• Journal of the Korean Society of Radiology
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• v.81 no.5
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• pp.1053-1068
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• 2020

In accordance with the new healthcare policy of government (Moon Jae-In Care) to strengthen health insurance coverage, the National Health Insurance (NHI) coverage of brain magnetic resonance imaging (MRI), brain/neck MR angiography (MRA), and head and neck MRI have been expanded since 2018 in Korea. This article has been reviewed focusing on the "Detailed matter concerning criteria and method for providing reimbursed services in the NHI. Some revisions" regarding reimbursement for MRI, which was revised from October 2018 to April 2020 and is currently in effect. It included the MRI reimbursement system in Korea, recent adjustment of the reimbursement coverage for patients with headache or dizziness, and reimbursement coverage, standard imaging, and radiologic report of brain MRI, brain/neck MRA and head and neck MRI. This article could help radiologists gain knowledge on health insurance to protect the expertise of the radiologist and to play a leading role in the hospital. As the policy changes, detailed matter concerning criteria and method for providing reimbursed services in the NHI may be revised. Therefore, radiologists should update issues related to insurance reimbursement for MRI continuously.

• Health Policy and Management
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• v.31 no.4
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• pp.423-436
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• 2021

This article summarizes the structure of China's current social health insurance system and reviews the development status of China's private health insurance (PHI). China's medical security system is mainly composed of two parts: basic medical insurance (BMI) and PHI. Among them, the BMI provides reimbursement of basic medical expenses for the insured persons according to different proportions. PHI is a necessary supplement to the BMI and provides assistance to the insured persons in the event of illness or accident. By having PHI, people can obtain medical protection outside the coverage of BMI. In the development of PHI in China, the total medical cost is high and the insurance market size is large, but the proportion of PHI expenditure is low and the personal burden is high. Through this Chinese case, it will be helpful for mutual development between Korean PHI and national health insurance, for Korean insurance companies to enter the Chinese market, and for removing the medical burden on the people.

• Health Policy and Management
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• v.27 no.2
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• pp.97-102
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• 2017

On May 10, 2017, Moon Jae-in's Government launched. The election pledges of Moon's Government in healthcare sector were extracted from those of president election camp and Democratic Party. The main pledges were enhancing the coverage of healthcare costs, management of healthcare costs for elderly, restructuring the health insurance contribution system, and improving the public nature of healthcare system. There are many policy tasks to realize the electoral pledge, especially, financial task is main. The National Planning and Advisory Committee are setting the policy priorities and making the detailed plans. Although this paper deals the initial evaluation of main election pledges, the precise evaluation is needed for the final plan of healthcare policy.

• Quality Improvement in Health Care
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• v.28 no.2
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• pp.30-38
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• 2022

Purpose: The Health Insurance Review and Assessment Service (HIRA) in South Korea initiated a quality assessment (QA) program for blood transfusion healthcare services in 2020 to ensure patient safety and appropriate blood use. This study examines the quality of blood transfusion services since the first national QA program for blood transfusion services in Korea. Methods: We analyzed HIRA claims and QA investigation data based on inpatient medical records from all tertiary, general, and primary hospitals between October 2020 and March 2021. The target population was patients aged 18 years and older who received either total knee arthroplasty or red blood cell transfusion. The QA indicators for transfusion healthcare service consisted of four quality indicators and four monitoring indicators. Results: We analyzed the results of QA indicators for transfusion service from the medical records of 189,668 patients from 1,171hospitals and expressed indicators as proportions. The average results for evaluation indicators were as follows: transfusion checklist presence, 64.8%; irregular antibody tests, 61.8%; transfusions in which the hemoglobin levels before transfusion met the transfusion guidelines for patients undergoing total knee arthroplasty, 20.6%, and transfusions in patients undergoing total knee arthroplasty, 59.3%. The average results for monitoring indicators were as follows: transfusion management implementation in medical institutions, 56.9%; preoperative anemia management in anemia patients undergoing total knee arthroplasty, 43.9%; one-unit transfusions, 82.5%; and the transfusion index. Conclusion: The quality of blood transfusion healthcare varied and the assessment revealed that there is scope for improvement. Hospitals require more effective blood transfusion management and this can be facilitated by providing feedback on the QA results about blood transfusion healthcare services to medical institutions, and by disclosing the results to the public.

• Healthcare Informatics Research
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• v.24 no.4
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• pp.327-334
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• 2018

Objectives: The objective of this study was to investigate the relationship between the level of Electronic Medical Record (EMR) system adoption and healthcare information technology (IT) infrastructure. Methods: Both survey and various healthcare administrative datasets in Korea were used. The survey was conducted during the period from June 13 to September 25, 2017. The chief information officers of hospitals were respondents. Among them, 257 general hospitals and 273 small hospitals were analyzed. A logistic regression analysis was conducted using the SAS program. Results: The odds of having full EMR systems in general hospitals statistically significantly increased as the number of IT department staff members increased (odds ratio [OR] = 1.058, confidence interval [CI], 1.003-1.115; p = 0.038). The odds of having full EMR systems was significantly higher for small hospitals that had an IT department than those of small hospitals with no IT department (OR = 1.325; CI, 1.150-1.525; p < 0.001). Full EMR system adoption had a positive relationship with IT infrastructure in both general hospitals and small hospitals, which was statistically significant in small hospitals. The odds of having full EMR systems for small hospitals increased as IT infrastructure increased after controlling the covariates (OR = 1.527; CI, 1.317-4.135; p = 0.004). Conclusions: This study verified that full EMR adoption was closely associated with IT infrastructure, such as organizational structure, human resources, and various IT subsystems. This finding suggests that political support related to these areas is indeed necessary for the fast dispersion of EMR systems into the healthcare industry.

