• Health Policy and Management
• /
• 제34권2호
• /
• pp.196-210
• /
• 2024

Background: In January 2018, revised elderly fixed outpatient copayment for the elderly were implemented. When people ages 65 years and older receive outpatient treatment at clinic-level medical institutions (clinic, dental clinic, Korean medicine clinic), with medical expenses exceeding 15,000 won but not exceeding 25,000 won, their copayment rates have decreased differentially from 30%. This study aimed to examine the changes of health utilization of elderly after revised elderly fixed outpatient copayment. Methods: We used Korea health panel data from 2016 to 2018. The time period is divided into before and after the revised elderly fixed outpatient copayment. We conducted Poisson segmented regression to estimate the changes in outpatient utilization and inpatient utilization and conducted segmented regression to estimate the changes in medical expenses. Results: Immediately after the revised policy, the number of clinic and Korean medicine outpatient visits of medical expenses under 15,000 won decreased. But the number of clinic outpatient visits in the range of 15,000 to 20,000 won and Korean medicine clinic in the range of 20,000 to 25,000 won increased. Copayment in outpatient temporarily decreased. The inpatient admission rates and total medical expenses temporarily decreased but increased again. Conclusion: We confirmed the temporary increase in outpatient utilization in the medical expense segment with reduced copayment rates. And a temporary decrease in medical expenses followed by an increase again. To reduce the burden of medical expense among elderly in the long run, efforts to establish chronic disease management policies aimed at preventing disease occurrence and deterioration in advance need to continue.

• Journal of Preventive Medicine and Public Health
• /
• 제34권2호
• /
• pp.149-156
• /
• 2001

Objective : To elucidate risk factors for coronary heart diseases among Korean males. Methods : A nested case control study was conducted among a Korea Medical Insurance Cooperation(KMIC) cohort composed of 108,802 males. The eases included 246 male patients who were admitted to hospital due to coronary heart diseases from 1993 to 1997 (120-25 by ICD) and whose diagnosis was confirmed by the protocol by WHO MONICA Project(1994). The control group was composed of 483 patients selected by frequency matching considering age and resident area from an inpatient care group without coronary heart disease during the same period. For study cases and the controls, the results of a health check-up in 1990 and a questionnaire on life style in 1992 were received through the KMIC. Some additional information was collected by telephone interviews during October 1999. Results : Multiple logistic regression analysis showed that the odds ratio(OR) of coronary heart diseases among past smokers and current smokers as compared to non-smokers were 1.94(95% CI : 1.14-3.31) and 2.20(55% CI : 1.35-3.59), respectively. The OR among persons who drank 4 cups or more of caffeinated beverages such as coffee or tea daily as compared to persons who drank one cup for 2-3 days was 2.50(95% CI : 1.07-6.12). The OR among persons with high normal BP and stage 3 hypertension against normotension were 2.51 (95% CI : 1.44-4.37) and 5.08(95% CI : 2.38-10.84). The OR among persons whose blood cholesterol were 240 mg/dL or mere against lower than 200mg/dL was 2.24(95% CI : 1.43-3.49). Conclusion : Smoking, drinking of excessive caffeinated beverages, hypertension and high blood cholesterol were proven to be significant risk factors for coronary heart diseases among Korean males.

• The Korean Society of Law and Medicine
• /
• 제16권1호
• /
• pp.221-254
• /
• 2015

