• Journal of dental hygiene science
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• v.6 no.2
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• pp.133-138
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• 2006

To find out influence of water fluoridation program on the economic benefit effect, this study analyzed comparatively dental treatment indicators obtained from dental clinics at Sangdang-gu in Chenongju City, fluoridated community and Manan-gu in Anyang City, non-fluoridated community, from January 1, 2003 to the end of June, and the results are as follows: 1. If water fluoridation program is carried out in Anyang, non-fluoridated community, the number of treatment from caries and disease of tissues around dental pulp and root apex from age 6 to 18 for the first half of year 2003 is expected to decrease by 1,272, 636 for low estimation, and 1,908 for high estimation. And the treatment cost is expected to decrease by 40,888,000 Wons, 20,444,000 Wons for low estimation, and 61,333,000 Wons for high estimation. 2. Assuming that water fluoridation program is spread to all over the country, the number of treatment per year is expected to decrease by 2,492,018, 1,246,009 for low estimation, and 3,738,027 for high estimation. And the treatment cost is expected to decrease by 80,105,075,000 Wons, 40,052,537,000 Wons for low estimation and 120, 157,612,000 Wons for high estimation respectively. 3. For Yeong-un water supply management office which has 48,925 water supply personnel, the benefit/cost rate was 2.9 times, and for Jibuk water supply management office which has 239,751 water supply personnel, the benefit/cost rate was 9.0 times. As the water supply personnel increased, the cost increase of water fluoridation program was little and as the scale got large, the economic effect was very large. Improving national oral health is thought to be associated with expense retrenchment of oral health insurance financial. So it may need to extend using tap water to all the area of the country and additionally establish confidence through an active public relations and education of water fluoridation program.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.46
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• pp.133-158
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• 2010

Independent guarantee is a creation of the need from the both sides, i.e. the applicant (principal debtor) and the beneficiary (creditor). The former used to have to deposit cash in favor of the beneficiary in case of his default, which laid a burden on his liquidity while the latter still wanted to have the equivalent to cash. Independent guarantee satisfied the both parties by freeing the applicant of a deposit and maintaining the beneficiary's right at the same time. The fact that independent guarantee has three payment mechanisms is not widely known to the public. They are (i) payment on first demand, (ii) payment upon submission of third-party documents, (iii) payment upon submission of an arbitral or court decision. From the applicant's point of view, the order in his favor is (iii), followed by (ii) and (i). As there shouldn't be a case where one party is at a disadvantage against the other, useful insight is being sought for the benefit of the applicant. First, the applicant can offer his intention to provide a payment mechanism (ii) or (iii) rather than (i) if he must deliver it. Second, if the beneficiary still wants to have (i) and the applicant is in a position not to reject it, the latter should thoroughly check any provisions that may work against him later. Third, the applicant could use counterbalancing provisions in underlying contract to cope with protective clauses in the guarantees. Forth, the applicant should review the beneficiary's sincerity to prevent unfair calling risks. The applicant may use an ECA(Export Credit Agency) in his country to which he can transfer not only unfair calling risks, but also political risks. On the other hand, a bank needs to keep the following advice in mind. The foremost important thing for the bank not to forget is that it provides a guarantee as a service provider, not as a responsible party for the feasibility of the project, etc. Credit risk of the applicant should require the greatest attention when issuing a guarantee: the bank should look into the possibility that it can procure immediate reimbursement from its customers after payment to the beneficiary. Second, the applicant's ability to complete the project should be reviewed by checking its track records, techniques and reputation, etc. Third, the bank may also use an ECA to cover the beneficiary's unfair calling risks as well as political risks. In the case of Korea, as Korea Export Insurance Corporation(KEIC) can cover all the risks mentioned above, the bank could use its service called 'Export Bond Insurance.' What's better for the bank is that ECA cover can enhance the bank's asset quality by putting it zero on its risk weighted asset.

• Journal of Preventive Medicine and Public Health
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• v.28 no.1 s.49
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• pp.207-223
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• 1995

