• 보건행정학회지
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• 제19권3호
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• pp.142-165
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• 2009

Although providing universal coverage for health care through the National Health Insurance(NHI) is a remarkable achievement, the issue of limited benefit coverage of the NHI has been at the core of national debate over how to improve its coverage. This study aims to evaluate benefit extension strategies and implemented policies with regard to the NHI since 1989 using 'policy window theory' proposed by John W. Kingdon. Understanding problem stream, policy stream, political stream, and coupling streams regarding the NHI, in particular benefit extension, would contribute to broaden policy debates and to develop more effective strategies for the future. Historically, political stream had opened policy window in the past two decades and policy streams can be characterized by three waves. Three streams have been coupled since 2003 and the government had a strong will to fulfill better performance of NHI coverage. Study findings indicate that identification of problem structure regarding NHI benefit was not connected with policy stream tightly. In addition, there has been limited discussion on policy goal and principles for extension coverage of the NHI. Policy strategies to improve coverage of the NHI should be linked to characteristics of problem and sought solutions under the principle which is expected to be sustainable through consensus in the society.

• 한국병원경영학회지
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• 제15권4호
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• pp.1-26
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• 2010

We achieved both industrialization and democratization during the shortest period in the world. We also achieved good performance in national health insurance: universal coverage, solidarity in financing, equitable access of health care. However, national health insurance system has faced the problem of sustainability: various expenditure and financing problems. The problem of sustainablity has two facets of economic sustainability and fiscal sustainability. Economic sustainability refers to growth in health spending as a proportion of gross domestic product(GDP). Rapid increasing rate of health spending exceeds the growth rate of domestic product. Growth in health spending is more likely to threaten other areas of economic activity. Concern on fiscal sustainability relates to revenue and expenditure on health care. Health care financing face demographic and technical obstacles. Democratic obstacle is aging problem. Technical obstacle is collection of contribution. Expenditure of health care has various problems in benefit structure and efficiency of health care system. In this article, I suggest several policy reforms to enhance sustainability: generating additional revenue from value added tax, changing method of levying contribution, increasing efficiency of health care system by introducing the competition principle. restructuring of benefit scheme of health insurance. contracting with health care institutions to provide health care services.

• 대한화학회지
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• 제67권1호
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• pp.68-71
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• 2023

• Journal of Preventive Medicine and Public Health
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• 제44권4호
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• pp.141-148
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• 2011

Annual epidemics of seasonal influenza occur during autumn and winter in temperate regions and have imposed substantial public health and economic burdens. At the global level, these epidemics cause about 3-5 million severe cases of illness and about 0.25-0.5 million deaths each year. Although annual vaccination is the most effective way to prevent the disease and its severe outcomes, influenza vaccination coverage rates have been at suboptimal levels in many countries. For instance, the coverage rates among the elderly in 20 developed nations in 2008 ranged from 21% to 78% (median 65%). In the U.S., influenza vaccination levels among elderly population appeared to reach a "plateau" of about 70% after the late 1990s, and levels among child populations have remained at less than 50%. In addition, disparities in the coverage rates across subpopulations within a country present another important public health issue. New approaches are needed for countries striving both to improve their overall coverage rates and to eliminate disparities. This review article aims to describe a broad conceptual framework of vaccination, and to illustrate four potential determinants of influenza vaccination based on empirical analyses of U.S. nationally representative populations. These determinants include the ongoing influenza epidemic level, mass media reporting on influenza-related topics, reimbursement rate for providers to administer influenza vaccination, and vaccine supply. It additionally proposes specific policy implications, derived from these empirical analyses, to improve the influenza vaccination coverage rate and associated disparities in the U.S., which could be generalizable to other countries.

• 한국병원경영학회지
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• 제19권4호
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• pp.57-68
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• 2014

Since the introduction of National Health Insurance(NHI) in 1977, it has grown rapidly and contributed to extend patient's access to the health care services. However, limited coverage for health care services of NHI has been ongoing challenge and private health insurance(PHI) has been rising as an alternative source of enhancing coverage and saving out-of-pocket(OOP) expenditure for patients. In this study, after controlling for socio-demographic, economic, health related variables, we identified the patients' healthcare utilization and subsequent OOP expenditure depending on their PHI enrollment and their enrollment types(fixed benefit, indemnity, fixed benefit plus indemnity). Data were collected from the 2010 Korean Health Panel. The unit of analysis was a member of household(n=13,324). Of the 13,324 cases, 70.7% of patients held PHI, in detail, fixed benefit(47.0%), indemnity(3.6%), fixed benefit plus indemnity(20.1%). Major findings showd that patients who enrolled in PHI used more outpatient services(outpatient visit, number of physician visit, number of examination) and spent more OOP expenditure than non-PHI patients. There were also differences of healthcare utilization and OOP expenditure among the types of PHI. In addition, PHI patients used more inpatient services(inpatient use, number of hospitalization, LOS), but there was no significant difference between PHI and non-PHI patients with regard to the OOP expenditure. Thus, we could not find any distinct relationship between the types of PHI and patients' tertiary hospital use. Policy-makers should need careful political deliberation for monitoring the effect of PHI on health care utilization and subsequent expenditure not only to improve patients' coverage but also to save their OOP expenditures.