The amendment of the Korea Civil Code will take place July 1, 2013. One of the most import issues related to adult guardianship system is a part. Though more than 100 new provisions, the revised Civil Code fundamentally reformed the guardianship system to establish a system to meet the diverse and complex needs of those who need a guardian and ensure due process. The new adult guardianship system intended to respect dignity and human right of mentally incapacitated adults, to guaranee their autunomy and to minimize the public interventions for assisting them. The new guardianship system for vulnerable adult has three kinds of legal guardianship system (adult guardianship, limited guardianship and specific guardianship). Mental patients forced the hospitalization of the mental health code and will be treated as an agreement incapable person. In principle an agreement incapable person has capacity of consent. The consent of the mental patients are admitted first. It is advisable to medical care only by the consent of the guardian when the the mental patient do not agree ability. If the mental patient do not agree with the mentally ill, but there should be a supervisory capacity for a guardianship of the couple guardian supervision. In conclusion, it not lost the capacity to consent to inpatient mental illness called. Therefore, we must discuss in detail the scope of the agreement for the mental patients. Mental Health Act amendments are necessary in accordance with the amended Civil Code.

• The Journal of the Korea Contents Association
• /
• 제10권4호
• /
• pp.247-256
• /
• 2010

This study, using questionnaires to target Servicemen were investigating. Study period of 2009 October to 24 was 20 days. All 600 questionnaires distributed affair, but 565 cases were collected. The purpose of the this study was serviceman investigate the actual conditions of utilization of private hospitals and awareness for the level of military hospital medical service as well as to the selection of future for the private hospitals is to finding. Results of the study are as follows: Outpatient utilization rate of each other the military hospital and private hospitals was 60.7% and 18.9%.(p<.000) The results of frequency study of the factors which affect the private hospital is satisfaction of medical workforce(58.9%), medical equipment and facilities(49.6%), etc. The choice of hospital were inpatient and outpatient both the selected by private hospitals. Had to prefer a private hospital were statistically significant (p<.005). In conclusion, to increase the preference of the military hospital is level of private hospital health care level of should be to developed. More support to financial should provide for medical workforce and setting of cutting edge medical equipment in the military hospital. Military hospital is should be competition with private hospital. Also should be improve the quality of military medical service.

• Journal of Physiology & Pathology in Korean Medicine
• /
• 제28권6호
• /
• pp.689-694
• /
• 2014

We report a female small cell lung cancer patient in the extensive stage(T3N3Mx). After 6 cycles of chemotherapy combined radiation therapy, she received inpatient Korean medical care including herbal medicine, acupuncture therapy and concurrent western oral medications of opioid analgesics and anti-anxiety agent. The chief complaint was right side thoracic wall pain which had started after chemotherapy and was not effectively controlled by analgesics. For this condition, we treated her with 2Hz of constant electrical stimulation on Jiaji (Ex-B2) points T5-T7 laterally (right) using three needles for 20 minutes once a day for 9 days. With every session of electrical acupuncture treatment, thoracic pain decreased acutely. Korean medicine treatments including Jiaji (Ex-B2) point stimulation might be tried for lung cancer patients with uncontrolled thoracic pain at least for the acute analgesic effect.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• 제20권7호
• /
• pp.272-280
• /
• 2019

This descriptive research study investigated the relationships between different degrees of family support, ego-resilience and employment volition of patients suffering from alcohol use disorder, and we identified the factors that had an influence on employment volition. This study used the survey research technique and structured questionnaires. The data was collected from 128 males (aged 20 years or older) and who had been diagnosed with alcohol use disorder. They had also undergone either inpatient hospital care or outpatient treatment. The data was analyzed using descriptive statistics, one-way ANOVA, Pearson's correlation coefficient and multiple regression analysis. The results of the study showed that family support had a value of 4.30, an ego resilience had a value of 2.37 and the employment volition had a value of 4.06. The results of the multiple regression analysis showed that there was statistically significant positive correlation between employment volition and ego resilience (${\beta}=-.314$, p<.01) and age (${\beta}=-.253$, p<.01), and the total explanatory power of these 2 factors was 16.3%. According to the results of this study, age-based approaches are needed to improve the employment volition of patients with alcohol use disorder. Additionally, the results of this study suggest that an ego resilience enhancement program be developed and implemented to help these patients.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
• /
• 제34권2호
• /
• pp.38-52
• /
• 2021

