• Health Policy and Management
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• v.32 no.2
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• pp.137-153
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• 2022

In the process of promoting policies to strengthen health insurance coverage, the relationship between public health insurance and private health insurance, along with the management of non-benefit, is also emphasized as a policy issue. First, the concept and scope of non-benefit were comparatively analyzed by country. Second, the interaction between the public and private health insurance was classified as 'large or small,' and the government's regulation and management policy on private health insurance was classified as 'strong or weak.' Korea has relatively smaller benefits covered by public health insurance, higher copayment expenses, and more areas and scope of non-benefits. In countries where the interaction between public and private health insurance is small, private health insurance-related policies are weak. And in countries with large interactions had public-private partnerships and the government's management policies were also strong. On the other hand, Korea has a large interaction, but the actual structure of cooperation between public and private insurance and management policies were weak. Because the non-benefit sector in Korea is relatively wide, it is difficult to manage compared to other countries where the concept of non-benefit is limited. In addition, the health authorities rarely perform the role of supervision over private health insurance, and they have so few linkages and cooperation for public-private insurance. Therefore, practical policy enforcement is necessary to achieve the easing of the burden of national medical expenses through linkage and cooperation of public-private health insurance with reference to relevant other countries' cases.

• Journal of Preventive Medicine and Public Health
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• v.54 no.1
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• pp.17-21
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• 2021

In 2020, the coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to global health systems. The Korea has taken full-fledged actions against this novel infectious disease, swiftly implementing a testing-tracing-treatment strategy. New obligations have therefore been given to the Health Insurance Review and Assessment Service (HIRA) to devote the utmost effort towards tackling this global health crisis. Thanks to the universal national health insurance and state-of-the-art information communications technology (ICT) of the Korea, HIRA has conducted far-reaching countermeasures to detect and treat cases early, prevent the spread of COVID-19, respond quickly to surging demand for the healthcare services, and translate evidence into policy. Three main factors have enabled HIRA to undertake pandemic control preemptively and systematically: nationwide data aggregated from all healthcare providers and patients, pre-existing ICT network systems, and real-time data exchanges. HIRA has maximized the use of data and pre-existing network systems to conduct rapid and responsive measures in a centralized way, both of which have been the most critical tactics and strategies used by the Korean healthcare system. In the face of new obligations, our promise is to strive for a more responsive and resilient health system during this prolonged crisis.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.12
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• pp.469-474
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• 2020

This study explains the characteristics of micro-insurance based on the theoretical model of health insurance, such as the low demand of low-income people and the lower demand of higher risk aversion. In particular, these characteristics contradict the existing insurance theory which states that the lower the income, the higher the risk aversion, and the higher the demand for insurance. This study postulates a two-period model focusing on health insurance, contrary to a one-period model assumed in existing studies. As a result, first, we show that the decrease in income leads to a decrease in the preventive effort for illness. Second, we offer a model for micro-insurance in which the individual chooses a partial insurance under an actuarially fair insurance premium, while full insurance is optimal in existing studies. Third, we also show that the insurance demand decreases when the outlook for the future improves. Fourth, we finally show that the lack of trust and default risk of the insurer decrease the insurance demand as risk aversion increases.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.11
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• pp.7463-7473
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• 2015

This study aims to analyze the effect of long-term care utilization on health care utilization of the national health insurance elderly. This study is a secondary data analysis of the long-term care insurance data that comprised of total 21,213 long-term care insurance with the level 1 elders who received either service or non-service. This study evaluated the impact of long-term care service on the probability of health care utilization experience and costs of health care utilization. The total medical cost, geriatric hospital's medical cost, inpatient day and geriatric hospital's inpatient day by 2007-2009 were significant factor influencing the long-term care utilization. This study suggests long term care system should proper medical service linkage system. The current long-term care insurance system should more resource allocation on long-term care utilization to increase the efficiency of insurance system.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.9
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• pp.386-394
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• 2017

The purpose of this study was to investigate how employed dental hygienists (graduates) and alumni are aware of dental health insurance and how to organize their classes for running efficient dental health insurance courses, and therefore to suggest opinions on the introduction of professional dental hygienist qualifications. The analyses was carried out using IBM SPSS Statistics 24.0. Sixty-nine students (56.1%) preferred one semester dental health insurance course as two semester courses and 63 students (51.2%) preferred theoretical course as practical course. Ninety-six (78%) students preferred dental health insurance claimants as others for their most necessary certification. Ninety-three dentists (75.6%) thought of the dental hygienist as the appropriate occupation for dental health insurance claims. The correlation coefficient was significant at the 0.01 level (both sides) and all showed a positive correlation. The effect of subjective understanding of dental health insurance and the perception of dental health insurance claim on students' intention to complete those courses explained 32% of the response, and the effect of the intention to complete those courses on the willingness to earn a certificate explained 22.3%. This study reveals the willingness of students to complete those courses to acquire qualifications in order to achieve a competitive advantage in employment, and suggests the necessity of institutional improvements such as changing the method of dental insurance education, varying the class time distribution, and introducing dental health insurance professional dental hygienist qualification in the country.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.8
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• pp.477-484
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• 2016