• 대한간호학회지
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• 제36권3호
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• pp.503-513
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• 2006

Purpose: This study focused on analysing costs per home health care nursing visit based on home health care nursing activities in medical institutes. Method: The data was collected in three stages. First, the cost elements of home health care nursing services were collected and 31 home care nurses participated. Second, the workload and caseload of home care nursing activities were measured by the Easley-Storfjell Instrument(1997). Third, the opinions on improving the home health care nursing reimbursement system were collected by a nation-wide mailing survey from a total of 125 home care agencies. Result: The cost of home health care nursing per visit was calculated as 50,626\. This was composed of a basic visiting fee of $35,090{\\}({\fallingdotseq}355$)$ and travel fee of $15,536{\\}({\fallingdotseq}15$)$. The major problems of the home care nursing payment system were the low level of the cost per visit, no distinction between first visit and revisits, and the limitations in health insurance coverage for home health care nursing services. Conclusion: This study's results will contribute as a baseline for establishing policies for improvement of the home health care nursing cost and for applying a community-based visiting nursing service cost.

• 보건교육건강증진학회지
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• 제23권5호
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• pp.29-46
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• 2006

Purpose: Since 1994, Asian Health Services, the Korean American Community Advisory Board, and the Center for Family and Community Health (University of California at Berkeley) have conducted periodic, population-based surveys on Korean American community health in Alameda County, California. The present study examines changes in health care access and utilization between 1994 and 2002 among Korean American adults in Alameda County, California. Method: We reanalyzed data from the 1994 and 2002 Korean Health Surveys. The primary variables of interest, health care access and utilization, were operationalized in terms of health insurance coverage, routine check-ups, a usual source of health care and reported barriers to health care. The frequency distribution of each indicator was calculated and its standard error was estimated using SUDAAN. The differences between 1994 and 2002 were examined with chi-square test. Results: Compared to 1994, Korean Americans in Alameda County were more likely to have health insurance coverage in 2002 (74.0% vs. 82.7%). Korean Americans in Alameda County were more likely to have received a recent (prior two years) routine health checkup in 2002 (50.4% vs. 57.2%). Health checkups increased over time for males, for adults with more than 12 years of education, and for employed adults. Also, compared to 1994, employed adults were more likely to have a usual source of health care in 2002 (66.5% vs. 78.4%). In both 1994 and 2002, high cost (58.0% vs. 47.8%) was the most commonly cited barrier to health care, and the next most frequently cited barriers were language (29.2% vs. 27.7%) and no time (29.2% vs. 30.3%). Conclusion: To improve health care utilization and health conditions, it is important to investigate factors related to health care and to monitor changing trends. Ongoing surveillance of health-related factors can contribute to the development of health education programs to reduce morbidity and mortality due to chronic disease, and thereby lead to improvements in health status among Korean Americans.

• 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.

• 의료법학
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• 제10권2호
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• pp.287-307
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• 2009

A person is injured in car accident caused by his/her slight negligence except he / she causes accident by his / her willfulness or gross negligence. Because the National Health Insurance Corporation (hereinafter called "Corporation") shall not provide any insurance benefit "when he has intentionally or through gross negligence caused a criminal conduct or intentionally contributed to the occurrence of an accident" referred to in Article 48 (1) 1 of the National Health Insurance Act. So, if he / she is insured by his / her own bodily injury coverage, he / she can be compensated for his / her medical expenses. The injured have the rights to file either National Health Insurance claim and Automobile Insurance claim but there is no clear and definite adjustment clause. The claim disputes between National Health Insurance (hereinafter called "NHI") and Automobile Insurance (hereinafter called "AI") in the own bodily injury coverage makes some problems. Firstly, there are some differences in co-payments which he / she chooses between NHI and AI. Profit per a patient is higher in the NHI than in the AI. Secondly, it can provoke criticism that people shall unnecessarily pay double contributions. Lastly, it can raise moral hazards. For example, if he / she can cover the compensations when the insured receives the compensations from his / her insurer, the Corporation can be claimed by medical care institution payment of the health care benefit costs. In conclusion, first of all, to improve the national health and preserve the insured's rights the Corporation shall keep notice these facts.

• 보건행정학회지
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• 제20권1호
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• pp.1-18
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• 2010

This article examines social determinants of population health in OECD countries, where life years, infant mortality, and PYLL are used as proxy variables of health. The unit of analysis is a country which is the OECD affiliate. A panel regression estimation is chosen as a method, using OECD Health Data. The results are: the increasing national health expenditure affected positively to improve population health. Education was rather a significant determinant of health than income level. The government direct investment for public health did not contribute positively to enhance population health. The expansion of health care coverage was working positively for improving health, but with a time lag. The supply of doctors was a most influential determinant of health. In case of Korea, the coverage expansion of health care was the most important determinant of health. The supply of doctors was, however, not a positive factor for better health, which is different result with the case of OECD countries.