• Research in Community and Public Health Nursing
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• v.22 no.1
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• pp.33-44
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• 2011

Purpose: This study examined the characteristics and service utilization of home nursing care beneficiaries under the Korean Long-Term Care Insurance (LTCI). Methods: We used assessment data and claim data of National Health Insurance Corporation from July to August 2008. Data were composed of subjects who were the beneficiaries of home nursing care. Results; A total of 634 subjects were analyzed. Of the subjects, 57.1% were 75 years and over. The average score of nursing care need was only 0.71 and the percentage of those whose nursing care need score was zero was 58.0%. More than half of the subjects had partially dependent musculoskeletal conditions, and 75.5% had two or more comorbidities. A third of them usedonly home nursing care, and another third used both home nursing care and general home care at the same time. Those who needed sore care used the largest home nursing care benefits. Conclusion: Home nursing care of LTCI performs community-based healthcare services under LTCI. Throughout the past two years, however, it has not been active. Understanding the characteristics of its users is important in order to develop effective strategies for activating home nursing care.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.16 no.1
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• pp.67-72
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• 2021

Objectives The purpose of this study was to analyze the current status of utilization of Korean medical institutions. Methods This study analyzed the Health Insurance Review and Assessment Service data (2016-2020). We included patients with one of the five most frequent diseases in Korea and examined the variation in healthcare utilization. Results This study analyzed the Health Insurance Review and Assessment Service data (2016-2020). We included patients with one of the five most frequent diseases in Korea and examined the variation in healthcare utilization. Conclusions As a result of this study, It was possible to understand the impact of Chuna treatment and COVID-19 on the use of Korean medical institutions. Further studies are needed to establish a definite conclusion regarding the relevance of COVID-19.

• Journal of The Korea Institute of Healthcare Architecture
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• v.17 no.4
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• pp.15-23
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• 2011

Long-term care Insurance system for the Elderly was started to respond to the aged society on July 2008 in Korea. So responsibility of the care for the old is being changed from the family to the society. The introduction of that insurance system has brought the growth of demand for care service. To improve the level of quality for care service providers in long-term care, the role of care worker in providers is recognized as important. But welfare system for the care worker seems to be poor. So the Seoul Metropolitan Council is preparing an ordinance for the care worker and the purpose of this study is for the ordinance as well. Questionnaires, interviews, documentary surveys were used to carry out this study. The results of this study are summarized as follows. The job stability is the most important thing for the care worker, so local government has to make efforts to promote the job stability of care worker. A welfare center for care workers is needed for the health for care workers in the local government. And the local government has to supervise service providers more strictly and evaluate them in treatments of care worker.

• Health Policy and Management
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• v.29 no.2
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• pp.99-104
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• 2019

On May 1, 2019, the Minister of Health and Welfare announced publicly the first Comprehensive Plan of National Health Insurance (NHI). The Comprehensive Plan which is the 5-year plan including expenditure and revenue aspect of NHI, is desirable in 42 years of introduction of NHI and 30 years of universal coverage of NHI, though the Plan was late and had some conflict process. The Comprehensive Plan was established without evaluation of Moon's Care Plan, did not included to relationship with NHI and other health security systems, and did not have the blue print of NHI. The Plan was not sufficient in content of adequate health care utilization and relationship with service benefit and cash benefit. The Comprehensive Plan should be modified in considering the blue print of NHI and national healthcare system with participating stakeholder in turbulent environment-low fertility, rapid ageing, low economic growth rate, era of non-communicable diseases, unification of the Korean Peninsula, and 4th industrial revolution. Therefore, I suggest to establish the President's Committee of Improving Healthcare System for the blue print of health care and NHI.

• Journal of The Korea Institute of Healthcare Architecture
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• v.14 no.4
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• pp.21-30
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• 2008

Domestic hospital architectures were developed with the nation's industrialization after 1960s. Particularly, with the rapidly growing healthcare demands according to The National Health Insurance Plan which was introduced in 1977 and expanded to entire nation in 1989, the number of healthcare facility is also increasing according to the expansion of the existing facilities and construction of new buildings. Now, twenty to thirty years were past since that growing period of healthcare architecture. Many hospitals are facing on the phase of restructuring and modernization for their resources. J university hospital is a representative case of hospital development which the growth of facility was stopped by insufficient site area. This study, analysing its past statistics and drawing data of that hospital, presents the characteristics of the changes and basic data of the master planning for the future hospital development.