Objectives : The purpose of this study is to analyze the use of insured herbal extracts and Korean medicinal treatments, which are mainly used to treat allergic rhinitis in Korean medicine. Methods : Among all HIRA(Health Insurance Review and Assessment Service) claims data in 2016, we included all statements that included J30(vasomotor and allergic rhinitis) or a subcategory of J30(J30.0, J30.1, J30.2, J30.3, or J30.4) as the main disease, using the Korean Standard Classification of Diseases(KCD-7). This study analyzed the most frequently used insured herbal extracts and Korean medicinal treatments for allergic rhinitis in Korean medicine. We performed a frequency analysis on subgroups based on treatment type(inpatient or outpatient), sex, age, insurance type, and medical institution type. Results : The result shows the 10 most frequently used insured herbal extracts and Korean medicinal treatments for allergic rhinitis. The total number of insured herbal extracts prescriptions was 82,533, and the most commonly prescribed insured herbal extracts was socheongryong-tang(35,131 prescriptions), followed by hyeonggaeyeongyo-tang(18,157 prescriptions), samsoeum(6,257 prescriptions), and galgeun-tang(4,465 prescriptions). The total number of Korean medicinal treatments prescriptions was 1,878,541, of which the most common Korean medicinal treatments was acupuncture(922,977 prescriptions), followed by moxibustion(372,120 prescriptions), cupping(242,094 prescriptions), and segmental acupuncture(161,553 prescriptions). Conclusions : It is expected that the results of this study can be used as a basis for establishing the priorities of evidence-based clinical research topics in the field of Korean medicine and making health care policy decisions to strengthen coverage in the future.

• Quality Improvement in Health Care
• /
• 제1권2호
• /
• pp.44-59
• /
• 1994

Medical consumers(patients) want evening-clinic because of busy work. For patient's convenience and improving service, hospital should accept it. Considering payment system and patient's demand, personnel expenses, hospital can not accept. The practice of shift system to accept patient's demand and hospital's economic aspect was made. To analysis the effect of the system and probability to alternative to evening clinic this study was done. This study was composed of basal study, intervention, evaluation of effect. The basal study were composed of studying demand on evening clinic, the number of beds, doctors employee, the time table of practice and work, and the number of patients at arrival time. The intervention composed of changing of practice time, changing of working time by the number of patients at arrival time, increasing of employee. The evaluation of effect were composed of evaluating the number of patient at time, the effect of shift system, the comparison of the number of in and out patients and questionnairing the practice of shift system. In the practice time at 2 shift system First team works 7-15 hours and Second team 12-20 hours. there are no lunch and supper time. At 18-20 hours the number of patients were 25-30. The number of patient a depart were 6-7. The number of out-patient increase in 13% and inpatient increase in 10% before the system. Doctors(100%), employee(94.6%), and patients(86.4%) approved this system. The advantage of this system were utilization of surplus time, lengthen the practice time, even distribution of patients and shortening of waiting time, rapid treatment of emergent patients. The disadvantage of this system were shortage of manpower, not all depart practice, continuity of practice, no lunch and supper time, irregular rounding. At present because of small Demanding on evening clinic, this shift system was economical. To succeed this study more effectively all depart in hospital participate. But because of economical reason it is impossible for hospital to do it. If the government assist the economic loss that all depart participate in this system it is very helpful for hospital to succeed in implementing this system more early.

