• Journal of Trauma and Injury
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• 제25권4호
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• pp.178-187
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• 2012

Purpose: In Korea, the nation's medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system. Methods: From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital's emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient's insurance, and the entire bill when the patient was discharged. Results: Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge. Conclusion: We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system.

• 보건행정학회지
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• 제31권2호
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• pp.173-179
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• 2021

Background: In Korea, the length of stay and medical expenses incurred by medical aid patients are increasing at a rate faster than the national health insurance. Therefore, there is a need to create a management strategy for each type of hospitalization to manage the length of stay of medical aid patients. Methods: The study used data from the 2019 National Health Insurance Claims. We analyzed the factors that affect the length of stay for 186,576 medical aid patients who were hospitalized for more than 31 days, with a focus on the type of hospitalization in long-term care hospitals. Results: The study found a significant correlation between gender, age, medical aid type, chronic disease ratio, long-term care hospital patient classification, and hospitalization type variables as factors that affect the length of hospital stay. The analysis of the differences in the length of stay for each type of hospitalization showed that the average length of stay is 291.4 days for type 1, 192.9 days for type 2, and 157.0 days for type 3, and that the difference is significant (p<0.0001). When type 3 was 0, type 1 significantly increased by 99.4 days, and type 2 by 36.6 days (p<0.0001). Conclusion: A model that can comprehensively view factors, such as provider factors and institutional factors, needs to be designed. In addition, to reduce long stays for medical aid patients, a mechanism to establish an early discharge plan should be prepared and concerns about underutilization should be simultaneously addressed.

• 보건의료산업학회지
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• 제10권4호
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• pp.1-11
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• 2016

Objectives : The aim of this study is to investigate the actual condition of the occurrence and recovery of medical expenses through seafarers insurance and to provide basic data that will be helpful in the establishment of efficient hospital management strategies for medical expenses of insurance companies depending on the type of seafarers insurance. Methods : Three general hospitals located in Busan, Korea, were selected, and seafarers insurance claim data was collected from January 1, 2012 to December 31, 2013(24 months) and analyzed. There were 5,490 cases in total. Results : There was a significant difference in the distribution of disease incidence, accrued medical expenses, reimbursement of medical expenses, and the actual condition of medical receivables depending on the insurance company. Conclusions : Therefore, differentiated payback strategies for medical expenses are needed that consider the various seafarers insurance companies and their treatment characteristics.

• 대한본초학회지
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• 제27권2호
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• pp.1-16
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• 2012

Objective : To investigate the current status of prescription drugs in Oriental medical institutes and to draw up a future plan for the revitalization of Oriental medical health insurance, this survey has been performed. Method : The survey has been made with 321 doctors working at Oriental medical institutes in Daegu and Kyungbuk areas for a period of 3 month from June 1, 2010 until September 1, 2010. Result : 1. When it comes to the current status of the use of herbal drugs in Oriental Health insurance, most of doctors surveyed prescribe insurance drugs, and they prescribe insurance drugs to patients, who are less than 20% of total patients visiting their clinics. 2. The awareness of Herbal Health Care Drugs is investigated. When it comes to the understanding of the difference between insurance drugs(powder type drugs) and granular type drugs, doctors admit that they differ only in one aspect, whether or not their being covered by health insurance. Based on the survey results on the understanding of insurance coverage of granular type drugs, doctors, even though they long for granular type drugs to be accepted as insurance drugs, are worrying whether the number of outpatients might dwindle due to increased insurance co-payments. They also point out that the biggest obstacles in the expansion of the granular type drugs as insurance drugs are the lack of understanding of the government and the objection of the Health Insurance Review and Assesment service (HIRA) for fear of increased insurance claims. 3. Upon investigation on Oriental medicine doctors' understandings of herbal pharmaceutical industry, it is found that doctors' responses on pharmaceutical industry are not all positive ones('new product development and neglect of R&D infrastructure' and 'smallness of industry'). When it is investigated what area needs the greatest improvement in herbal pharmaceutical industry, 'securing sufficient capital, good manufacturing, and strengthening quality control', is the highest. 4. When it is asked what are the most needed in order to improve herbal health insurance medicine, responses such as 'the increase in the accessibility to and the utilization of Oriental medical clinics through the diversification of the means of prescriptions', 'the improvement of insurance benefits(cap adjustments)', 'increase the proportion of high quality medicinal plants', 'the ceiling of co-payments(deductible) at 20,000 won or more', 'expansion of the choices of formulations', 'formulational expansions of tablets and pills', and finally 'admittance and expansion of granular type drug as insurance drug' are the highest. 5. Upon investigating the general characteristics of the current status of the usage of Oriental health care herbal drugs, the followings are observed. First, the frequency of use of health insurance drugs by the doctors who use health insurance with general characteristics shows similar differences in case of total monthly sales amount (p<0.001), average number of daily patients (p<0.05). Secondly, as to the willingness of the expanded usage of insurance drugs, similar differences are observed in case of total monthly sales amount (p<0.05). 6. Upon investigating the general characteristics of the perception of Herbal health care drugs, the followings are observed. First, inspecting general characteristics and insurance claims due to increased co-payments(deductible amount) reveals similar differences in case of working period (p<0.01) and in case of total monthly sales amount (p <0.01). Secondly, inspecting general characteristics and the obstacles that hinder granular type drugs from being accepted as health care insurance drugs shows similar differences in case of working period (p<0.05). 7. Upon investigating the general characteristics of the understanding of Oriental Herbal pharmaceutical companies, the followings are observed. First, opinions on the general characteristics of pharmaceutical companies, when examined with variance analysis, shows similar differences in case of total monthly sales amount (p<0.05). Secondly, when opinions are examined on general characteristics and the problems of herbal pharmaceutical companies, similar differences are found in case of working period (p<0.01) and in case of total monthly sales amount (p<0.001). Lastly, opinions on the general characteristics and reforms of pharmaceutical companies, similar differences are observed in case of working period (p<0.001). 8. Upon investigating the general characteristics of the improvement of insurance Herbal drugs, the followings are observed. First, regarding general characteristics and insurance benefits, similar differences are observed in case of working period (p<0.05), in case of total monthly sales amount (p<0.05), and in case of average number of daily patients (p<0.01). Secondly, opinions on the general characteristics and the needs for the improvement of Herbal insurance drugs are examined in 5 different aspects, which are the approval of granular type drugs as insurance drugs, the expanded practices of the number of prescription insurance drugs, the needs of a variety of formulations, the needs of TFT of which numbers of Oriental medical doctors are members for the revision of the existing system, and the needs of adjusting the current ceiling of the fixed amount and the fixed rate. When processed by the analysis of variance, the results show similar differences in case of average number of daily patients (p<0.01). Conclusion : From the results of this study the first measures to take are, to reform overall insurance benefit system, including insurance co-payment system(fixed rate cap adjustment), to expand the number of the herbal drugs to be prescribed matching with insurance benefit accordingly, and to revitalize herbal medicine insurance system through the change of various formulations. In addition, it is recommended to improve the effectiveness of herbal medicine by making plans to enhance the efficacy of herbal medicine and by enabling small pharmaceutical companies to outgrow themselves.

