• 제목/요약/키워드: Health insurance benefit expansion

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의료서비스 선택과 비급여 의료비 부담: 일본 혼합진료금지제도 고찰 (Choices of Medical Services and Burden of Health Care Costs: Japanese Prohibition of Mixed Treatment in Health Care)

  • 오은환
    • 보건행정학회지
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    • 제31권1호
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    • pp.17-23
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    • 2021
  • With the introduction of national health insurance, the burden of health care costs decreased and choices of medical services widened. However, because of the rapid expansion of non-covered medical services by health insurance, financial security for health care expenditure is still low. This gives patients barriers to choose medical services especially for non-covered medical services, and it becomes narrower. Compared to Korea, Japan has high financial protection in health care utilization, but there exists a limitation using covered and non-covered medical services both together. This is called a prohibition of mixed treatment in health care. This study reviews the Japanese health care system that limits choosing medical services and the burden of health care costs. The prohibition of mixed treatment can alleviate the out-of-pocket burden in the non-benefit sector, but it can be found that it has a huge limitation in that it places restrictions on choices for both healthcare professionals and patients.

한방의료의 이용행태 및 이용결정요인 분석 - 일부 대도시 지역주민을 중심으로 - (Utilization Patterns and Determinants of Oriental Medical Services : Focused on the Residents of Taegu City)

  • 유왕근;류경아
    • 대한예방한의학회지
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    • 제4권2호
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    • pp.1-24
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    • 2000
  • This study was conducted to examine utilization patterns and determinants of oriental medical services. Data were collected from 545 residents in Taegu city The results of this study are summarized as follows 1) 37.8% of subjects used oriental medical services in the past year. Especially, the female, the ages of 50 and 60 over, the single. low-educated. high-income class, white-collar class, medical insured tended to use more oriental medical services than another groups. 2) 46.7% of users of oriental medical services reported that number of visits in the past year was 2 - 5 times 37 1% of them was 1 times, and 4.5% over 10 times. 3) According to the reasons to choose the oriental medical facilities, most was 'on their own judgement'(48.8%) and 'by the advice of relatives and friends'(42.0%) Regarding to the objectives of using oriental medicine, 68.3% was 'treatment', 31.7% 'health counselling and promotion'. And among diseases of users, diseases of musculo-skeletal system was the highest(54.5%). 4) 57.9% of oriental medical services users had experience of utilizing western medicine on the same diseases. Among peoples with experiencing western medicine on the same diseases. 54.4% received oriental medical services 'in addition to western medicine', 45.6%'in place of western medicine 'And 41.2% of using both services reported that they had difficulty in deciding to choose the type of services -oriental medical services or western medicine-for their diseases. 37.3% of them answered that 'providing relevant information' was the most desirable measure to solve this problem, 27.3% 'establishment of effective referral system between oriental and western medical facilities '23.6% 'cooperative medical treatment systems in the same facilities', 11.8%'integration of oriental medicine into western medicine 5) According to the satisfaction level with each items of oriental medical services, the respondents had positive views on efficacy, kindness, and side-effects. They, however, had negative view on the cost of oriental medical services. 6) In regarding to the priority of improvement of oriental medical system,'expansion of insurance benefit package 'ranked first. 'expansion of insurance benefit Package 'ranked second, 'improvement of scientific methods and diagnostic technique 'third, and 'safety of herbal medicine' fourth in order. 7) The significant factors influencing the utilization of oriental medical services were kindness of oriental medical practitioners, efficacy , travel time, age To be brief, utilization rate of oriental medical services in urban area generally tends to be high. There, however, have been various barriers to limit oriental medical services, such as incomplete benefit package of oriental medical insurance and lack of coordination and referral system between oriental and western medical services, lack of scientific diagnostic procedures, high price etc . For the development of oriental medical services, Much attention to remove these limiting factors should be placed. In addition, kindness of oriental medical practitioners , which is expected to be more important factor in the consumer - focused health care environment than ever, should be kept high consistently. Since this study was conducted for specific residents of an urban city. further research including more sampling in different urban areas should be required to generalize the results of the study.

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한방의료서비스에 대한 인식도 및 개선요구도 (A Study on Recognition Level of the People on Oriental Medical Services and the Need for its Improvement)

  • 유왕근
    • 대한예방한의학회지
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    • 제7권2호
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    • pp.45-64
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    • 2003
  • This study was conducted to examine the recognition level of the people on oriental medical Services and the need for it's improvement. Data were collected from 1174 residents in Daegu metropolitan city and Gyungbuk province. According to the satisfaction level with each items of oriental medical services, the respondents had positive views on efficacy, kindness, and side-effects. They, however, had negative view on the cost of oriental medical services. In regarding to the priority of improvement of oriental medical system, 'expansion of insurance benefit package' ranked first. Followed by 'safety of herbal medicine(heavy metal/pesticides)', 'improvement of scientific methods and diagnostic technique' etc. For the further development of oriental medical services in the consumer - focused and evidenced-based health care environment, much attention to implement relevant health policy reflecting user's need positively should be made.

