• Health Policy and Management
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• v.5 no.1
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• Health Policy and Management
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• v.29 no.4
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• pp.513-522
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• 2019

Background: South Korea operates a Medical Aid (MA) program targeting selected low-income individuals to ensure medical service delivery to the disadvantaged while enhancing self-sufficiency of work-capable beneficiaries. However, as reasons behind welfare exits are diverse and do not always infer poverty relief or the provision of appropriate levels of health care services, this study aimed to investigate the association between changes in MA status and health care utilization. Methods: This study used the 2006 to 2015 National Health Insurance claims data. The impact of changes in annual MA status on health care utilization (yearly number of outpatient visits, inpatient visits, length of stay, and emergency department [ED] visits) was investigated using the generalized estimating equation model. Results: In 117,943 adult subjects aged 20 to 64, compared to the 'MA to MA' group, the 'MA to MA exit' group showed general decreases in utilization (outpatient visits: β=-3.93, p<0.0001; hospital admissions: relative risk [RR], 0.87; 95% confidence interval [CI], 0.83-0.91; length of stay: β=-3.64, p<0.0001; ED visits: RR, 0.83; 95% CI, 0.77-0.90). Similar patterns were found in the 'MA exit to MA exit' group (outpatient visits: β=-5.72, p<0.0001; admissions: RR, 0.91; 95% CI, 0.87-0.94; length of stay: β=-5.87; p<0.0001; ED visits: RR, 0.81; 95% CI, 0.75-0.88). Likewise, in 74,747 older adult subjects aged 65 or above, the 'MA to MA exit' group showed reduced levels of utilization (outpatient visits: β=-1.51; p=0.0020), as well as the 'MA exit to MA exit' group (admissions: RR, 0.92; 95% CI, 0.89-0.95; length of stay: β, -5.45; p<0.0001; ED visits: RR, 0.90; 95% CI, 0.83-0.97). Conclusion: MA exit was associated with general decreases in health care utilization. Utilization patterns of individuals with experiences of receiving MA benefits should be monitored to promote the ideal use of health care services while preventing potential financial barriers present in accessing medical care.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.10 no.11
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• pp.3444-3450
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• 2009

Our study was carried out to suggest the way of improving the accessibility of medical service through identifying the factors that make patients be hospitalized in non-residential area not in their residential area. The subjects were 523,782 inpatients of the 2005 Patient Survey data. The 2004 Hospital Evaluation data, the 2005 census data which were obtained from the Korean National Statistics Office, and the 2006 Survey on National Healthcare Resources data were used. The data were analyzed using descriptive statistics, chi-square test and logistic regression in a SAS program. The most important factor was quality level of care of local hospitals. In the possibility of being hospitalized in non-residential areas, the region with the score of more than 9.5 per 100,000 people in the hospital evaluation was 8.3 times more than the region with the score of less than 9.5. However patients is hospitalized in the area with the hospitals with above 910 beds per 100,000 people more than in the area with the hospitals with less than 910 beds by 2.0 times. For the accessibility of medical services, government policy should focus on improving the quality of care in local hospitals not on increasing and distributing health care resources.

• Quality Improvement in Health Care
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• v.9 no.2
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• pp.210-228
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• 2002

Background: The purpose of this research was to examine the fall incidence rate and its related factors of fall in inpatients. Methods: The data were collected from the 138 fall incident reports in one tertiary hospital in Seoul from April 1st 1999 to September 30th 2001. The Fall Incident Report Form was originally developed based on that of Massachusetts General Hospital revised in 1995. And this was modified for this survey by the collaborating work of QI team including researcher and department of nursing service of this particular hospital. The contents of Fall Incident Form were general characteristics of patient. factors related to fall. types and places of fall. circumstances, nursing interventions. and outcome. Results: 1) The incidence rate of fall was 0.08% of total discharged patients and 0.081 per 1000 patient-day. This incidence rate is much lower than that of several hospitals in USA. This finding might result from the different incidence report system of each hospital. 2) The characteristics of fall-prone patient were found as follows. They were mostly over 60 years old, in alert mental status, ambulatory with some assistance, and dependent on ambulatory device. The types of diseases related high incidence rate were cerebrovascular disease(3.2), hypertension(1.6), cardiovascular disease(1.4), diabetes(1.3) and liver disease(0.6). 3) The majority of fall events usually occurred m bed. bedside(walking or standing) and bathroom in patient room. Usually they were up on their own when they fell. And there were more falls of elderly occurred during night time than day or evening. 4) 63.8% of fall events resulted in physical injuries such as fracture and usually the patients had diagnostic procedures and some treatment(ex. suture) which caused additional cost to the patients and their families. 5) The found risk factors of fall were drugs(antihypertensive drug, diuretics) and environmental factors like too high bed height, long distance of bedside table and lamp switch, and slippery tile of bathroom floor. Conclusion: Considering these results, every medical and nursing staff should be aware of the risk factors of patients in hospital, and should intervene more actively the preventive managements, specially for the elderly patients during night. Therefore, it is recommended that the development of Fall Prevention Programs based on these results.

