• 대한소아치과학회지
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• 제48권2호
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• pp.151-159
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• 2021

대한민국에서 2019년 1월부터 만 12세 이하 어린이에 대한 우식 영구치 복합 레진 수복 치료가 급여화 되었다. 이 연구의 목적은 2009년 1월부터 2020년 3월까지 급여화 적용 전후의 강동 경희 치과대학병원에서의 만 12세 이하 영구치 복합 레진 치료 패턴을 분석하는 것이다. 급여화가 시작된 2019년에 만 12세 이하 어린이 대구치 복합 레진 수복량은 2배 이상 증가하였다. 급여화 전후 치료 나이, 성별, 치아의 위치에는 유의한 변화가 없었으나 와동의 형태에서 유의한 변화가 관찰되었다. 수용할 만한 생존율을 보이는 영구치 복합 레진 수복에 대한 접근성이 급여화로 증가함에 따라, 만 12세 이하 어린이의 초기 영구치열에서의 구강 건강이 증진될 것으로 보인다.

• Korean Journal of Radiology
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• 제25권5호
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• pp.414-425
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• 2024

Objective: This study aims to explore the opinions on the insurance coverage of artificial intelligence (AI), as categorized based on the distinct value elements offered by AI, with a specific focus on patient-centered outcomes (PCOs). PCOs are distinguished from traditional clinical outcomes and focus on patient-reported experiences and values such as quality of life, functionality, well-being, physical or emotional status, and convenience. Materials and Methods: We classified the value elements provided by AI into four dimensions: clinical outcomes, economic aspects, organizational aspects, and non-clinical PCOs. The survey comprised three sections: 1) experiences with PCOs in evaluating AI, 2) opinions on the coverage of AI by the National Health Insurance of the Republic of Korea when AI demonstrated benefits across the four value elements, and 3) respondent characteristics. The opinions regarding AI insurance coverage were assessed dichotomously and semi-quantitatively: non-approval (0) vs. approval (on a 1-10 weight scale, with 10 indicating the strongest approval). The survey was conducted from July 4 to 26, 2023, using a web-based method. Responses to PCOs and other value elements were compared. Results: Among 200 respondents, 44 (22%) were patients/patient representatives, 64 (32%) were industry/developers, 60 (30%) were medical practitioners/doctors, and 32 (16%) were government health personnel. The level of experience with PCOs regarding AI was low, with only 7% (14/200) having direct experience and 10% (20/200) having any experience (either direct or indirect). The approval rate for insurance coverage for PCOs was 74% (148/200), significantly lower than the corresponding rates for other value elements (82.5%-93.5%; P ≤ 0.034). The approval strength was significantly lower for PCOs, with a mean weight ± standard deviation of 5.1 ± 3.5, compared to other value elements (P ≤ 0.036). Conclusion: There is currently limited demand for insurance coverage for AI that demonstrates benefits in terms of non-clinical PCOs.

• 대한예방한의학회지
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• 제23권1호
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• pp.1-13
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• 2019

Backgrounds : The market of Complementary Alternative Medicine(CAM) in the United State(U.S.) accounts for a large proportion of the global CAM market and has a high growth rate. The recent introduction of Obama Care has brought the change in the health insurance system for CAM, and we need to analyze it for its implication to Korean system. Objectives : The purpose of this study is to investigate the current status of acupuncture and chiropractic health insurance in the U.S., and to draw implications for expanding the health insurance coverage for Korean traditional medicine through the comparison between the U.S. and Korean health insurance systems. Methods : We examined the data through the literature search and from the websites of both U.S. government departments and related organizations for the health insurance policy. Based on the collected data, we analyzed its CAM health insurance system in Korea. Results : The acupuncture covered by public health insurance in the U.S. has a limit in the number of treatments and a range of applied diseases compared with Korea. In addition, the practice of acupuncture is not subdivided. However, the chiropractic in the U.S. which also has a limited number of coverage and only three categories of practices are similar to that of Korea. Conclusions : Although the use of CAM by public health insurance is not active in the U.S., but the organizations such as Veterans Health Administration in Vermont is already discussing the use of acupuncture to solve the problem of opioid overuse. Thus Korea also needs to discuss to promote the expansion of the insurance system for CAM.