• Journal of Oral Medicine and Pain
• /
• 제34권1호
• /
• pp.63-79
• /
• 2009

While previous epidemiological studies on temporomandibular disorders (TMD) have been based on a given health center or population sample, no study has been performed on general population of Korea, especially concerning about treatment pattern such as clinician’s specialty involved in TMD treatment, types and amount of prescription medication and cost. This study aimed to investigate magnitude of health visits and treatment patterns for Korean patients with TMD through the computerized database of Health Insurance Review and Assessment Service (HIRAS). Inclusion criteria were all patients registered on the HIRAS database over 3 years' period from 2003 to 2005 and the medical records of patients with TMD as a main diagnosis were extracted. Information collected was as follows; distribution related to gender, age and region and type of hospital the patients visited, treatment duration, clinicians' specialty involved in treatment, cost, types of prescription medication and surgical treatment. The results of this study indicated that 0.15% of the population yearly sought TMD treatment, presenting with increase of incidence over the three years. Most of TMD patients were women (99.8%) and the biggest age group was second and third decades and decreased with age. Seoul and Kyeonggi province presented with higher incidence of TMD compared to the other regions of Korea, which seems to be related with magnitude of population. 56% of TMD patients visited primary care sector and the numbers of treatment visits was the highest in dental clinic (38.4%), followed by orthopedics (28%) and ENT (13.6%) clinics in order. Duration of prescription medication was the longest for anti-inflammatory analgesics, followed by antipsychotic drugs and muscle relaxants. Inpatient care related to TMD was primarily performed in dental hospital compared to medical hospital. Medical database of HIRAS provided comprehensive and vast information on epidemiologic characteristics and treatment patterns for patients seeking TMD treatment, which can be more reliable data to expect medical demand for TMD in condition that accurate diagnosis and standardized treatment is delivered in clinical settings.

• Health Policy and Management
• /
• 제2권2호
• /
• pp.221-237
• /
• 1992

The reasons for cost inflation in medical insurance expenditure are classified into demand pull inflation and cost push inflation. The former includes increase in the number of beneficiaries and utilization rate, while the latter includes increase in medical insurance fee and the charges per case. This study was conducted to analyze sources of increases of expenditure in medical insurance demonstration area by the period of 1982-1987 which was earlier than national health insurance and the period of national health insurance(1988-1990). The major findings were as follows: Medical expenditure in these areas increased by 9.4%(15.1%) annually between 1982 and 1990 on the basis of costant price(current price) and for this period, the yearly average increasing rate of expenses for outpatient care[10.5%(15.8%)] was higher than that of inpatient care [7.3%(12.6%)]. Medical expenditure increased by 6.3%(8.9%) annually between 1982 and 1987, the period of medical insurance demonstration, while it increased by 10.7%(18.9%) after implementing national health insurance(1988-1990). Medical expenditure increased by 35.9%(45.9%) between 1982 and 1987. Of this increase, 115.2%(92.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 61.0%(68.1%) was due to the increase in the charges per case, but the expenditure decreased by 76.2%(60.2%) due to the reduction in the number of beneficiaries. Beteen 1988 and 1990, the period of national health insurance, medical expenditure increased by 21.2%(41.4%). Of this increase, 87.5%(46.4%) was attributable to the increase in the frequencies of utilization per beneficiary and 52.4%(73.4%) was due to the increase in the charges per case, and of the increase in the charges per case, 69.6%(40.8%) was attributable to the increase in the days of visit per case. Medical expenses per person in these areas increased by 78.2%(89.0%) between 1982 and 1987. Of this increase, 76.6%(69.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 23.4%(30.9%) was due to the increase in the charges per case. For this period, demand-pull factor was the major cause of the increase in medical expenses and the expenses per treatment day was the major attributable factor in cost-push inflation. Betwee 1988 and 1990, medical expenditure per person increased by 31.2%(53.1%). Of this increase, 60.8%(37.2%) was attributable to the demand-pull factor and 39.2%(62.8%) was due to the increase in the charges per case which was one of cost-push factors. In current price, the attributalbe rate of the charges per case which was one of cost-push factors was higher than that of utilization rate in the period of national health insurance as compared to the period of medical insurance demonstration. In consideration of above findings, demand-pull factor led the increase in medical expenditure between 1982 and 1987, the period of medical insurance medel trial, but after implementing national health insurance, the attributable rate of cost-push factor was increasing gradually. Thus we may conclude that for medical cost containment, it is requested to examine the new reimbursement method to control cost-push factor and service-intensity factor.