This study was carried out to determine the factors affecting the trend and usage of Magnetic Resonance Imaging before and after the implementation of National Health Insurance. The research materials were the MRI Execution Data, Health Insurance Review Data, and Medical Expenses in the Health Insurance Data from a General Hospital located in Dae-jeon Metropolitan City from 2004 to 2013. The subjects of analysis were 3,754 people in 2004 (prior to the implementation of Health Insurance), and 4,107-8,603 people from 2005-2013(after the implementation of Health Insurance). In terms of analysis, a comparison of the use of MRI before and after implementation of the Health Insurance of User Characteristics and Provider Characteristics were taken as $X^2$, while factor analysis for the elements that affect MRI usage was carried out by Hierarchical Multiple Regression Analysis. According to the results of this study, the level of use decreased temporarily in the initial application stages of the national health insurance, but it soon increased. In particular, the inspection rates for women, the head and neck, those not subject to the application of the national health insurance, internal medicine, and the inpatients increased. The application of the national health insurance for MRI influenced the increasing inspection rates (P<.0001). As the inspection rate for the MRI increased, it is important to expand the application of the national health insurance to reduce the national health expenditure.

• Health Policy and Management
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• v.33 no.4
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• pp.379-388
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• 2023

This study aims to propose the implementation of innovative payment models in Korea in order to promote the financial sustainability of the national health insurance system by reviewing the current status of the payment system in Korea and examining other countries' experiences with various innovative payment models. Korea primarily uses a fee-for-service payment system and additionally uses various payment systems such as case payment, per diem, and pay-for-performance. However, each payment system has its limitations. Many OECD (Organization for Economic Cooperation and Development) countries have pointed out the limitations of existing payment systems and have been attempting various innovative payment models (e.g., add-on payment, bundled payment, and population-based payment). Therefore, it is essential for Korea to consider innovative payment models, such as a mixed payment model that takes into account the strengths and weaknesses of each payment system, and to design and pilot these models. This process requires stakeholders to work together to build a social consensus on the implementation of innovative payment systems and to refine legal and systematic aspects, develop an integrated health information system, and establish dedicated organizations and committees. These efforts towards innovative payment models will contribute to developing a sustainable health insurance system that ensures the public's health and well-being in Korea.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.1
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• pp.497-505
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• 2018

This study was conducted to investigate the characteristics of private health insurance subscribers and non-subscribers as they relate to severely ill patients, and to identify the factors of participation. The study was conducted using the National Health and Nutrition Examination Survey for 2015, and data were analyzed using SPSS ver. 23.0. The subjects were 417 patients with severe disease (cancer, heart disease, cerebrovascular disease) over 19 years of age. Crossover analysis was employed to identify differences between the state of private health insurance participation, while binary logistic regression analysis was used to confirm the factors affecting private health insurance subscription. Analysis of the effects of the subjects on the private health insurance participation rate revealed that the social and demographic characteristics were higher in younger individuals regardless of sex, residence, or marital status. Moreover, higher household income, regardless of the education level, was associated with a higher participation rate of health insurance target individuals compared to medical benefit target individuals. The private health insurance participation rate was low and the explaining power was 51.7%, regardless of subjective health awareness and walking practice. Therefore, efforts should be made to improve the living environment and support local governmental programs for the elderly, low income households, socially vulnerable groups with limited activities and groups with limited health behavior. It is also necessary to consider various health policies, such as providing government health education or programs to prevent severe illness.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.12 no.2
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• pp.646-652
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• 2011

The interest in personal health is now growing around the world. Accordingly, the insurance industry which is closely related to personal health is becoming more important. Insurance industry can be divided into to main stream, life insurance and indemnity insurance. This study attempts to compare the economic impacts of the life insurance industry and indemnity insurance industry using an inter-industry analysis. The study investigates production-inducing effect, value added inducing effect, employ-inducing effect, sectoral price effect using Exogenous specification. The results show that indemnity insurance industry induces production-inducing effect of 2.7 won, value-added-inducing effects of 1.6 won, employ-inducing effect of 26.9 person, sectoral price effects is 2.0%. On the other hand, life insurance industry induces production-inducing effect of 1.6 won, value-added-inducing effects of 1.0 won, employ-inducing effect of 16.5 person, sectoral price effects is 1.2%. Overall, indemnity inducements has higher economic impacts than life insurance.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.2
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• pp.247-260
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• 2018

This study examined the mental health status (depression, cognitive impairment and dementia) and its association with the related factors in the elderly people who were admitted from long-term care insurance. The study subjects were 1,488 people (male 740, female 748) aged over 70 years of age who had been recognized for long-term care insurance services in the years 2011~2014 from the National Health Insurance Corporation. The data collected from the National Health Insurance Corporation set forth a lifestyle questionnaire, itemized health screening tests, and long-term care as recognition data for research purposes. As a result, depression, cognitive impairment, and dementia of subjects increased significantly with age. As a multiple logistic regression result, the risk ratios of depression, cognitive impairment, and dementia, which indicated the mental health status, were significantly higher in women than in men, in the lower body weight group than in the overweight group, in the smoking group than in the non-smoking group, and in the drinking group than in the non-drinking group. These results suggest that the mental health status (depression, cognitive impairment, and dementia) of subjects decreased with increasing age, particularly the group with poor health related behaviors, such as smoking, drinking, and regular exercise, indicating that the mental health condition is lower than in the good group.