• Journal of Society of Preventive Korean Medicine
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• v.23 no.3
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• pp.109-119
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• 2019

Background : Germany is the first country in the world to introduce modern systems of public health insurance, and the country which most widely uses complementary alternative medicine(CAM) in Europe. In early 21^st century, a large evaluation studies were conducted to include acupuncture in health insurance payments, which were eventually decided. Objectives : This study is to investigate and analyze the process of public policy determination on insurance coverage for acupuncture in German health insurance system. Methods : We collected the data and information through the literature search and from the websites of German government departments and health insurance organizations. To obtain contextual information, German experts of health insurance and acupuncture clinical study were interviewed. Results : As use of acupuncture had been growing, German public health insurers wanted to evaluate the validity of acupuncture coverage and sponsored three evaluation projects for clinical effectiveness of acupuncture using randomized clinical trials, systematic reviews, and pragmatic trials from 2001 to 2005. For some pain condition, acupuncture was founded not to be effective than sham acupuncture, but more effective than standard care. The federal joint committee of health insurance decided to cover acupuncture for chronic pain of lumbar spine and chronic pain in at least one knee joint due to gonarthrosis. Conclusions : Considering the controversial subject matter in the process of acupuncture's health insurance coverage in Germany, expanding the benefits of Korean medicine in Korea needs to come up with ways to overcome the difficulties of placebo effect, standardization and lack of literature evidence.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6985-6989
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• 2013

Background: This study aimed to examine out-of-pocket expenditure for cancer treatments of hospitalized patients and to analyze changing patterns over time. Materials and Methods: This study examined data of all cancer patients receiving inpatient care from two tertiary hospitals from January 2003 to December 2010. Medical expenditures per admission were calculated and classified into those covered and uncovered by the Korean National Health Insurance (NHI) and co-payment. Results: The medical expenditure per admission increased slowly from 3,455 thousand Korean won (KRW) to 4,068 thousand KRW. While expenditures covered by the NHI have increased annually, co-payments have generally decreased. The out-of-pocket expenditure ratio, which means the proportion of uncovered expenditure and co-payment among total medical expenditure dropped sharply from 2005 to 2007 and was maintained at a similar level after 2007. Medical expenditures, NHI coverage, and the out-of-pocket expenditure ratio differed across cancer types. Conclusions: It is necessary to continually monitor the expenditure of uncovered services by the NHI, and to provide policies to reduce this economic burden. In addition, an individual approach considering cancer type-specific characteristics and medical utilization should be provided.

• Health Policy and Management
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• v.27 no.2
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• pp.139-148
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• 2017

Background: The purpose of this study is to investigate family caregivers' opinions about out-of-pocket payment for long-term care (LTC) facilities, and find the differences in the opinions for family caregivers of all different levels of income. Methods: We used the data of the study on out-of-pocket payment in national long-term care insurance, including 1,552 family caregivers with the elderly in long-term care facilities. Results: The average out-of-pocket payment per month was 511,635 Korean won and distributed from 230,750 to 1,365,570 Korean won. The amount of out-of-pocket payment might be affected by not co-payment but the cost of non-covered service. There were differences in them for family caregivers of all different levels of income. Opinions were surveyed about 5 issues. By levels of income, there were differences in their opinions about 3 issues, the financial burden on LTC, the necessity of reducing out-of-pocket payments, and to be willing to pay more for a high quality service. But there were not different opinions about the interruption of LTC service and staying with LTC facilities. Conclusion: These findings suggest that the range of out-of-pocket payment for LTC facility is wide and it can be a burden to lower income group. It should be to prepare the policies to ease the financial burden and support the appropriate LTC use.

• The Korean Society of Law and Medicine
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• v.10 no.2
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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.

• International conference on construction engineering and project management
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• 2013.01a
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• pp.344-351
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• 2013

Private participation on public infrastructures projects is being promoted by governments of several developing countries, among them Colombia. As a result, several advantages such as service delivery efficiency, technology application and faster execution of the projects have been recognized. Hence, the Colombian Government is looking for schemes that allow the private investment in projects like hospitals, schools, prisons and public edification. In this paper, experiences in PPP from other countries were analyzed and adjusted to the Colombian environment. As a result, a model adapted to Colombia is presented, based on a well-developed case from Spain. The awarding process is defined by economic criteria, previous compliance of minimum technical exigencies. Once the infrastructure is operating, contractual periodical payments will be done, based on the performance of the facility.