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지역보건의료기관의 진료현황 분석을 통한 보건소 기능개편 방향 (Direction Reorganization of Public Health Center Functions through Analysis of Medical Service Status by Public Health Care Institutions)

  • 박선희;이미선;오유미
    • 보건행정학회지
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    • 제32권1호
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    • pp.3-13
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    • 2022
  • Health centers provided intensive health care services for local residents according to changes in the times and environment. Public health centers were given various roles such as medical treatment, administration, and service, and the demand for functional reorganization has emerged. We analyzed the literature on the functional restructuring of public health care institutions. In addition, the current status of medical services, which is the main function of institutions, will be analyzed through health insurance statistical data, and detailed contents will be analyzed according to regional types and income levels. As a result of the analysis of medical services at institutions, the total number of patients was 2,238,000, and the number of visits was 11,806 times. Total medical expenses were 169.6 billion won, of which 132 billion won was found to be benefit. When analyzing the number of patients per institution, public health centers had the largest number of 4,326, and the share of benefit was also the highest at public health centers. It should focus on the function of providing local health and medical services related to health promotion and disease prevention in the community. This functional reorganization of public health centers can contribute to forming cooperative relationships with private medical institutions in the local community. For this, first, to establish the role, essential functions for public health centers for preventive health management are established. Secondly, regular manpower expansion and flexible manpower management are required in the human resources sector. Finally, in the organizational sector, it is necessary to establish a step-by-step organizational system according to environmental changes.

가계직접부담 비용의 현황과 추이 (Household Out-of-Pocket Payments and Trend in Korea)

  • 박윤식;박은철
    • 보건행정학회지
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    • 제29권3호
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    • pp.374-378
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    • 2019
  • After the announcement of Moon Jae-in Government's plan (Moon's Care) for Benefit Expansion in National Health Insurance in August 2017, it is necessary to monitor the effects of the policy, especially household out-of-pocket payments (OOP). This paper aims to observe the current status and trend of OOP in Korea. Current health expenditure (CHE) was 144.4 trillion won in 2018, which accounts for 8.1% of gross domestic product (GDP) increased 9.7% from the previous year. Although GDP's share of CHE has been close to the average of the Organization for Economic Cooperation and Development (OECD) countries, the public fund's share was 59.8% of the total in 2018, which was lower than the OECD average of 73.5%. OOP's share was 32.9% in 2018, which decreased from 37.4% in 2008. The share of OOP of non-covered services was 20.0% in 2018, which decreased from 22.9% in 2008. The share of cost-sharing with third-party payers was 12.9% in 2018, which decreased from 14.5% in 2008. The OOP of non-covered services was significantly decreased in hospital and inpatient curative care, but the OOP of non-covered services was significantly increased in the medical clinic. The effect of Moon's Care was not showed in OOP through the results of 2017 and 2018, but further monitoring is needed because the Moon's Care is progressing and the observational period is short.

재가노인의 장기요양예방과 자립지원에 관한 연구: 예방·자립지원 모형설계 방안제언 (A Study on a Prevention of Long-term Care self-reliance Support for the Elderly in Home: Proposal of an Prevention and Support for Self-reliance Support Model)

  • 김현실;황성자
    • 한국노년학
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    • 제30권4호
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    • pp.1359-1375
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    • 2010
  • 본 연구는 고령사회에 따른 장기요양재가노인 인구의 증가 현상을 예견하면서, 요양급여 의존 증을 최소화하고, 예방·자립지원의 유효성을 높이기 위하여 예방·자립지원 모형의 기초를 제시함으로 예방·자립지원의 실천적 함의를 얻고자 함이다. 연구방법으로는 첫째, 이론적 문헌연구를 통하여 장기요양노인에게 예방·자립지원에 대한 개념을 명확히 하며, 둘째, 표준장기요양이용계획서와 연구대상자가 소속된 노인복지센터의 장기요양급여 관련문서 분석을 통하여 예방·자립지원에 저해하는 요소를 분석하고, 셋째, 요양급여 이용자들의 요양급여이용실제에서 예방·자립지원을 저해하는 요소와 실제 욕구를 조사하여 이 세 가지의 질적 연구결과를 바탕으로 예방·자립지원 모형의 방향을 제시함으로써 예방·자립지원의 유효성을 높이기 위한 실천적 함의를 얻고자 하였다. 따라서 D시에 있는 주간보호센터와 노인복지센터의 사업자와 전문사회복지사의 협력과 승낙을 얻어 문서자료 수집과 연구 참여자에게 심층면접을 실시하였다. 연구 결과 문헌연구에서는 장기요양 예방·자립지원은 장기요양급여노인에게도 자신이 삶의 주체가 되어 살아가도록 이용자의 권리를 지원하는 '이용자 중심의 지원체계의 강화'로 전개되어야하는 것으로 분석되었다. 문서분석에서는 보건의료와 관련한 급여제공이 부재한 것으로 나타났고, 예방·자립지원을 위한 사회적지지체계의 미비 등이 나타났으며, 심층면접조사결과에서 장기요양급여이용노인의 예방·자립과 관련된 서비스의 강화가 요구되었으며 예방·자립을 위한 요양급여이용노인의 절실한 욕구는 ①고독감, 외로움, 불안, 공포 ② 자녀와 사람에 대한 그리움과 걱정, ③이동, 외출, ④ 보건·의료서비스·재활프로그램, ⑤ 주간보호이용욕구, ⑥주택구조의 불편, ⑦식사메뉴의 욕구, ⑧폐용증후군(disuse syndrome)의 발생 등이 도출되었다. 따라서 예방·자립지원모형은 ①이용자 중심의 지원체계의 강화, ②보건의료연계지원체계의 강화, ③사회적지지 체계강화의 3가지 축을 중심으로 예방·자립지원모형설계의 기초를 제시하고자 했다.