• Health Policy and Management
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• v.11 no.2
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• pp.85-122
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• 2001

This study compared and analyzed the effect of income-redistribution, collecting data on the basis of the estimated details of insurance contribution and individual money wage lists for each one year before and after the combination of medical insurance program for industrial workers, by systematic sampling, extracting 4,160 families(14,764 people) among people applied to medical insurance program for self employees in Taegu City on the basis of Oct. 1st in 1998 with 227 associations of medical insurance program for self employees and medical insurance program for government employees and private school teachers combined, comparing the effect of income redistribution of before and after the combination of medical insurance program for self employees. The insurance contribution by household after the combination of medical insurance program for self employees showed the increase rate of average 20.9%, among them households of 68.8% increased and 31.2% decreased. The effect of income-redistribution was more positive because the degree of inequality was more deepened from 0.64 of the before-combination to 0.45 of the after-one in decile distribution ratio, from 0.26 to 0.34 in Gini -coefficient. Decile distribution ratio on the basis of insurance benefits by household was from 0.09 in the before-combination to 0.14 in the after-one, Gini-coefficient from 0.16 in the before-combination to 0.57 in the after-one was a little lowered. And decile distribution ratio of insurance benefits on the basis of insurance contribution was higher from 1.08 in the before-combination to 1.23 in the after-one, concentration index was a little lowered from 0.14 to 0.11, the effect of income-redistribution was improved in the phase of insurance benefits. The income-transfer rate of medical insurance program for self employees (the occupied rate of insurance benefits/ the occupied rate of insurance contribution) showed a lower trend in all of the before and after-combination towards upper classes, it was known that the income-transfer rate was higher from 1st degree to 7th degree in the after-combination in comparison with the before-one, but the effect of income¬redistribution was high because the income-transfer rate was lowered from 8th degree to 10th degree. The rate of medical insurance benefits (insurance benefits/ insurance contribution) increased from 0.79 in the before-combination to 1.07 in the after-one, and showed over 1.0 under 3th degree before the combination, but all of it was higher than 1.0 under 7th degree after the combination, the after-combination was more improved than the before-one in view of the rate of insurance benefits. As the result of above, on the basis of Oct. 1st in 1998 that 227 associations of medical insurance program for self employees was combined into one, we could say that the equality of imposing medical insurance contribution was more re-considered in the after-combination than in the before-one. But this study analyzed with classes divided, anyway, on the basis of insurance contribution, we have limit in explaining the correct effect of income-redistribution, because it was not analyzed according to classes of income, though it helps to analogize the effect of income-redistribution. So there must be analysis about the effect of income-redistribution, on the basis of the system, building up the system to grasp the correct income of the insureds of medical insurance program for self employees.

• The Journal of the Korean life insurance medical association
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• v.29 no.1
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• pp.16-21
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• 2010

The measurement of prostate specific antigen (PSA) in screening for prostate cancer is recently performed as a routine check-up in clinical medicine and insurance medicine. Several factors may affect serum PSA levels. As prostate size increases with increasing age, the PSA concentration also rises. Increasing body mass index (BMI) is associated with a lower mean PSA concentration. Inhibitors of 5-alpha-reductase such as finasteride and dutasteride produce a 50 percent or greater decrease in serum PSA during the first three months of therapy, which persists as long as the drug is continued. Men who are regularly taking non-steroidal antiinflammatory drugs (NSAIDs) or acetaminophen have lower PSA levels. Emerging concepts regarding PSA testing that may help refine the interpretation of an elevated concentration include: PSA density, PSA velocity, and Free versus complexed or bound PSA. With many insurance companies, PSA level has become part of a standard battery of blood tests, along with HIV, cholesterol, liver enzymes, and other predictors of premature death. But, there is no clear proof of benefit, so we have to monitor the value of PSA test as a prostate cancer screening test in insurance medicine.