• Health Policy and Management
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• v.2 no.2
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• pp.131-151
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• 1992

The contents of prescription service were comparatively analysed between health centers(HC) and private clinics(PC). Medical chart review was done for 330 otu-patients diagnosed with upper respiratory tract infection(UR) of 120 adults and 90 children, and gastritis or duodenitis of 120 adults. Emphasis on comparison was the prime cost of medication which used in prescription service. The results were as follows; 1. The prime costs fro the medication per visit of HC group were significantly higher than PC group in all three diseases, and the out of pocket payments of patients per visit were significantly lower in the HC group than PC group. 2. The reason for high prime costs of medication per visit of HC in adult case of URI were due to the idverse use of medication and long prescription period per visit. And high medication costs in children cases of URI in HC group were due to the longer prescription day. In cases of gastritis, the prime cost of medication was also higher because of longer prescription period and the higher prime cost of medication. The proportions of medications for injection in the HC and PC groups showed similar features. 3. In depth analysis of the prescription services showed the differences of the contents of medication. In adults cases of URI, the averaged cost of oral medication was significantly lower in HC group, but that of medication for injection was higher in HC group. In children cases of URI, the averaged cost of oral medication and medication for injection was lower in HC group than in PC group. But in the cases of gastritis it was was higher in HC group than in PC group. The prescription periods were longer in HC group than in PC group in all three diseases. As a conclusion prime medication cost and quality of prescription services of HC group were higher than PC group. In terms of health care the cost containment and quality assurance in physician visit for common disease, public sector utilization is good option for those perspectives. But it should not be generalized unless future study about structure and outcome research for quality assurance.

• International Journal of Advanced Culture Technology
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• v.5 no.4
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• pp.15-19
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• 2017

With the increased economic profit in China, people tend to give more attention to the nurturing of children. The change in the food markets directly connected to the infants' health seem to have brought various consumption patterns different than before. Based on the actual condition survey operated by this research, the expansion in the scale of consumption and preference to the imported food for infants appeared in the Chinese food markets for infants. The rapidly increased amount of the online purchases of the food for Chinese infants was checked through the condition survey. Based on the analysis results, with the purpose of increasing the purchase opportunities of the Korean food for infants to the Chinese consumers, it should not only perform the promotion activities such as the promotion for the product's superiority and various promotional event, but also establish the pricing strategy for each entry step to the Chinese market. Because the purchase experience of the Korean food for infant plays the important role for the additional payments decision, it is estimated that there is a need to expand the opportunities for the Chinese consumers to approach the Korean food for infants both directly and indirectly.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.17 no.1
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• pp.45-54
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• 2010

Purpose: This study sought to provide basic information for the establishment of home care nursing system in cancer patients. Methods: Data were collected by the descriptive questionnaires consisting of 42 articles from five fields of nursing services. Patient's symptoms were investigated by the Korean version of EORTC QLQ-C30. Data were analysed using SPSS-PC 12.0. Results: Among the cancer patients (n=182), 40.1% had serious limitations on their usual lives. 74.7% had serious economic burdens. 79.7% agreed strongly with the necessity of home care nursing system, 74.2% were willing to use home care nursing, and 91.2% felt that home care nursing should be mandatory in cancer centers. There was no correlation between the frequency of symptoms or nursing items and the degree of home care nursing requirements. Digestive symptoms, symptoms requiring procedures, and symptoms to meet educational help displayed a high degree of requirement. Conclusion: Home care nursing should be activated for cancer patients as a bridge between hospital-based acute care and community-based chronic care which could increase the quality of care and reduce insurance related payments.

• Health Policy and Management
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• v.14 no.2
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• pp.78-98
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• 2004

The purpose of this study was to categorize the contribution evasion and develop the expected models for contribution arrears in National Health Care System. The modified logistic regression model in non-payments was used as logistic regression model based on the statistical method. By using this model, we arranged non-payment types and typical branches those are appeared by statistical technique. First fact, sex and age branches those are able to take a part in economy had effect mostly. Also they had difference in non-payment probability by existence of their incomes and property. Especially people who didn't have their own house and car were appeared in high non-payment probability, disease and reduction characteristic(rare diseases, reduction of seniors, handicaps, numbers of medical treatments) didn't effect much in probability. The reason for some characteristic of non-payment which is higher than the correct threshold value of Logistic Regression Model (a suggested model for predicting non-payment)'s distribution of probability was mostly moral hazard. Living difficulty was the bigger reason for non-payment, but moral slackening was the bigger reason for non-payment. But it is careless to decide that moral hazard is just the reason, there is a necessity to examine on the side of sociology based in family. By the reason, the member's non-payment reason can be classified by economy, population, and psychology, but there was a comprehension that losing of work desire could be one reason. So we analyzed informations for composition of family of members. In conclusion, we grasped that family conflict makes non-payment and conversion of member in the National Basic Livelihood Protection System difficult.

• Safety and Health at Work
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• v.11 no.3
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• pp.291-300
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• 2020

Background: The study aimed to determine the association of individual cognitive ability in late midlife with labor market participation among older workers. Methods: This prospective cohort study estimates the risk of long-term sickness absence, disability pension, early retirement, and unemployment from scores on the Intelligenz-Struktur-Test 2000R by combining data from 5076 workers from the Copenhagen Aging and Midlife Biobank with a register on social transfer payments. Analyses were stepwise adjusted for age, gender, physical and psychosocial work environment, health behaviors, occupational social class, education, and chronic diseases. Results: In the fully adjusted model, low cognitive ability (≥1 standard deviation below the mean for each gender) and high cognitive ability (≥1 standard deviation above the mean for each gender) were not associated with risk of any of the four labor market outcomes. Conclusion: Individual cognitive ability in late midlife was not associated with risk of long-term sickness absence, disability pension, early retirement, and unemployment in the fully adjusted model. Thus, no direct effect of individual cognitive ability in late midlife was observed on the risk of permanently or temporarily leaving the labor market.