• Title/Summary/Keyword: Healthcare insurance

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Correlation between Outpatient's Medical Adherence and National Insurance Types in the Type 2 Diabetes Mellitus (제2형 당뇨병의 외래환자 복약순응도와 보험유형과의 관계)

  • Lee, Mi-Joon;Kang, Hee-Kyung;Seo, Bum-Jeun
    • Journal of Convergence for Information Technology
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    • v.8 no.4
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    • pp.9-14
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    • 2018
  • The purpose of this study was to analyse the relationship between the characteristics of the patients who received oral antihyperglycemic drugs and their medical adherence in Korea. The study method was a cross-sectional study using the patient sample data of the Health Insurance Review and Assessment Service for 2016, and it was analyzed with 109 major components of diabetes drug. The medical adherence was slightly higher in male than female. The patriots & veterans(free) type had the highest medication adherence because they have low self burden to access medical institutions compared to other insurance types. It is expect that this study result will be used as a basic data to understand the burden of outpatients with health insurance and establish a policy to reduce of the self outpatients' burden with chronic diseases such as type 2 diabetes.

General Radiography Usage and Exposure Dose of Korean Elderly: Based on Data from Aged Patients in 2016 (한국 노인의 일반촬영 이용량 및 피폭선량: 2016년 고령환자데이터 기반)

  • Gil, Jong-Won;Yoo, Se-Jong;Lee, Won-Jeong
    • Journal of radiological science and technology
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    • v.44 no.5
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    • pp.495-502
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    • 2021
  • This study aims to provide basic data for elderly health insurance policy and medical radiation safety management by analyzing the general radiography usage and exposure dose of the elderly in Korea. The effective dose for each general radiography was calculated using the ALARA-GR program for 260 general radiography codes selected from 'National Health Insurance Care Benefit Cost'. The usage of general radiography was analyzed in the 2016 elderly patient data of the Health Insurance Review and Assessment Service, and the effective dose for each general radiography was applied. The general radiography usage and exposure dose per person aged 65 years and over was 6.47 cases and 0.56 mSv. Females showed higher value than males as 7.15 cases and 0.66 mSv(p<.001). By age, those between 75 and 79 showed the highest number as 6.97 cases and 0.62 mSv(p<.001). Those who were supported by Medical Aid showed higher value than those who were insured by National Health Insurance as 8.82 cases and 0.76 mSv(p<.001). In addition, the ratio by radiography was in the order of Chest 20.85%, Knee Joint 15.58%, and L-spine 14.67%, and the exposure dose was L-spine 29.40%, Chest 15.82%, Abdomen 7.97%, and Entire Spine 7.20%. General radiography, which is widely used due to the high frequency of diseases in the elderly population should be taken into consideration when establishing health insurance policies. In addition, it is necessary to check whether the general radiography with high exposure dose is performed as a routine examination without considering medical necessity.

A Study on the Applicability of the Population-Based Health Care Model: Focusing on Social Cooperative-type Medical Clinics in a Local Area (인구집단 기반 건강관리모형의 적용가능성 검토: 한 지역의 의료복지사회적협동조합형 의료기관을 중심으로)

  • Lee, Keun-Jung;Oh, Ju-Yeon;Lee, Da-Hee;Hahm, Myung-Il;Lee, Jin-Yong
    • Quality Improvement in Health Care
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    • v.26 no.2
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    • pp.95-103
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    • 2020
  • Purpose: This study was to examine whether a health care model that provides comprehensive medical services based on population groups to members of the medical cooperative is applicable as a policy alternative in terms of medical use and cost. Methods: Data were derived from National Health Insurance claim data in 2019. We compared the medical volume and expenses of patients who visited social cooperative-type medical clinics with other patients, control group who visited other clinics in a local area. Results: The average number of visit days was 25.3 days in social cooperative-type medical clinics, more than 24.2 days in the control group (p=.004). However, the average medical cost per visit was KRW 46 thousand in social cooperative-type medical clinics, which was significantly lower than KRW 51 thousand in the control group (p<.001), and the total medical cost was also KRW 16.1 billion in social cooperative-type medical clinics and KRW 16.9 billion in the control group. Conclusion: We identified that a population-based health care model might change patients' behaviors to health care services and decrease total medical cost. Further population based experiment is needed to develop alternative healthcare model.

Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study

  • Yeong Geun Gwon;Seung Jin Han;Kyoung Hoon Kim
    • Journal of Preventive Medicine and Public Health
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    • v.56 no.3
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    • pp.248-254
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    • 2023
  • Objectives: Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care. Methods: Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients' characteristics over time, and significant changes in the rates were identified by joinpoint regression. Results: The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic. Conclusions: The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.

Analysis of the propensity of medical expenses for auto insurance patients by type of medical institution (의료기관 종류별 자동차보험 환자의 진료비 성향 분석)

  • Ha, Au-Hyun
    • Journal of Convergence for Information Technology
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    • v.12 no.2
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    • pp.184-191
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    • 2022
  • This study aims to provide basic information necessary to find an efficient management plan for patients using auto insurance. The analysis was conducted on the five-year auto insurance medical expenses review data registered in the health care bigdata Hub from 2016 to 2020. As a result of the analysis, the number one composition ratio of auto insurance inpatient treatment expenses was treatment and surgery fees for Certified tertiary hospitals, hospitalization fees for general hospitals, hospitals and clinics, and treatment and surgery fees for oriental medical institutions and dental hospitals. outpatient treatment expenses was doctor's fee for medical institution, treatment and surgery fees for oriental medical institutions and dental hospitals. The ratio of medication, anesthesia, and special equipment significantly affected the cost of inpatient. And the ratio of physical therapy significantly affected the cost of outpatient.

Physical Activity and Non-specific Neck Pain Recurrence: A Nationwide Cohort Risk Factor Study Based on National Health Insurance Data (신체활동과 비특이적 목 통증의 재발 -국민건강보험 자료에 기반한 전국 코호트 위험인자 연구-)

  • Mi-ran Goo
    • PNF and Movement
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    • v.22 no.1
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    • pp.101-111
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    • 2024
  • Purpose: The purpose of this study was to investigate physical activity as a risk factor for neck pain recurrence using the National Health Insurance Data Sharing Service that utilizes a nationwide cohort in South Korea. Methods: Medical records spanning a two-year period were extracted from the National Health Insurance database for 541,937 patients who sought healthcare services for neck pain (ICD 10 codes: M54.2) in 2020 and completed the national health examination survey. Selected variables for analysis included age, gender, health insurance premium decile, regional health vulnerability index, body mass index (BMI), acuity, blood pressure, and types of physical activity. A mixed-effect multivariate logistic regression analysis was conducted to examine the recurrence rate of neck pain and identify risk factors for neck pain recurrence. Results: Among the participants, 124,433 patients (23.0%) experienced a recurrence of neck pain within two years, with higher recurrence rates observed among older individuals and females. Regression analysis revealed that the risk of neck pain recurrence increased with age (OR=1.51), being female (OR= 1.10), being a medical aid recipient (OR=1.51), and having anaerobic (OR=1.04) or vigorous physical activities (OR=1.06). By contrast, an increased health insurance premium decile (OR=0.96) and having moderate physical activity (OR=0.97) were associated with a decreased risk of neck pain recurrence. Conclusion: This study highlights the importance of moderate physical activity as an effective strategy for reducing the recurrence of nonspecific neck pain, underscoring the necessity for personalized physical activity programs for patients.