• Journal of Preventive Medicine and Public Health
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• v.43 no.1
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• pp.42-49
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• 2010

Objectives: To compare the performance of three International Statistical Classification of Diseases, 10th Revision translations of the Charlson comorbidities when predicting in-hospital among patients with myocardial infarction (MI). Methods: MI patients ${\geq}20$ years of age with the first admission during 2006 were identified(n=20,280). Charlson comorbidities were drawn from Heath Insurance Claims Data managed by Health Insurance Review and Assessment Service in Korea. Comparisions for various conditions included (a) three algorithms (Halfon, Sundararajan, and Quan algorithms), (b) lookback periods (1-, 3- and 5-years), (c) data range (admission data, admission and ambulatory data), and (d) diagnosis range (primary diagnosis and first secondary diagnoses, all diagnoses). The performance of each procedure was measured with the c-statistic derived from multiple logistic regression adjusted for age, sex, admission type and Charlson comorbidity index. A bootstrapping procedure was done to determine the approximate 95% confidence interval. Results: Among the 20,280 patients, the mean age was 63.3 years, 67.8% were men and 7.1% died while hospitalized. The Quan and Sundararajan algorithms produced higher prevalences than the Halfon algorithm. The c-statistic of the Quan algorithm was slightly higher, but not significantly different, than that of other two algorithms under all conditions. There was no evidence that on longer lookback periods, additional data, and diagnoses improved the predictive ability. Conclusions: In health services study of MI patients using Health Insurance Claims Data, the present results suggest that the Quan Algorithm using a 1-year lookback involving primary diagnosis and the first secondary diagnosis is adequate in predicting in-hospital mortality.

• Journal of Digital Convergence
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• v.15 no.12
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• pp.625-633
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• 2017

The purpose of this study is to investigate the effect of private insurance revenues and household spending on household income inequality. To this end, we conducted a concentration index and concentration curve analysis for the income level of medical panel survey data in 2015. The main results are as follows. First, the household income concentration ratio is 0.3580, which means that income is concentrated in the high income group, and the degree of inequality is considerably large. Second, although the portion of the private insurance benefits was small on the high-income household, it helped to strengthen the benefits concentration on this group. Third, the low income group has a large self-pay medical expense. Finally, the index of the income excluding the burden of the total medical expenses in the household income was 0.3676, so that even accounting for medical expenses, the income was concentrated in the high income class. Therefore, private insurance benefits and medical expenses were all contributing factors to the inequality of household income, and this study provides the essential materials for research and policy planning which could lead to the convergence of different fields.

• Health Policy and Management
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• v.29 no.2
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• pp.130-137
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• 2019

The fee-for-service system is used as the main payment system for health care providers in Korea. It has been argued that it can't reflect differences in the medical practice costs across regions because the fee schedule is calculated based on the average cost. So, some researchers and providers have disputed that there is need for adopting geographic practice cost index (GPCI) used in the United States for the Medicare program for the elderly to the fee-for-service payment system. This study performed to identify whether the difference in the practice costs among regions exists or not and to examine the feasibility of applying GPCI to Korea payment system. For this purpose, we calculated modified-GPCI and examined considerations to introduce GPCI in Korea. First we identified available data to calculate GPCI. Second, we made applicable GPCI equations to Korea payment system and computed it based on four types of regions (metropolitan, urban, suburban, and rural). We also categorize the regions based on the availability of the medical resources and the capability of utilizing them. As a result, we found that there wasn't any significant difference in the GPCI by regional types in general, but the indices of rural areas (0.91-0.98) was relatively low compared to the indices of other regions (0.96-1.07). Considering the need to use GPCI floor, the pros and cons of using GPCI, and the concern of the regional imbalance of resources, the introduction of GPCI needs to be carefully considered.

• Journal of Digital Convergence
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• v.17 no.11
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• pp.201-206
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• 2019

While many users searched for insurance information online, there were not many cases of contents recommendation researches on insurance companies' websites. Therefore, this study proposed a page recommendation system with high possibility of preference to users by utilizing page visit history of insurance companies' websites. Data was collected by using client-side storage that occurs when using a web browser. Collaborative filtering was applied to research as a recommendation technique. As a result of experiment, we showed good performance in item-based collaborative (IBCF) based on Jaccard index using binary data which means visit or not. In the future, it will be possible to implement a content recommendation system that matches the marketing strategy when used in a company by studying recommendation technology that weights items.

