference data for stabilization scheme of medical insurance benefits through forecasting of the medical care utilization rate, the medical expence per case, and the treatment days per case in medical insurance program for government employees & private school teachers and for industrial workers. For the achievement of above objective, this study was carried out by Box-Jenkins time series analysis (ARIMA Model), using monthly statistical data from Jan. 1979 to Dec. 1989, of medical insurance program for government employees & private school teachers and for industrial workers. The results are as follows ; ARIMA model of the medical care utilization rate in medical insurance program for government employees & private school teachers was ARIMA (1, 1, 1) and it for outpatient in medical insurance program for industrial workers was ARIMA (1, 1, 1), while it for inpatient in medical insurance program for industrial workers was ARIMA (1, 0, 1). ARIMA model of the medical expense per case in medical insurance program for government employees & private school teachers and for outpatient in medical insurance program for industrial workers were ARIMA (1, 1, 0), while it for inpatient in medical insurance program for industrial workers was ARIMA (1, 0, 1). ARIMA model of the treatment days per case of both medical insurance program for government employees & private school teachers and industrial workers were ARIMA (1, 1, 1). Forecasting value of the medical care utilzation rate for inpatient in medical insurance program for government employees & private school teachers was 0.0061 at dec. 1989, 0.0066 at dec. 1994 and it for outpatient was 0.280 at dec. 1989, 0.294 at dec. 1994, while it for inpatient in medical insurance program for industrial workers was 0.0052 at dec. 1989, 0.0056 at dec. 1994 and it for outpatient was 0.203 at dec. 1989, 0.215 at 1994. Forecasting value of the medical expense per case for inpatient in medical insurance program for government employees & private school teachers was 332,751 at dec. 1989, 354,511 at dec. 1994 and it for outpatient was 11,925 at dec. 1989, 12,904 at dec. 1994, while it for inpatient in medical insurance program for industrial workers was 281,835 at dec. 1989, 293,973 at dec. 1994 and it for outpatient was 11,599 at dec. 1989, 11,585 at 1994. Forecasting value of the treatment days per case for inpatient in medical insurance program for government employees & private school teachers was 13.79 at dec. 1989,13.85 at an. 1994 and in for outpatient was 5.03 at dec. 1989, 5.00 at dec. 1994, while it for inpatient in medical insurance program for industrial workers was 12.23 at dec. 1989, 12.85 at dec. 1994 and it for outpatient was 4.61 at dec. 1989, 4.60 at 1994.

• Health Policy and Management
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• v.33 no.2
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• pp.166-172
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• 2023

Background: To improve the support low-income individuals' medical expenses, it is necessary to think about ways to enhance the Catastrophic Health Expenditure Support Program. This study proposes expanding support criteria and changing the income standard. Methods: This study conducted simulations using national data from the National Health Insurance Service. Simulations performed for people who have used health services (n=172,764) in 2022 to confirm the Catastrophic Health Expenditure Support Program's size based on changes to the subject selection criteria. Results: As a result of the simulation with expanded criteria, the expected budget was estimated to increase between Korean won (KRW) 13.2 (11.5%) and 138.6 billion (37.4%), and the number of recipients increased between 41,979 (48.9%) and 150,317 (76.1%). The results of the simulation for the change in income criteria (applied to health insurance levels below the 50th percentile) estimated the expected budget to increase between KRW -8.9 (-7.8%) and 55.6 billion (15.0%) and the number of recipients to increase between -8,704 (-10.1%) and 41,693 (21.1%) compared to the current standard. Conclusion: The 2023 Catastrophic Health Expenditure Support Program's criteria were expanded as per the 20th Presidential Office's national agenda to alleviate the burden of medical expenses on the low-income class. In addition, The Catastrophic Health Expenditure Support Program needs to be integrated with other medical expense support policies in the mid- to long-term, and a foundation must be prepared to ensure the consistency of each system.