• 보건행정학회지
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• 제10권1호
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• pp.57-94
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• 2000

Korea's social health insurance system was introduced in 1977, which has made a universal coverage possibly by July 1989. Korean government had pursued a single objective for the last decade to put the whole population under the coverage of medical security, and the objective was achieved within 12 years. The rapid accomplishment is primarily due to such factors as limited benefits, high copayment rate, low contributions as well as rapid economic growth. There are several sources of pressure for the implementation of social health insurance such as health professional group, labor unions, politicians, international organizations etc.. However it is important to look at the feasibility of social health insurance. Among other things, it is necessary to identify the administrative infrastructure of insurance system and to assess income for source of fund. As many developed countries, Korea began to apply health insurance to the employees of the large firms, and the expansion based on employment status. Thus the several funds system was inevitable according to the gradual expansion strategy. However many persons had criticized several funds system in respect with equity and efficiency aspects. In the short history of the Korean health insurance, whether one fund or sever or funds had been the most controversial issue. In Febrary 1999, the National Assembly passed the act of one fund system. From July 2000 separate funds will be unifed under new health insurance scheme. In this study we will analyze the policy making process on implementation, expansion and integration of health insurance system of Korea. And also analyse problems related to policy making.

• 대한한의학회지
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• 제39권3호
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• pp.51-60
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• 2018

Objectives: This study aimed to investigate the opinions of Korean medical doctors on how to elucidate possible remedial measures for expanding the health insurance benefits coverage item of Korean medicine (KM). Methods: An online survey was conducted to all members who had registered e-mail address in the association of Korean medicine from 1 to 17 November, 2016. Statistical analysis was performed and odds ratio with 95% confidence interval were calculated by each subgroup. Results: A total of 743 members answered the questions and the response rate was 4.1%. The priorities for expanding health insurance benefits were as follows: thermographic imaging, Sasang constitution typing test, and pulse wave among examinations; pharamacopuncture, embedding acupuncture, and acupotomy among procedures; Chuna manual therapy, manual therapy for meridian muscle, and Daoyin exercise therapy among manual therapies; low-frequency electrical therapy, traction, paraffin bath, and light therapy among physical therapies; and aromatherapy, enema therapy, and color therapy among activities of KM. Conclusions: It should be covered by the national health insurance (NHI) of KM that thermographic imaging, pharmacoacupuncture, Chuna manual therapy, low-frequency electrical therapy, aromatherapy as a top priority. We also suggest that basic medical tests, such as blood, urine, or imaging, should be included in the coverage of the NHI of KM. It is necessary to review the expertise and public opinions about the plans and priorities for the conversion of the desired medical services to be covered by the NHI.

• 한국병원경영학회지
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• 제3권1호
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• pp.121-133
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• 1998

We analyzed volume changes in the computerized tomography(CT) and the magnetic resonance imaging(MRI) utilizations. These two volumes are comparative because CT has been covered by the Medical Insurance from the beginning of 1996, however, MRI has not been covered up to now. We investigated 80 hospitals which afforded a facility of CT by the end of 1994. For the comparison of CT utilization, we selected two periods. The first period was from January to June of 1995, in which CT had not been covered by the Medical Insurance and the second period was from January to June of 1966, in which CT had been covered. The information we obtained were characteristics of hospitals, patients numbers per month, monthly uses of CT and MRI, and payments of CT claims, etc. After the Medical Insurance coverage, the number of CT uses per 1,000 patients were increased from January to March, however, was decreased from April to June in 1996 compared to the same periods of 1995. the number of CT uses in clinics were large than those in tertiary hospitals. The number of CT uses in small cities were larger than those in big cities. On the other hand, the number of MRI uses per 1,000 patients did not changed from January to May and was increased from June in 1996 compared to the same periods of 1995. These results showed the substitutional relationship of CT and MRI uses. After the insurance coverage for CT, the utilization of CT was increased because patients payed less than before. However, insurers restricted the payments to the CT claims. This impact might explain the substitutional relationship between CT and MRI.

• 한국임상약학회지
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• 제21권4호
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• pp.319-331
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• 2011

Purpose: The purpose of this study is to evaluate current criteria for insurance coverage by Health Insurance Review & Assessment Service (HIRA) on the systemic therapy used in the treatment of advanced or metastatic renal cell carcinoma (RCC), by reviewing all available clinical evidences including a variety of clinical practice guidelines. Methods: We searched clinical databases and collected data from published phase 1 through 3 randomized clinical trials on all systemic therapies used in RCC, including novel targeted therapies. Additionally, current clinical practice guidelines on the management of kidney cancer or RCC were reviewed. Based on the collected data we evaluated the appropriateness of the HIRA criteria for insurance coverage on the systemic therapy of RCC whether they are evidence-based and up to date. Results: On the basis of the collected data we concluded that there was a need for a revision in HIRA criteria for systemic therapy of RCC. Despite recent emerging therapeutic advances and changes in therapeutic strategies of management of RCC, some of anticancer regimens were inappropriately listed even though they were not proven to provide efficacy or safety superior to those of other therapies. We thus proposed an updated recommendation based on current clinical evidences. Conclusion: Systemic therapy of RCC is being rapidly changed with the advancement of understanding of the molecular biology of cancer. Consequently newly developed targeted therapies are becoming the standard therapy in the management of medically or surgically unresectable advanced or metastatic RCC. To provide effective and safe therapy to patients with RCC, the criteria for insurance coverage should be made carefully taking into consideration of most up-to-date and high-quality clinical evidences, and should be continuously reviewed so as to reflect evidence-based clinical practice.