• 지역사회간호학회지
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• 제32권1호
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• pp.64-72
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• 2021

Purpose: The purpose of this study is to analyze occupational accident compensation insurance coverage and occupational accidents incidence for special-type delivery workers. Methods: The data for occupational accident compensation insurance coverage and occupational accidents from 2012 to 2017 were analyzed through descriptive statistics. Results: Rates of occupational accident compensation insurance coverage of special-type delivery workers decreased gradually from 43.4% in 2012 to 28.5% in 2016, and 29.0% in 2017. Rates of occupational illnesses death per ten thousand workers increased gradually from 2.1‱ in 2013 to 3.1‱ in 2016, and 8.6‱ in 2017. All occupational illness deaths were due to cerebro-cardiovascular diseases. Road traffic accidents and slips accounted for the largest proportion of occupational accidents. Conclusion: Special-type delivery workers have a high risk of industrial accidents, so it is necessary to raise industrial accident insurance coverage and provide professional and systematic occupational safety and health services.

• Journal of Periodontal and Implant Science
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• 제49권4호
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• pp.248-257
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• 2019

Purpose: The purpose of this retrospective study was to investigate the relationships of types of dental insurance coverage in Korea with sociodemographic characteristics and the prevalence of systemic and oral diseases, as well as to evaluate the socioeconomic impact of Korean dental insurance policies. Methods: Sample cohort data from 2006 to 2015 were obtained from the National Health Insurance Service. Patients were divided into 2 groups. The exposed group comprised patients who received insurance benefits for complete dentures, removable partial dentures, and implant care, while the control group comprised patients who did not receive these benefits. The type of insurance coverage and the prevalence of systemic and oral diseases were compared between the 2 groups. Results: Patients who received benefits in the form of complete dentures, removable partial dentures, and implants had similar sociodemographic characteristics in terms of sex, age, income quintile, and type of insurance coverage to the control group. The prevalence of hypertension, anemia, renal disease, rheumatoid arthritis, osteoporosis, asthma, and cerebral infarction was higher in the exposed group than in the control group (P<0.05). The prevalence of periodontal diseases and dental caries was also higher in the exposed group. Conclusions: Korean dental health insurance policy has been beneficial for the medical expenses of low-income and elderly people suffering from a cost burden due to systemic diseases. However, since there is a tendency to avoid invasive interventions in older patients due to the high risk of systemic diseases, insurance coverage of dentures may be more helpful from a socioeconomic perspective than coverage of dental implant treatments.