• Journal of Korean society of Dental Hygiene
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• v.11 no.2
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• pp.275-289
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• 2011

Objectives : The recognition rate for issues and improving resolution for the recuperation income expense claim policy was examined. Methods : 1,135 copies of survey have been sent to the group of people who have claimed the dental recuperation income expense to dental recuperation institutions in Daejeon, Chungcheong Do that are registered to the health insurance evaluation and estimation office as of the May 2010 and 207 surveys that were regarded to be sincere for answering were analyzed. Results : Majority of respondence were belonged to the dentist institutions with more than 5 years of claim experiences as well as 10~50% of claim rate. The recognition of medical fee evaluation guideline was normal level, and negative recognition was higher to the health center with daily charge policy compare to the dental hospital and university affiliated dental center with treatment charge policy, Highest opinion for inappropriateness of dentist with significance was found (p<0.05). The openness of evaluation cases are regarded to be discharged through the transparent evaluation and most of the opinions for insurance claim evaluation adjustment are within the both 'Do not understand the evaluation guideline and program error of disease category, code and program' with significance(p<0.05). The reaction after the evaluation adjustment was high in reflection on the claim process after examining the reason for the evaluation adjustment through the evaluation and estimation office and university affiliated dental institution and dental center was regarded to be most active and deputy reclaimment was seemed to be most actively discharge the objection registration task (p<0.05). The claim error improving resolution recognition was highly prioritized to the accurate charting for the disease title and treatment description, improving the setting of claim program, and most highly recognized by the university affiliated dental hospital/dental center and comparably low by health center(p<0.05). and although the most of the responds of treatment description and browsing the medical fee was positive, 50% of dentists disagreed the idea so that this was creating a significant discrepancy with other groups(p<0.05). Conclusions : From this research, the recognition of medical fee evaluation guideline for dental (university) hospital and dentists were negative and high adjustment experience was examined as lacking of evaluation guideline understanding and error of disease name, code and programs and deputy reclaimment, university affiliated dental hospital/dental center were most actively handle the objection registration tasks and dentists have objection on the treatment description and browsing the treatment fee so that if these indexes can be referred to implement into the recuperation income claim process, this can be regarded to be a opportunity to create mutual credibility between recuperation institution, treatment pensioner and the evaluation institutions.

• Korean Journal of Adult Nursing
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• v.28 no.4
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• pp.378-387
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• 2016

Purpose: The purpose of this study was to describe the impact of fatigue and distress on self-efficacy among breast cancer survivors and to provide a base for development of nursing intervention strategy to improve self-efficacy. Methods: A descriptive research design was used. The subjects were 158 patients who were either being treated or were receiving follow-up care at a university breast center in D City from May 30 to August 30, 2014. Structured questionnaires, Revised Piper Fatigue Scale, Distress Thermometer, and Self-Efficacy Scale for Self-Management of Breast Cancer were used to measure fatigue, distress, and self-efficacy. Data were analyzed using t-test, ANOVA, Pearson's correlation coefficients, and multiple regressions. Results: The mean scores of fatigue, distress, and self-efficacy were 3.83, 4.31, and 3.77, respectively. There were significant differences among participants in terms of educational background, current treatment methods, perceived health status, economic burden for fatigue and perceived health status for distress. Self-efficacy was impacted by age, educational background, marital status, average monthly income, perceived health status, and medical expenses. Fatigue, age, and the burden on medical expense had the most impact on self-efficacy, accounting for 17% of the variance. Conclusion: Fatigue should be managed to improve self-efficacy of breast cancer survivors. Therefore, nursing programs designed to decrease fatigue may be helpful.

• Korea Journal of Hospital Management
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• v.14 no.4
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• pp.71-87
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• 2009