• Pediatric Infection and Vaccine
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• v.28 no.3
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• pp.144-148
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• 2021

Purpose: Nonpharmaceutical measures, such as social distancing, have resulted in unintended consequences, including a decrease in the incidence of childhood diseases. This study aimed to estimate the impact of social distancing on the incidence of febrile seizure (FS) in Korea using nationally representative data. Methods: We used claims data from the Health Insurance Review and Assessment Service, a single-payer database capturing >95% of the Korean population. The database included any inpatient encounter with a FS diagnosis from January 2010 to September 2020 for those aged 0-5 years old. We aggregated the monthly number of cases to estimate the incidence per 100,000 patient-years in 2020 (January 1 to September 30) for the same periods in 2010-2019. Results: The incidence of FS in 2020 ranged from 113 per 100,000 (95% confidence interval [CI], 108-118 per 100,000) in January to 27 per 100,000 (95% CI, 25-30 per 100,000) in September, whereas the average FS incidence in 2010-2019 ranged from 116 per 100,000 (95% CI, 112-121 per 100,000) in January to 101 per 100,000 (95% CI, 97-106 per 100,000) in September. Conclusions: The incidence of FS decreased by -38% in 2020, suggesting that social distancing contributed towards decreasing the incidence of FS.

• Journal of Oral Medicine and Pain
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• v.34 no.1
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• pp.63-79
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• 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.

• KDI Journal of Economic Policy
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• v.30 no.2
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• pp.99-128
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• 2008

Nearly all Koreans are insured through National Health Insurance(NHI). While NHI coverage is nearly universal, it is not complete. Coverage is largely limited to minimal level of hospital and physician expenses, and copayments are required in each case. As a result, Korea's public insurance system covers roughly 50% of overall individual health expenditures, and the remaining 50% consists of copayments for basic services, spending on services that are either not covered or poorly covered by the public system. In response to these gaps in the public system, 64% of the Korean population has supplemental private health insurance. Expansion of private health insurance raises negative externality issue. Like public financing schemes in other countries, the Korean system imposes cost-sharing on patients as a strategy for controlling utilization. Because most insurance policies reimburse patients for their out-of-pocket payments, supplemental insurance is likely to negate the impact of the policy, raising both total and public sector health spending. So far, most empirical analysis of supplemental health insurance to date has focused on the US Medigap programme. It is found that those with supplements apparently consume more health care. Two reasons for higher health care consumption by those with supplements suggest themselves. One is the moral hazard effect: by eliminating copayments and deductibles, supplements reduce the marginal price of care and induce additional consumption. The other explanation is that supplements are purchased by those who anticipate high health expenditures - adverse effect. The main issue addressed has been the separation of the moral hazard effect from the adverse selection one. The general conclusion is that the evidence on adverse selection based on observable variables is mixed. This article investigates the extent to which private supplementary insurance affect use of health care services by public health insurance enrollees, using Korean administrative data and private supplements related data collected through all relevant private insurance companies. I applied a multivariate two-part model to analyze the effects of various types of supplements on the likelihood and level of public health insurance spending and estimated marginal effects of supplements. Separate models were estimated for inpatients and outpatients in public insurance spending. The first part of the model estimated the likelihood of positive spending using probit regression, and the second part estimated the log of spending for those with positive spending. Use of a detailed information of individuals' public health insurance from administration data and of private insurance status from insurance companies made it possible to control for health status, the types of supplemental insurance owned by theses individuals, and other factors that explain spending variations across supplemental insurance categories in isolating the effects of supplemental insurance. Data from 2004 to 2006 were used, and this study found that private insurance increased the probability of a physician visit by less than 1 percent and a hospital admission by about 1 percent. However, supplemental insurance was not found to be associated with a bigger health care service utilization. Two-part models of health care utilization and expenditures showed that those without supplemental insurance had higher inpatient and outpatient expenditures than those with supplements, even after controlling for observable differences.

• Health Policy and Management
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• v.2 no.2
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• pp.221-237
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• 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.

• Quality Improvement in Health Care
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• v.1 no.2
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• pp.44-59
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• 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 Hospice and Palliative Care
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• v.13 no.3
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• pp.181-189
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• 2010

Purpose: Recently, health policy making is increasingly based on evidence. Therefore, Korean Terminal Cancer Patient Information System (KTCPIS) was developed to meet such need. We aimed to report its developmental process and statistics from 6 months data. Methods: Items for KTCPIS were developed through the consultation with practitioners. E-Velos web-based clinical trial management system was used as a technical platform. Data were collected for patients who were registered to 34 inpatient palliative care services, designated by Ministry of Health, Welfare, and Family Affairs, from $1^{st}$ of January to $30^{th}$ of June in 2009. Descriptive statistics were used for the analysis. Results: From the nationally representative set of 2,940 patients, we obtained the following results. Mean age was $64.8{\pm}12.9$ years, and 56.6% were male. Lung cancer (18.0%) was most common diagnosis. Only 50.3% of patients received the confirmation of terminal diagnosis by two or more physicians, and 69.7% had an insight of terminal diagnosis at the time of admission. About half of patients were admitted to the units on their own without any formal referral. Average and worst pain scores were significantly reduced after 1 week when compared to those at the time of admission. 73.4% faced death in the units, and home-discharge comprised only 13.3%. Mean length of stay per admission was $20.2{\pm}21.2$ days, with median value of 13. Conclusion: Nationally representative data on the characteristics of patients and their caregiver, and current practice of service delivery in palliative care units were obtained through the operation of KTCPIS.