A new medical delivery system which regulated outpatient department(OPD) use from tertiary care hospitals was adopted in 1989. Under the new system, patients using tertiary care hospital OPD without referral slip from clinics or hospitals could not get any insurance benefit for the services received from the tertiary care hospital. This study was conducted to evaluate the Patient Referral System(PRS) with respect to health care expenditures and utilization. Two data sets were used in this study. One was monthly data set(from January 1986 to December 1992) from the Annual Report of Korea Medical Insurance Corporation(KMIC). The other was monthly joint data set composed of personal data of which 10% were selected randomly with their utilization data of KMIC from January 1988 to December 1992. The data were analyzed by time-series intervention model of SAS-ETS. The results of this study were as follows: 1. There was no statistically significant changes in per capita expenditures following PRS. 2. Utilization episodes per capita was increased statistically significantly after implementation of PRS. The use of clinics and hospitals increased significantly, whereas in tertiary care hospitals the use decreased significantly immediately after implementation of PRS and increased afterwards. 3. Follow-up visits per episode were decreased statistically significantly after implementation of PRS. The decrease of follow-up visits per episode were remarkable in clinics and hospitals, whereas in tertiary care hospitals it was increased significantly after implementation of PRS. 4. There was no statistically significant changes in prescribing days per episode following PRS. Futhermore, clinics and hospitals showed a statistically significant decrease in prescribing days per episode, whereas in tertiary care hospital it showed statistically significant increase after implementation of PRS. 5. Except high income class, the use of tertiary care hospitals showed statistically significant decrease after implementation of PRS. The degree of decrease in the use of tertiary care hospitals was inversely proportional to income. These results suggest that the PRS policy was not efficient because per capita expenditures did not decrease, and was not effective because utilization episodes per capita, follow-up visits per episode. and prescribing days per episode were not predictable and failed to show proper utilization. It was somewhat positive that utilization episodes per capita were decreased temporarily in tertiary care hospitals. And PRS policy was not appropriate because utilization episodes per capita was different among income groups. In conclusion, the PRS should be revised for initial goal attainment of cost containment and proper health care utilization.

• The Korean Society of Law and Medicine
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• v.23 no.4
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• pp.3-28
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• 2022

Recently, the targets and clauses of negotiation between 'National Health Insurance Service (NHIS)' and Pharmaceutical companies has been expanded. Due to newly adopted 'Quality management clause', 'Compulsory supply maintenance clause' and 'Penalty for breach of contract clause', not only 'Ministry of Health and Wellfare (MOHW)'s 'drug listing' and 'Price cap' announcement, but also 'negotiation between NHIS and pharmaceutical companies' can be a legal sanction to the suppliers. Once secretary of MOHW order NHIS to negotiate with pharmaceutical company, NHIS notify this order to the company and enter into the negotiation. 'The order' exists in the public domain between the government (MOHW) and public institutions (NHIS) and does not constrain the legal rights of companies (Therefore companies cannot pile a lawsuit about the order). However, 'the notice' or 'negotiation' is an act which has a counterpart, can be a target of administrative litigation if the company get some disadvantages from the talks. Negotiations can be divided into four types according to "the target (whether it is listed on the insurance benefit list)" and "the purpose (whether the target is price or conditional)." In particular, negotiations on listed drugs, whose goal is to set unfavorable conditions for companies, can be illegal if there is no price. So we need to consider compensation for the company as an incentive to negotiate.

• 한국노년학
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• v.31 no.4
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• pp.985-998
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• 2011

This study was conducted to understand current management status of 'day and night care' facilities and to explore the related factors with rates of operation of them. The nationwide mailing survey was conducted with structured questionnaires from July, 14, 2010 to July, 28, 2010. The subjects were 277 facilities (response rate 24.5%). Regarding the types of operating, 79.1% of faculties was run by cooperation, and 17.8% and 3.6% for individuals and national/public institutes respectively. The average of operation rate was 70.15%. National/public institutes showed higher in the rate of operation(79.08%) than 72.49% of cooperations and 57.78% of individuals. The number of manpower was not nearly different by the types of operating bodies, but the number of nurse was significantly different among them. The national/public institutions had 1.07 nurses while individual institutions have only 0.08. We found that facilities run by national/public institutes and founded before 2008 years showed higher rate of operation. In case of providing regular monitoring and evaluation services, and music program for patients showed higher rate of operation. In addition, the number of managers, social workers, and nurses increase the rate of operation. We suggest that quality management and monitoring program for the facilities which run by individuals or established after 2008 years would be developed. We also call for development of programs for facilitating utilization of 'day and night care' facilities such as expanding the family support.

• Journal of Preventive Medicine and Public Health
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• v.22 no.2 s.26
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• pp.248-258
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• 1989

As a result of cost-benefit analysis by making a macroscopic approach to the health screening projects conducted 4 times since 1950 for the insured people of the Korea Medical Insurance Corporation, the following conclusions were reached. 1. The direct costs put into the health screening project, and the time costs which were paid by examinees or calculated in terms of social costs have been estimated. The results is that the lowest estimation was 10,337 million won and the highest 15,141 million won when a minimum of 1.5 hours of time spent and a maximum 4 hours were applied. 2. In terms of the psychiatric benefits, the lowest estimation was 5,341 million won while the highest was 5,585 million won. 3. In terms of the benefits for each kind of diseases, the lowest estimation of 37,188 million won and highest estimation of 74,383 million won have been calculated for the liver diseases. And for the cardiovascular diseases, the minimum estimation was 14,475 million won while the maximum was 20,532 million won. In case of pulmonary tuberculosis, with external effect benefits being included, the estimation ranged from the minimum of 1,649 million won to the maximum of 1,832 million won. And the estimation of benefits for diabetes mellitus and renal diseases ranged from 89 million won to 92 million won and from 4,567 million won to 7,598 million won respectively. 4. In comparing costs and benefits, as a results of comparing each highest and lowet estimation a range of minimum 46,708 million won and maximum 98,071 million won of benefits has been gained.

