• Health Policy and Management
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• v.29 no.2
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• pp.228-236
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• 2019

Background: This study investigates the impact of weekend admission with a patient safety indicator (PSI) on 30-day mortality among long-term insurance beneficiaries. Methods: Data were obtained from the National Health Insurance Service-Senior claim database from 2002 to 2013. To obtain unbiased estimates of odds ratio, we used a nested case-control study design. The cases were individuals who had a 30-day mortality event after their last medical utilization, while controls were selected by incidence density sampling based on age and sex. We examined the interaction between the main independent variables of weekend admission and PSI by categorizing cases into four groups: weekend admission/PSI, weekend admission/non-PSI, weekday admission/PSI, and weekday admission/non-PSI. Results: Of the 83,400 individuals in the database, there were 20,854 cases (25.0%) and 62,546 controls (75.0%). After adjusting for socioeconomic, health status, seasonality, and hospital-level factors, the odds ratios (ORs) of 30-day mortality for weekend admission/PSI (OR, 1.484; 95% confidence interval [CI], 1.371-1.606) and weekday admission/PSI (OR, 1.357; 95% CI, 1.298-1.419) were greater than for patients with weekday admission/non-PSI. Conclusion: This study indicated that there is an increased risk of mortality after weekend admission among patients with PSI as compared with patients admitted during the weekday without a PSI. Therefore, our findings suggest that recognizing these different patterns is important to identify at-risk diagnosis to minimize the excess mortality associated with weekend admission in those with PSI.

• Journal of Digital Convergence
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• v.16 no.12
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• pp.533-540
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• 2018

The purpose of this study was to use the data from the Health Insurance Review and Assessment Service to analyze the disagreement in disease coding given by different medical institutions on the same disease of the same patient and provide basic data that could help improve the quality of national public health statistics. 9,976,826 patients' data records from the Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) of 2014 were analyzed. The disagreement in disease coding differed by movement paths for medical institutions; the disagreement rate tended to increase when moving from a medical institution other than public health centers to a public health center and decrease remarkably when moving from a specialized general hospital to another. Therefore, this analysis of disagreement in disease coding among medical institutions suggests the need to supplement the system so that domestic medical institutions can realize consistent disease coding.

• Journal of the Korea Convergence Society
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• v.13 no.5
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• pp.77-84
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• 2022

The purpose of this study is to provide basic data necessary for preparing a sustainable health insurance system in the future by analyzing the difference in the results of claims according to the claims status of health insurance of dental medical institutions and the level of health insurance knowledge. In this study, a self-written online questionnaire was conducted for dental medical institutions 209 workers from March to May 2019. As a result of the study, The demand for professional manpower according to claim satisfaction was statistically significant in the qualification requirements (p<.05). Therefore, the necessity of professional workers for dental health insurance claims was confirmed and policies for this should be prepared.

• Korea Journal of Hospital Management
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• v.29 no.2
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• pp.37-47
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• 2024

Purpose: This study aimed to determine the effect of adjusted out-of-pocket maximum rules in the 'differential co-payment ceiling', which means having a higher burden of co-payment, that expanded to the entire ceiling level in long-stay admission patients in long-term care hospitals(LTCH). Methodology: We used health insurance claim data between January 1, 2022, and December 31, 2022 received from the National Health Insurance Service. The study populations were inpatients in long-term care hospitals more than 1 days during the study period. We performed the difference in characteristics of the LTCH patient of the differential and general ceiling by the chi-square test. We estimated the change of the population, cost, and co-payments per person under the assumption of restructuring. Finding: Based on adjusted out-of-pocket maximum rules in 2023, it was expected that the number of benefits decreases at the high-income level while increasing at the low-income level. The burden of health expenditure after reimbursement of co-payment ceiling, is expected to increase by 65.1% in the highest medical necessity, whereas the low medical necessity would decreases compared to 2022. Practical Implications: The results demonstrate that the current out-of-pocket maximum rules do not reflect the needs of medical necessity. This study suggested the need to reflect the medical necessity in LTCH on the out-of-pocket maximum rules in the future.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.32 no.3
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• pp.242-252
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• 2022