This study was conducted to present strategies for efficient use of older people's medical expense and efficient management of hospital beds 삭제by analyzing factors which influenced medical charge of inpatients with stroke and medical charge of each medical treatment. The subjects was 1,070 inpatients with stroke in Academic hospital. The result of this study can be summarized as follows. In the case of cerebral hemorrhage, the rate of female was higher than that of male. In the case of cerebral infarction, the rate of male was higher than that of female. With increase of age, patients with cerebral hemorrhage decreased and patients with cerebral infarction increased. Medical charge for cerebral hemorrhage was 12,600,000 won, while that for cerebral infarction was 572,000 won. The medical charge with surgery was four times of that with non-surgery. The total medical charge for inpatients with stroke was 6,860,000 won. The patient payed 2,240,000 won(32.6%) and National Health Insurance Corporation payed 4,620,000 won(67.3%). Among charges of specific medical treatments, operation and treatment charge was highest(27.7%) in the case of cerebral hemorrhage, while examination charge was highest(32.2%)in the case of cerebral infarction. This study will provide basic information for efficient use of Medical Charge for Inpatients with Stroke.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.1
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• pp.121-130
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• 2019

Automobile insurance medical expenses increased by 12% in year 2015 compared to year 2014. But the oriental medical service expenses in automobile insurance increased by 36% during the same period. In this paper the reason for the rapid increase of expenses for oriental medical service was analyzed using the method of decomposing medical expenses. As a result of analyzing 34,351,120 cases that were examined and completed during the period of 2014~2015, the number of oriental medicine patients increased by 27% and the medical expense per patient increased by 7%. The result of analysis showed that there was no significant change in service period per patient but medical expense per day increased by 7%. The increase in the number of patients receiving only oriental medical services was 32%. Increase in the number of patients receiving medical treatment and oriental medical services was 24% and the number of patients receiving medical treatment only decreased by 4%. There was significant increase in non standardized cost of oriental physical therapy which was one reason of the increase of the expenses. However, the most influential factor of the increase in the expenses of oriental medical services was the increase of the number of patients.

• Health Policy and Management
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• v.7 no.1
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• pp.73-99
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• 1997

This study was carried out by using questionnaires with 126 insurance societies from Sept. 30, 1995 to Oct. 18, 1995. The primary data collected bythe survey have been significantly supplemented by secondary data obtained from sources such as health insurance statistical year books and internal data in the Ministry of Health and Wolfare. Major findings were summarized as follows: Two financial coordinating programs have significantly improved financial status of regional health insurance societies: the catastrophic program for high cost medical care that was initiated in 1991 and the program for hospitalization cost of the aged in 1995. Another finding is that there existed ambiguity and inconsistency of equity index that had been used by stabilization programs and its side effects could not be ignored. Regression analyses were made to identify factors that affect financial transfers. Inde pendent variables in the regression include utilization frequency, dependancy ration, insurance contribution per insured and medical expense per insured. All these variables were statistically significant in the equations of applying distribution rate (distribution/contribution) and transfer rate (transfer/contribution) as dependent variables. Policy suggestions for the catastrophic program for high cost medical care are modifying the definition of catastrophic case and setting the maximum amount of subsidies for each society based on distribution rates. To solve the problems of the financial coordinating program for the aged, we could consider reimbursing more than 50% of the copayment incurred by the aged 65 or more and determining the maximum amount of outpatient copayment at 10,000 Won per day or per visit for the elderly. More fundamental improvement could be made by amending the Welfare Benefit Act to establish and expand medical and welfare facilities for the elderly.

• Women's Health Nursing
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• v.21 no.3
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• pp.171-183
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• 2015

Purpose: The purpose of this study was to explore the perception of infertile women on the use of the national support program that provides medical expense aid to infertile couples. Methods: Thirty Korean infertile women participated in five focus groups. Data were collected from January to August 2014. After obtaining permission from the participants, each session of the focus group was audio-taped and transcribed. The responses were analyzed using qualitative content analysis. Results: The main themes identified from the sessions with the participants were "feeling thankful for the reliable support program," "feeling happy or unhappy," "enduring inconveniences," and "hoping for a more comprehensive support service." Although most of the participants perceived the benefits of the national support service positively, they stated that the service was not comprehensive because it did not cover all the medical expenses for tests and other medical treatments. Conclusion: The benefits given to infertile couples by the program should be increased by covering all the medical expenses, expanding its criteria to include more eligible candidates, and by including special leave benefits for working women. Furthermore, it is essential to take measures for infertility prevention at the individual and national policy levels.