헬스케어시스템을 위한 역할 기반의 신뢰협상 모델

  • Jo, Hyeon-Suk;Lee, Hyeong
    • Proceedings of the Korea Society of Information Technology Applications Conference
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    • 2007.05a
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    • pp.84-102
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    • 2007
  • Security is crucial for the successful deployment of large distributed systems. Many of these systems provide services to people across different administrative domains. The traditional identity-based access control mechanisms are un scalable and difficult to manage. Unlike the closed systems, open systems provide services to people from different security domains. Healthcare systems need to be highly available in order for the patients to get a timely treatment. The health care information should be available to authorized users both inside the administrative domain and outside the domain, such as pharmacies and insurance companies. In this paper, we first analyzed the necessities and advantages of importing attribute-based trust-management models into open distributed systems. Then we reviewed traditional access-control models and presented the basic elements of the new trust-management model.

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Analysis of Total Hospital Charges, Length of Stay, and Cost of Rehabilitation by Hospital and Stroke Type (의료기관별 뇌졸중 유형에 따른 진료비, 재원일수 이학요법료의 차이분석)

  • Kim, Sun-Mi;Kim, Da-Yang;Lee, Kwang-Soo
    • The Korean Journal of Health Service Management
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    • v.11 no.1
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    • pp.91-105
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    • 2017
  • Objectives : This study analyzed the differences in length of stay(LoS), total hospital charges(THC), and cost of rehabilitation(CoR) between two types of stroke patients, intracerebral hemorrhage(ICH) and cerebral infarction(CI). Factors associated with these differences were also assessed. Methods : Data were obtained from the 2011 National Inpatient Sample data of Health Insurance Review and Assessment Service. We used propensity score matching to match the characteristics of the two types of stroke patients, and conducted a regression analysis to analyze their associations. Results : The differences between THC, LoS, and CoR by stroke and hospital types were shown. Each type of hospital showed different results. Conclusions : A rapidly aging population will accelerate the number of stroke patients requiring effective management. Studies evaluating healthcare utilization of stroke patients will provide evidence for both healthcare resources allocation and healthcare policy decisions.

Usefulness of RHadoop in Case of Healthcare Big Data Analysis (RHadoop을 이용한 보건의료 빅데이터 분석의 유효성)

  • Ryu, Wooseok
    • Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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    • 2017.10a
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    • pp.115-117
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    • 2017
  • R has become a popular analytics platform as it provides powerful analytic functions as well as visualizations. However, it has a weakness in which scalability is limited. As an alternative, the RHadoop package facilitates distributed processing of R programs under the Hadoop platform. This paper investigates usefulness of the RHadoop package when analyzing healthcare big data that is widely open in the internet space. To do this, this paper has compared analytic performances of R and RHadoop using the medical treatment records of year 2015 provided by National Health Insurance Service. The result shows that RHadoop effectively enhances processing performance of healthcare big data compared with R.

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The Financial Burden of Catastrophic Health Expenditure Among Older Women Living Alone (여성독거노인가구의 과부담 의료비 지출에 관한 연구)

  • Shin, Serah
    • Journal of Family Resource Management and Policy Review
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    • v.23 no.1
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    • pp.17-34
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    • 2019
  • Older women who live alone are among society's most vulnerable people, since they experience increased risk of multiple chronic diseases and have limited financial protection. This can lead older women living alone to catastrophic health expenditure(CHE), which is defined as a healthcare expenditure that exceeds a certain portion of a household's ability to pay. Using the Korean Longitudinal Study of Ageing(KLoSA), this study investigated the incidence of CHE among older women living alone and identified the factors related to this incidence. Applying health expenditure thresholds of 10%, 20%, 30% and 40% of ability to pay, the proportions of those with CHE were 41.3%, 22.9%, 14.6%, and 9.4%, respectively. Logistic regression models were used to identify factors related to CHE incidence, which include demographics, income, the number of chronic diseases, perceived health status, and health insurance type. The results show that the health care safety net in South Korea is insufficient for older women living alone. The findings can guide policymakers in improving healthcare and welfare policies to protect people from catastrophic payments. Particularly, welfare policies should be established for poor non-recipients who are not included within the benefits scope of the National Basic Livelihood Security System due to the unrealistic criteria of income recognition and family support obligation.