• Journal of Korean society of Dental Hygiene
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• v.19 no.5
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• pp.765-776
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• 2019

Objectives: The purpose of this study was to compare the oral health statuses pre- and post-insurance using the $5^{th}$ and $6^{th}$ National Health and Nutrition Examination Survey data to confirm the effect of scaling insurance after a year. Methods: Data were analyzed using IBM SPSS ver. 21.0 (IBM Co., Armonk, NY, USA). The four years were integrated, and a composite sample analysis was performed. A total of 26,990 people were included in the study before applying for scaling insurance (14,343 persons) or after receiving scaling insurance (12,647 persons). A chi-squared test was performed to compare the demographic characteristics and oral health status of the subjects. The significance level of the statistical test was 0.05. Results: The proportion of patients without implants was high before the provision of scaling insurance once a year, however, the proportion of patients with one or more implants was high (p<0.05) after the provision of scaling insurance once a year. Hemorrhagic periodontal tissues and tartar formation in periodontal tissues were highly prevalent before the provision of scaling insurance once a year, however, healthy periodontal tissues and formation of periodontal pockets were highly prevalent (p<0.05) after the provision of scaling insurance once a year. The decay, missing, and filled teeth index scores were higher before the provision of scaling insurance once a year (p<0.05). Conclusions: The aforementioned results showed that scaling once a year helps prevent or treat periodontal disease. In addition, we confirmed the effect of prevention on periodontal disease and dental caries, therefore, we expect it to develop into a stable policy.

• Health Policy and Management
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• v.19 no.2
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• pp.51-70
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• 2009

Background : Previous studies have reported that enhanced continuity of care prevented a sudden worsening in progress among chronic disease patients, and as a result was favorable for efficient spending of health care funds. This study aims to estimate the continuity of care of Korean with diabetes and to identify factors affecting the continuity of care. Methods : This study used the Korean National Health Insurance Claims Database which includes E11 (ICD-10) as a primary or secondary disease as of 2006. Study population is 1,160,725 type 2 diabetics (20-84 years). Continuity of Care Index (COC), Modified, Modified Continuity Index (MMCI), and Most Frequent Provider Continuity (MFPC) were used as indexes of continuity of care. Results : The continuity of care in the study population was $0.94{\pm}0.10$ as calculated by MMCI, $0.91{\pm}0.16$ as calculated by MFPC and $0.86{\pm}0.23$ as calculated by COC. The lower continuity of care was shown in the patients who were female, 65 and over years old, Medical Aid recipients, 13 times or more visitors, hospital users as main attending medical institution, patients experienced hospitalizations or comorbidities. Conclusion : The continuity of care for adult patients with type 2 diabetes was high in Korea, and showed variation according to patients' characteristics. This result provides empirical evidence for policymakers to develop or strengthen programs for managing patients showing low continuity of care.

• Health Policy and Management
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• v.20 no.4
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• pp.45-57
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• 2010

Background : If different cost efficiency indexes were informed to the same clinic depending on the inclusion or exclusion of pharmacy cost, it may impair the reliability of provider-profiling system. This study aimed to investigate whether the omission of pharmacy cost affects cost-efficiency rankings in medical clinics. Methods : Data for ambulatory care cost at 23,112 medical clinics were collected from the claims database, which was constructed after review by the Health Insurance Review and Assessment Service (HIRA) of Korea in April 2007. We calculated two types of cost efficiency indexes by inclusion or exclusion of pharmacy cost for a medical clinic. The agreement between the decile rankings of the two indexes was also assessed using the weighted kappa statistic of Landis and Koch. Results : When the cost efficiency index for total cost including pharmacy cost was compared with the index for total cost excluding it, the agreement between the two indexes was only 55%. The agreements between the two indexes were relatively low within specialties which have larger pharmacy volume of total cost and lower correlation between total cost with or without pharmacy cost included than the average level of all the specialties. Conclusion : These results suggest that the omission of pharmacy cost may result in contradictory outcomes that may be confusing to a medical institution and may impair the reliability of provider-profiling systems. It is very important to standardize profiling criteria for the reliability of provider profiling system.

• 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.