• 디지털융복합연구
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• 제11권7호
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• pp.59-66
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• 2013

보험은 위험보장이라는 본래의 기능으로 세법에서 다른 금융상품보다 우대되어 왔다. 그러나 최근의 보험상품은 위험보장 뿐만 아니라 투자기능 및 저축기능이 결합된 다양한 방식으로 출시되고 있다. 더욱이 보험사의 판매방식이 절세전략, 조세회피 등과 관련된 컨설팅 등을 포함하고 있어 저축성 보험차익의 비과세와 관련된 조세정책에 비판이 제기되어 왔다. 이에 정부는 고액자산가의 조세회피방지와 타금융상품 간의 형평성 등을 위하여 2013년 소득세법 시행령 제25조를 개정하였지만 여전히 많은 문제점이 존재하고 있다. 본 연구에서는 저축성 보험차익에 대한 조세정책의 타당성을 2013년에 개정된 소득세법 시행령을 중심으로 살펴보고 이에 대한 개선방안을 도출하고자 하였다.

• 보건의료산업학회지
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• 제9권3호
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• pp.115-126
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• 2015

Objectives : This research was performed to investigate the characteristics and determination factors of health care policy satisfaction and welfare recognition for health insurance & health care financing. Methods : The utilized data were 4,174 cases who responded to a welfare recognition survey in the 8th wave of the Korea Welfare Panel Study (2013). The statistical methodology used in this study is the multiple regression model. Results : The significant affecting factors of health care policy satisfaction were age, education, household income, welfare attitudes, and health status. Medical utilization & private medical insurance were not related to health care policy satisfaction. The affecting factors of health insurance reinforcement were age, health status, welfare attitudes. The affecting factors of health care financing expansion were age, economic activity type, medical utilization, welfare attitudes. The affecting factors of welfare attitudes were age, economic activity type, household income, health insurance, and health status. Conclusions : Health care policy satisfaction, health insurance reinforcement, and health care financing expansion were all affected by age and welfare attitude; but this was not the case for private health insurance. This study recommended that the Korean government provide active planning for reinforcement of health insurance and publicity of the health care system in order to accord with the prospects of people.

• 보건행정학회지
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• 제33권4호
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• pp.450-456
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• 2023

Background: This study aims to develop a "Predictive Model for the Possibility of Collection Delinquent Health Insurance Contributions" for the National Health Insurance Service to enhance administrative efficiency in protecting and collecting contributions from livelihood-type defaulters. Additionally, it aims to establish customized collection management strategies based on individuals' ability to pay health insurance contributions. Methods: Firstly, to develop the "Predictive Model for the Possibility of Collection Delinquent Health Insurance Contributions," a series of processes including (1) analysis of defaulter characteristics, (2) model estimation and performance evaluation, and (3) model derivation will be conducted. Secondly, using the predictions from the model, individuals will be categorized into four types based on their payment ability and livelihood status, and collection strategies will be provided for each type. Results: Firstly, the regression equation of the prediction model is as follows: phat = exp (0.4729 + 0.0392 × gender + 0.00894 × age + 0.000563 × total income - 0.2849 × low-income type enrollee - 0.2271 × delinquency frequency + 0.9714 × delinquency action + 0.0851 × reduction) / [1 + exp (0.4729 + 0.0392 × gender + 0.00894 × age + 0.000563 × total income - 0.2849 × low-income type enrollee - 0.2271 × delinquency frequency + 0.9714 × delinquency action + 0.0851 × reduction)]. The prediction performance is an accuracy of 86.0%, sensitivity of 87.0%, and specificity of 84.8%. Secondly, individuals were categorized into four types based on livelihood status and payment ability. Particularly, the "support needed group," which comprises those with low payment ability and low-income type enrollee, suggests enhancing contribution relief and support policies. On the other hand, the "high-risk group," which comprises those without livelihood type and low payment ability, suggests implementing stricter default handling to improve collection rates. Conclusion: Upon examining the regression equation of the prediction model, it is evident that individuals with lower income levels and a history of past defaults have a lower probability of payment. This implies that defaults occur among those without the ability to bear the burden of health insurance contributions, leading to long-term defaults. Social insurance operates on the principles of mandatory participation and burden based on the ability to pay. Therefore, it is necessary to develop policies that consider individuals' ability to pay, such as transitioning livelihood-type defaulters to medical assistance or reducing insurance contribution burdens.

• 한국병원경영학회지
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• 제20권3호
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• pp.36-44
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• 2015

The Activity Based Costing(ABC) means the process that makes clear how the actions and input resources have changed into service to calculate medical services costs. These days, the number of hospital which is using the ABC system is increasing to make their policy decision making efficient and run the hospitals more resonable. This study analyzes the unbalance in the level of health insurance service fee and the improvement plans based from 8 hospitals(ABC system) and 95 clinics(ABC survey). The cost recovery ratio has shown different levels according to each service type. A surgery service type recorded 76.8% and an evaluation & management service type is 84.6%, a treatment procedure type(85.8%), a function test type(91.6%) and health insurance fee even did not reach to the original cost. Meanwhile, a laboratory test type and imaging test type show high level of cost recovery ratio. they recorded 188.3% and 158.8%. Resultingly now of unbalance in the level of health insurance service fee accelerates supply of every test. so there is a need to make laboratory test type and imaging test type lower to keep balance with the surgery and medical service. These methods should be performed gradually with monitoring the unbalance fee ratio and for this, a panel medical institution have to be established for generalizations of studying result, fairness of selecting researching sample.