• 대한치위생과학회지
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• 제2권1호
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• pp.31-39
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• 2019

This study focused on the change of environment and cognition of dental hygienists about dental calculus removal after the national health insurance. We conducted online and offline surveys for 290 dental hygienists working in dental clinics in Seoul, Gyeonggi and Incheon areas. Differences in perceptions were assessed by independent t-test and ANOVA. 62.1% answered that the health insurance coverage of dental calculus removal was appropriate, and 49.6% said that the desired number of health insurance coverage about the dental calculus removal should be applied twice a year. 54.3% said that the age after 20 years-old was not appropriate in national health insurance coverage of dental calculus removal, and 49.3% said that the appropriate starting age of dental calculus removal should be applied from high school students. 26.3% said that the number of national health insurance applications should be increased yearly, 20.5% said that oral care education should be added. Most of the dental hygienists said that the number of scaling patients increased, but that the quality of the scaling did not deteriorate. According to general characteristics, in the recognition of the removal of calculus, the dental hygienists having a career for 7~8 years felt less change. The dental hygienist wanted to expand the scope of national health insurance about scaling removal so that more subjects could remove dental calculus removal. Dental hygienists wanted that national health insurance should be systematically supplemented in order to contribute to the promotion of oral health of the people.

• 대한치과기공학회지
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• 제38권1호
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• pp.9-22
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• 2016

Purpose: The Purpose of this study are to describe the Dental field of present health insurance for custom-made prosthetic implant by dental technicians' work. Results: A total of 300 dental technicians working at dental laboratories in Korea were randomly selected and surveyed, 206(68.7%) of them were used for the statistical analysis. Conclusion: Average daily working time was 10 hours 66%. The average cumulative credit of the clinic for dental prosthesis fabrication rates was Less than 10 million won(21.8%), 10~80 million won(11.7%), more than one hundred million won(1.5%). Remake dental prosthesis was one more than the monthly average of 98.5%. Causes of remake dental prosthesis was dentist impression 83% but did not pay 62.5%. Dental technicians Implant production period was 7 days(48.5%), 10 days(35%) was commissioned by dentists production time is 5 days(46.1%), 7 days(36.5%). President of dental laboratories 3.86 points and dental technicians 3.06 points knew differently about starting of implant health insurance coverage(p<.001). They alike were in favor of insurance coverage for the implant. Dental technicians were lower by 2.36 points for work do you know whether your health insurance application of dental prostheses. Dental technicians are 2.16 points on whether confidence in the pores payment of insurance coverage dental prosthesis, dental laboratory president was lower by 1.85 points. They are very low with 1.97 points on whether confidence in the rate payment of health insurance coverage dental prosthesis(p<.01). The implant prosthesis abutment selected, the abutments designed, design of the implant upper prosthetic, the upper prosthetic fitting dental technicians participate of dental laboratory president showed higher score (p <.05). Conclusion: Hours of dental technicians were making this short period of remake dental prosthesis-related dental prosthesis. Dental clinic and a detailed representation of the dental prosthodontic fabrication request is required for communication between the laboratory in order to reduce the remake of a dental prosthesis, dental insurance coverage written dental prosthodontic fabrication request should be legislated. Implant classification standard medical practice 1-3 Step conduct a thorough costing a total of no. 73 of the correct classification standard medical practice in addition to eight times defined by the act of dental technicians should be defined.

• 보건행정학회지
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• 제19권4호
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• pp.53-65
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• 2009

Purpose: This study was conducted to identify the prenatal heath care utilization and expenditure among pregnant women. Method: This was a 5-month follow-up study using a stratified sampling and the data were drawn from the "nationwide claim database of Korean National Health Insurance Corporation". Result: This study found that pregnant women were first diagnosed with pregnancy when they were 7.1 weeks pregnant, received 12.7 times of prenatal examinations and 10.6 times of ultrasonogram. It was revealed that 67.5% of the subjects continued to receive prenatal care at the same medical institutions from the diagnosis of pregnancy to the delivery. The study also showed that the total expenditure of prenatal care per pregnant woman was 700,000 Korean Won (KRW) on average and the insurance coverage rate stood at only 20%. Pregnant women living in metropolitan area spent more on prenatal healthcare expenditure than those who living in medium-sized city or rural area. Conclusion: The results of this study implies that the government needs to provide pregnant women with continuous support by increasing health insurance coverage for prenatal care. Especially, it is considered to provide more support to the pregnant women residing in medically underserved areas.