Objectives: Firefighters and police officers are exposed to various occupational hazards. No studies in Korea have investigated the occurrence of cancer by type of cancer for the two occupations. This study aims to investigate the risk of occurrences associated with types of cancers in firefighters and police officers. Methods: Utilizing National Health Insurance(NHI) Claims data from 2006-2015, the study included 8,871,468 general workers, 25,001 firefighters, and 102,274 police officers. Using general workers as a control group, we calculated the standardized incidence ratios(SIR) by types of cancer for firefighters and police officers. After calculating the SIR for all subjects, the SIR was calculated by stratifying according to gender. Results: SIR of colon cancer 1.38(95% CI, 1.11-1.69), cancer of the liver and intrahepatic bile ducts 1.27(95% CI, 1.04-1.54), and 1.88(95% CI, 1.28-2.65) bladder cancer were higher firefighters than general workers. SIR of Lip, oral cavity, and pharynx 1.26(95% CI, 1.07-1.47), Stomach 1.14(95% CI, 1.06-1.23), colon 1.33(95% CI, 1.21-1.46), liver and intrahepatic bile ducts 1.21(95% CI, 1.10-1.32), pancreas 1.24(95% CI, 1.02-1.49), other skin 1.60(95% CI, 1.26-2.00), bladder 1.27(95% CI, 1.04-1.54), other urinary tract 1.46(95% CI, 1.27-1.68), other parts of central nervous system 1.68(95% CI, 1.10-2.46) were higher police officers than general workers. Conclusions: Both firefighters and police officers are exposed to various cancer occurrence risks, necessitating the development of occupational medical protection measures to reduce risk exposure factors.

• The Journal of Korean Medicine
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• v.37 no.3
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• pp.112-122
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• 2016

Objectives: This study aimed to assess the validity of 'Korean Diagnosis Related Groups-Korean Medicine (KDRG-KM)' which was developed by Health Insurance Review & Assessment Service (HIRA) in 2013 Methods: Among inpatient EDI claim data issued by hospitals and clinics in 2012, the data which included Korean medicine procedures were selected and analyzed. We selected control targets in the Korean medicine hospitals which had longer Episodes-Costliness index (ECI) and Lengthiness index (LI) than average of total Korean medicine hospitals, and compared the results of selection between the major diagnosis-based patient classification system and the KDRG-KM system. Finally, the explanation power (R2) and coefficient of variation (CV) of the KDRG-KM system using practice expenses were calculated. Results: The numbers of control target in Korean medicine hospitals changed from 36 to 32 when patient grouping adjustment method was changed from major diagnosis to KDRG-KM. For expenses of all outpatient claim data on Korean medicine, explanation power of KDRG-KM system was 66.48% after excluding outliers. CVs of expenses of patient groups in Korean medicine hospitals were gathered from under 70% to under 90%, and those in long-term care hospitals mostly belonged under 70%. Conclusions: The validity of KDRG-KM system was assured in terms of explanation power. By adapting KDRG-KM system, fairness of control targets selection for costliness management in Korean medicine hospitals can be enhanced.

• Korean journal of food and cookery science
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• v.21 no.5
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• pp.616-628
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• 2005

The purpose of this study was to monitor the current nutrition labeling practice on the packaging of the processed foods providing consumers with reliable nutrition information, which has been considered as a useful aid for food selection and a potent educational tool for nutrition in a daily life. The 2,214 processed foods purchased at the a wholesale market in July, 2003, were divided by food categories issued from the 2003 food codes and assessed in the terms of the nutrition composition labeling and nutrition claims. Nutrition composition labeling was found on 533 out of the 2,214 processed foods items. The findings of this study were as follows : Milk and dairy products had 66.4% of nutrition composition labeling, which was the largest percentage among the food categories. Tables format (71.3%) is the most widely used type of nutrition labeling. The title of nutrition composition labeling used the most widely was nutrition composition (71.3%). Nutrition composition included many different ways of expression, such as a table of nutrition composition, and indication of nutrition composition, etc. The expression unit of the nutrition composition labeling was use per 100g or 100mL (40.5%). The processed foods with nutrition claims were 18.0% (399 items). Nutrition claims were divided into two categories: nutrient content claims and nutrient comparative claims. The most frequently used nutrient content claims were contained (43.9%) and more or plus in the nutrient comparative claims (16.0%). Ca was the most popular item as a nutrition claim nutrient (33.6%).