• Korean Journal of Community Nutrition
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• v.17 no.3
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• pp.341-352
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• 2012

It is well established that excessive sodium intake is related to a higher incidence of chronic diseases such as hypertension, stroke, coronary heart disease, cardiovascular disease and gastric cancer. Although the upper limit of the current sodium intake guideline by WHO is set at 2,000 mg/day for adults, sodium intake of Koreans is well over 4,700 mg/capita/day implying an urgent need to develop and implement sodium intake reduction policy at the national level. This study investigated the cost-effectiveness of the sodium intake reduction policy, for the first time, in Korea. Analyses were performed using most recent and representative data on national health insurance statistics, healthcare utilization, employment information, disease morbidity/mortality, etc. The socioeconomic benefits of the policy, resulting from reduced morbidity of those relevant diseases, included lower medical expenditures, transportation costs, caregiver cost for inpatients and income losses. The socioeconomic benefits from diminished mortality included reductions in earning losses and welfare losses caused by early deaths. It is estimated that the amount of total benefits of reducing sodium intake from 4.7 g to 3.0 g is 12.6 trillion Korean Won; and the size of its cost is 149 billion Won. Assuming that the effect of sodium intake reduction would become gradually evident over a 5-year period, the implied rate of average return to the sodium reduction policy is 7,790% for the following 25 years, suggesting a very high cost-effectiveness. Accordingly, development and implementation of a mid-to-long term plan for a consistent sodium intake reduction policy is extremely beneficial and well warranted.

• Journal of agricultural medicine and community health
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• v.44 no.4
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• pp.195-208
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• 2019

Objectives: The purpose of this study was to analyze whether there are differences in medical expenses according to medical security type in the use of medical services with high disease burden such as coronary intervention. Methods: Chi-square test and covariance analysis(ANCOVA) were conducted to identify the differences in the characteristics and costs according to medical security type of 1,904 patients who underwent coronary intervention in a university hospital from 2011 to 2012. Hierarchical regression analysis was conducted to determine whether the cost affects medical expenses. Results: In the medical aid group, the proportion of women, those without a job, those without a spouse, and those who received hemodialysis was high, length of stay was high, patients using the emergency room and those who died was high. The medical aid patients were significantly higher in the non-benefit medical expenses, optional medical expenses, physician and admission, meals, medications and injections. National health insurance patients were significantly higher in procedure. The medical security type was found to be significant as a variable affecting the medical expenses. Conclusions: Provision of medical expenses should be managed in advance by providing prevention and education services for the vulnerable, and care services in the region should be provided to suppress the occurrence of medical expenses due to the increase in the number of days spent. In addition, it is necessary to support medical expenses to prevent unsatisfactory medical services from occurring for non-benefit and optional care.

• The Journal of the Convergence on Culture Technology
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• v.3 no.2
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• pp.21-30
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• 2017

This study investigated the total annual direct cost of cerebrovascular disease patients. For this study, 265 respondents who answered that they used more than one emergency, inpatient, and outpatient services for cerebrovascular disease during the year of 2012 among Korean medical panel investigators in 2012 were included. In general, patients with cerebrovascular disease responded to cerebrovascular disease among Korean medical panel respondents in 2012. Percentage of respondents using inpatient and outpatient services. Total direct cost was calculated. According to the results of the study, the per capita annual medical expenditure per person is about 561,934 won, 669,557 won for men and 448,696 won for women. In the case of health insurance subscribers, the per capita self burden due to cerebrovascular disease averaged 634,459 won and the medical benefit recipients 160,236 won. The average total direct cost of 265 people with cerebrovascular disease is about 162,165,690, 193,223,955 won for men and 129,486,685 for women. The total direct cost per person due to cerebrovascular disease was 183,095,125 won and the medical benefit recipient was 46,241,705 won. According to household income, the highest rate of 672,268 won in the third income group of the household income, and 108,970,650 won in the fifth income group, the lowest total direct cost of the patients with cerebrovascular disease.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.20
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• pp.8993-9004
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• 2014

Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.