• Health Policy and Management
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• v.27 no.4
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• pp.366-371
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• 2017

The National Health Promotion Fund has grown as the increase of tax on tobacco consumption, but more than half of the fund was spent on health insurance supporting. It is important to use the fund appropriately to keep legitimacy and sustainability of health promotion. Therefore, services regarding health promotion should be a priority in spending health promotion fund, and operation system should be established to manage and administer the fund properly.

• Dementia and Neurocognitive Disorders
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• v.16 no.1
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• pp.1-6
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• 2017

The purpose of this study is to examine interventions and supporting systems by dementia stage, take a look at dementia insurance policies in Korea and the United States, and present Korean private insurance programs for dementia patients. According to the study, our suggestions of a design of private insurance products for Korean dementia patients are as follows. First, the products should support people aged 80 and older. Second, new products should include the mild stage dementia in the insurance coverage. Third, non-pharmacological treatments, such as the cognitive stimulation, the cognitive training, and exercises need to be covered through the new private insurance. Fourth, the private insurance should be contained home health care services in its coverage. These suggestions can reduce the dependence of the public insurance, help people choose appropriate treatments for themselves, and give people a good opportunity to improve the effect of dementia treatment and to increase the satisfaction of patients and their families.

• The Korean Society of Law and Medicine
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• v.8 no.1
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• pp.137-177
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• 2007

The medical expenses review system in Korea has developed under fee-for-service system with its own unique structure. The importance of reviewing medical expenses has been emphasized, as the size of medical expenditures moving through the health insurance legal context and its weight in the national economy have increased very rapidly. It is, however, analyzed that the feuds and arguments continue among the stakeholders for the lack of laws supporting the medical expenses review system. The medical expenses review is a series of administrative procedures, deciding whether claims from medical care institutions to the insurer are legal and valid or not. It mainly controls the increase of unnecessarily excessive health insurance claim and prevents fraudulent claim and abuse and checks the less use or unsuitable use of medical resources. It also works a function guarantees medical benefits for the appropriate treatment according to the object of health insurance system as a social insurance scheme. The dispute on legal base of the medical expenses review is about the source of law in the medical expenses review. There are the Health Insurance Act and administrative laws as jus scriptum and the guidelines of review as administrative orders. The medical expenses review should reflect various factors, such as the development of medical healthcare technologies, the health expenditures distribution, the financial situation of the health insurance, and the evaluation on the level of appropriate benefits. It is also likely to adapt to the traits of characters of medicine, and trends and transition, Besides it should judge the legality and the validity of medical benefits expenditures by synthesizing these all factors. And the evaluation system of appropriateness of medical benefits was administrative procedure which was consecutive with reviewing the medical expenses system and it was intended to make up for the result of reviewing the medical expenses in more comprehensive levels.

• Health Policy and Management
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• v.21 no.4
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• pp.585-598
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• 2011

This study was conducted to examine the trend of national health insurance service use with relation to pregnancy, childbirth, and the puerperium among pregnant and postpartum women older than 35 over the last decade. A descriptive analysis was conducted, using the data which were drawn from the "nationwide claim database of Korean National Health Insurance Corporation(NHIC)". Data were composed of the total cases related to pregnancy, childbirth, and the puerperium (International Classification of Disease, $10^{th}$revision [ICD-10] codes O00-O99) from 2001 to 2008. During 2001-2008, the number of pregnant and postpartum women older than 35 had continuously increased and the percentage of them also had increased in both hospital and ambulatory care. There are similar trends in their total use of national health insurance service and total expenditure. According to demographic characteristics, there was the biggest increase of the percentage in residents in large cities, self-employed workers, ones in the highest income level. According to ICD-10 codes, there was the biggest increase of the percentage in O10-O16 (oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium). According to the major prevalent disease, there was the biggest increase of the percentage in O60 (preterm labor and delivery). Throughout the past decade, the necessity has been emphasized of supporting pregnant and postpartum women older than 35. But in maternal and child health care, they are in an early stage of development. The findings of this study would be helpful in developing the support programs for the aged pregnant and postpartum women.

• Health Policy and Management
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• v.21 no.3
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• pp.397-413
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• 2011

Purpose: The purpose of this study is to examine the relationship between the income level and the healthcare utilization by health insurance type in all cancer patients in year 2005. Methods: The target population was cancer patients with health insurance who used healthcare as a diagnosis code (C00-C97) from January 1 to December 31 of 2005. The Korea Central Cancer Registry Center's Cancer Patient Registry Data, the list of cancer patients of the National Health Insurance Corporation, and the claim data of the Health Insurance Review & Assessment Service were used. The I was the wealthiest, followed by II, III, IV. The V was the poorest in this study. For the analysis, the $x^2$-test, ANOVA (and Kruskal-Wallis test), and regression were used. Results: Outpatient and hospitalization medical expenses, and outpatient visit days of cancer patients with self-employed health insurance were highest in I (p<.001, respectively), and the hospitalization days were the highest in II (p<.001, respectively). Outpatient and hospitalization medical expenses, and outpatient visit and hospitalization days of cancer patients with occupational health insurance were the highest in I (p<.001, respectively). Outpatient and hospitalization medical expenses, and outpatient visit and hospitalization days in cancer patients were higher in I compared to V, and higher in II and III, IV compared to V (p<.001, respectively). Conclusion: Supporting plan for cancer patients' outpatient healthcare utilization are necessary. Moreover, we should make specialized strategy for low income cancer patients with self-employed health insurance when we develop quality improvement policy for inpatient service.