• The Korean Society of Law and Medicine
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• v.12 no.1
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• pp.227-255
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• 2011

Recently, many nations said "yes" to human embryonic stem cell research, signing an executive order to permit funding for the research in the mame of achieving health and life of humankind. Human Embryo Research is permitted by our Bioethics & Biosafety Act. But, illegal research cannot be divorced from civil liability since it requires the destruction of eggs of fertilized eggs and personal rights of embryo-creator. After all, though we allow to do research embryo, we should control the capacity of abuse of embryo research for embryo-creator. If research violate the law(Bioethics & Biosafety Act or Civil Law, etc), it comes to a delict by pecuniary loss and non-pecuniary loss. When it comes to pecuniary loss, Human Embryo is not body but special property. Supreme Court maintained a stance that mental suffering is generally deemed as compensable for damages for the loss of property where a person's property right is invaded by a tort or non-performance of obligation. Thus, where mental suffering occurs, which cannot be compensated by recovery of property losses, the situation must be a special circumstance and the injured could claim consolation money for such losses only if the offender knew or would have known of such special circumstances(Supreme Court Decision 96Da31574 delivered on Nov, 26, 1996, etc.). That is to say, Supreme Court regards mental suffering through person's property right invaded by a tort as damages that have arisen through special circumstances. According to Civil law article 393 (2), the injured could claim consolation money for such losses only if only if the offender had foreseen or could have foreseen such circumstances. Also our court will solve through damages for non-pecuniary loss by complementary function of consolation money in that pecuniary loss could be difficult to valuate.

• The Korean Society of Law and Medicine
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• v.15 no.2
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• pp.91-122
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• 2014

For a variety of reasons, the number of medical disputes is continuously rising. Due to the intrinsic qualities of medical treatments, one would find it more apt to subject medical disputes to general conflict resolution procedures rather than to once-for-all decisions under legal suits. To address the increasing medical disputes with greater professionalism and efficiency, the Medical Disputes Mediation Act was enacted and a medical dispute mediation system put in place, while drawbacks have been blamed to both. The current mediation procedures require the respondent's agreement as a disclosure requirement. A reasonable improvement to this would be to amend the regulation of agreement supposition, or to enforce procedural participation only to public health facilities managed by the national or regional government. Furthermore, small claims cases of 20 million KRW or less in claim may be considered for conciliation-prepositive principle. The concentration on small claim medical disputes is a phenomenon that can be addressed by carrying out maximum authentication commissions or similar measures, one of the solutions by enhancing the public trust in the Korea Medical Dispute Mediation and Arbitration Agency. The proper management of medical authentication teams is one way to address the existing problems in the authentication system. For this, the number of team members shall be increased under more flexible authentication procedures. All indemnity resources for medical accidents of force majeure must be borne by the Government, for it is the body principally responsible for social compensation. Placing this cost on the establisher of the subject medical facility holds the possibility of violating fundamental rights. While the costs for subrogation payment system for damages may be borne by the healthcare facility establisher, a deposit-based system must be created for cases in which the facility shuts down, without holding the responsibility for accident cause. Such change to a deposit-based system will evade the controversies of unconstitutionality, etc.

• Korean Journal of Clinical Pharmacy
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• v.31 no.2
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• pp.153-159
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• 2021

Background: With increasing economic evaluation studies on the treatment of or screening tools for liver diseases that cause hepatocellular carcinoma (HCC), interest in the analysis of the medical utilization and costs of HCC treatment is increasing. Therefore, we aimed to estimate the medical utilization and costs of HCC patients, and calculate the cost of main procedures for HCC treatment, including liver transplant (LT), hepatic resection (HR), radiofrequency ablation (RFA), and transarterial chemoembolization (TACE). Methods: We analyzed claim data from January to December 2018 from the Health Insurance and Review and Assessment Service-National Patient Sample (HIRA-NPS-2018) dataset, including data of patients diagnosed with HCC (Korean Standard Classification of Diseases code C22.0) who had at least one inpatient claim for HCC. Results: A total of 715 HCC patients were identified. In 2018, the yearly average medical cost per HCC patient was ₩18,460K (thousand), of which ₩14,870K was attributed to HCC. Among the total medical costs of HCC patients, the inpatient cost accounted for the largest portion of both the total medical and HCC-related costs. The major procedures of HCC treatment occurred most frequently in the order of TACE, RFA, HR, and LT. The average medical cost per treatment episode was the highest for LT (₩87,280K), followed by HR (₩10,026K), TACE (₩4,047K), and RFA (₩2,927K). Conclusion: By identifying the medical costs of HCC patients and the costs of the main procedures of HCC treatment, our results provide basic information that could be utilized for cost estimation in liver disease-related economic evaluation studies.