• Korean Journal of Health Education and Promotion
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• v.15 no.2
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• pp.217-233
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• 1998

This paper analyzed four different perspectives on health care reform in Korea in terms of the basic values, formulated problems and reform plans, implementation methods, and supporting groups. The medical security plan was insisted by social security specialists and social activists focusing on the integration of medical insurance coops in order to enhancing equity and right of the people. However, its perspective was limited to promoting security instead of reforming health care system. The government proposed the health care reform plans in 1994 and in 1997, focusing on promoting efficiency by remedying many problems in health care delivery system. However, its implementation was not successful due to the lack of organizational and financial supporters. Recently, two opposite proposals were issued. The market reform plan paid attention to revitalizing the market function to promoting efficiency by allowing hospitals to treat private patients instead of applying the medical insurance regulation. The government reform plan focused on intensifying governmental planning and intervention in the health care sector in order to removing inefficiency and promoting equity with the supports of social activists and labor unions. Finally, this paper proposed an alternative plan to promote harmonious social relationship between actors in the health care system.

• Journal of Preventive Medicine and Public Health
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• v.41 no.5
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• pp.331-338
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• 2008

Objectives : The purpose of this study was to measure the workload of home visit care activities and their relative values. This study examined also factors that affect the workload of home visit care activities. Methods : The participants of this study were 126 home-helpers of 50 home visit care agencies at the 2nd Long-term Care Insurance Demonstration Project. The workload of home visit care activities was divided into total work and four dimensions ; physical efforts, mental efforts, stress and time. Home visit care activities consisted of four categories with 24 items. We used magnitude estimation method to measure their relative values of the four dimensions. The participants answered the relative values of each activities based on the reference service. We used the activity for supporting their elderly's evacuation as the reference service. Results : Most of the respondents were over 40 years old female. They consumed most their time supporting elderly's going out. They consumed their highest physical, mental efforts, and stress for activities of coping with emergency situation. The Pearson correlation coefficients showed significant relationships between workload and each dimensions. This study showed that all four dimensions are statistically significant predictors of workload of home visit care activities. Also, we found that the home-helper's career affects the workload of home visit care activities. Conclusions : The workload of home visit care activities could be explained by physical efforts, mental efforts, stress and time.

• Korean Journal of Health Education and Promotion
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• v.31 no.3
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• pp.83-95
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• 2014

Objectives: This study was to examine the experts perception on the operation of the national health promotion fund and related policies, and to obtain the perspective on the improving governance of the fund. Methods: Experts opinion survey was recruited 120 experts who were public health officials, and members of board in academic societies related to health promotion and health policy, and 60 experts participated in the survey. Results: Most health care experts agreed that the current allocation of health promotion fund was not optimal with its lack of allocation on promoting healthy lifestyle and R&D for health promotion, while the majority of the fund was being spent on supporting national health insurance. Thus, establishing governance system and control tower for the fund was viewed as critical. Also the status of deliberation committee should be raised to higher position where it can hold practical authority to plan and evaluate fund spending. Conclusions: The priority of health promotion fund spending should be more on improving health such as modifying life-style and spreading healthy habits, rather than on disease management or subsidizing health insurance. It is recommended that change from to environment in health promotion policy regime is required to establish effective governance system for the fund operation.

• The Journal of the Korea Contents Association
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• v.18 no.8
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• pp.483-493
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• 2018

Through the improvement of the Labor Relations Act, the Social Insurance Act, and the Artists Welfare Act for occupational status and rights of artists, the character of workers, joining exception in the Employment Insurance Act, and applying exception in the National Health Insurance Act and the National Pensions Act should be recognized. For this, the scope of workers should be expanded through the interpretation of the court and legislation of the Labor Relations Act, and supporting range of social insurance should be expanded by applying exception in the National Health Insurance Act and joining exception in the Employment Insurance Act for artists who are currently excluded. Artists' compensation insurance that is an optional entry system and paid entirely by artists need to have effectiveness of the system through insurance support. The Artists Welfare Act also needs to be revised to strengthen legal protection for artists and it is important to secure finances for artists' welfare projects. The standard contract should be mandatory and a career certification system for artists should be established so that artists who need welfare benefits can not be omitted.

• Health Policy and Management
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• v.6 no.2
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• pp.14-42
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• 1996

On rationale for government intervention is the failure of competition in the market. Health care markets are characterized by such unique aspects as information asymmetry, prevalence of insurance, and cost-increasing competition based on the adoption of costly medical technology. Therefore, government policy to guarantee a sufficient number of providers in markets may not lead to socially beneficisal outcomes such as higher quantity and lower price. This paper examines the unique nature of health services and its implications for competition, the evidence that competition may not reduce health care ex[enditures, and policy tools that government can use to encourage competition which contributes to supporting a sustainable health care system.