• The Korean Society of Law and Medicine
• /
• v.8 no.2
• /
• pp.69-118
• /
• 2007

In providing general medical treatments, the medical service contract between the patient and the doctor is the mutually responsible onerous contract. However, the nature of the mutually assumed contract standings of the patient and the doctor has been changing since the implementation of the national health insurance program. For instance, besides the cases of beyond excessive medical charges and medical negligence, if the doctor charged for his/her medical treatments violating the post-treatment/nursing cover criteria, the overpaid medical charge, regardless of being collected with the patient's consent, has to be refunded back to the patient. Medically needed aspects, treatment results, and unfair benefits favoring the patient are not at all taken into consideration in the health insurance scheme. This makes it easier for patients to get refunds for their share of the medical payments by involving the Health Insurance Review & Assessment Service or the National Health Insurance Corporation, without engaging in civil law suits (for reimbursement claim) against doctors. In other words, the doctor's responsibility to provide medical treatments and the patient's responsibility to pay for the medical treatment provided within the contractual realm are being demolished by the administrational arbitration of the National Health Insurance system. The basic rights of medical service providers, and the patient's right to choose are as important constitutional rights, as the National Health Insurance program, which is essential in the social welfare system. Furthermore, the development of the medical fields should not be prevented by the National Health Insurance system. If the medical treatment services can be divided into necessary treatments, general treatments, and high quality treatments, the National Health Insurance is supposed to guarantee the necessary and general treatments to provide medical treatments equally to all the insured with limited financial resources. However, for the high quality treatments, it is recommended that they should not be interfered by the National Health Insurance system, and that they should be left to the private contract between the patient and the doctor.

• Health Policy and Management
• /
• v.33 no.3
• /
• pp.325-337
• /
• 2023

Background: While there are many studies estimating the effects of private health insurance on various types of health care utilization, few have examined how such effects change in conjunction with important policy reforms in national health insurance (NHI). This study examined how the effect of private health insurance (supplemental and fixed cash benefit) on high-cost outpatient imaging test utilization changed following the expansion of magnetic resonance imaging (MRI) coverage in 2018, which is a key example of the NHI benefit expansion policy in recent years. Methods: Data from the 2017 and 2019 Korea Health Panel Survey, which contained information about healthcare utilization before and after the expansion of MRI coverage in 2018, were used. The incremental effect of private health insurance on high-cost outpatient imaging test utilization for each period were quantified and compared, with special attention given to the type of private health insurance. Results: While people with supplemental private health insurance were more likely to use high-cost outpatient imaging tests than those without, both before and after the expansion of MRI coverage, the incremental effect increased from 1.6% points in 2017 to 2.5% points in 2019. Conclusion: Benefit expansion in NHI does not necessarily reduce disparities in the use of health care between private health insurance subscribers and non-subscribers. The results of our study also suggest that the path through which private health insurance affects healthcare utilization may not be limited to the price mechanism alone but can be more complex.

• Health Policy and Management
• /
• v.19 no.4
• /
• pp.53-65
• /
• 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.

• The Korean Society of Law and Medicine
• /
• v.10 no.2
• /
• pp.37-82
• /
• 2009

Korea has gained the much more performances in the fields of pubic health laws and related policies on the basis of the substantial economic achievements. In 1977, the social medical insurance was established for companies with more than 500 employees, and in 1989, Korea successfully achieved the national medical insurance system covering the total population within only 12 years beginning with multiple insurers. There remained some problems, however, to be improved such as both the low level of contribution rates and benefit packages due to the inefficiency in utilizing limited medical resources. In 2000, all insurers were unified into a single insurer (National Health Insurance Corporation), and special independent Health Insurance Review & Assessment Service (HIRA) was also established. From the origin of medical insurance system in 1977, the Korean reimbursement system has been fee-for-service system, and after the establishment of HIRA, it has been providing objective and expert medical cost review services and health quality assessment services.

• Health Policy and Management
• /
• v.17 no.2
• /
• pp.52-67
• /
• 2007

Korean government is preparing the long-term care financing and delivery system in order to cope with rapid population aging. The system should be designed to provide demented patients with an appropriate services that the patients want to take, and considered to be necessary for them. In this regard, this study aims to analyse empirically a relationship between the types of long-term care services that demented patients wanted to take and they actually received during 2004. The caregivers of 609 dementia patients, who were randomly selected in a manner of proportional allocation from a nationwide claim database of the Korean National Health Insurance Corporation, were interviewed in September, 2005. Independent variables include socio-demographic characteristics, Activities of Daily Living(ADL) and Instrumental Activities of Daily Living(IADL). To explore the correspondence of the types of long-term care services that demented patients wanted to take and that they actually received, and its affecting factors, we conducted chi-square test and logistic regression analysis. Main findings are as follows. First, while only 20% of study subjects wanted home services as a long-term care services, those who wanted to use the long-term care facilities and general hospital were 37%, 43% respectively. Second, the correspondence rate was just 38% on average, and extremely low in the demented patients who wanted to use long-term care facilities. Third, the demented patients who resided in urban areas and received relatively high level of education showed high correspondence rate. Fourth, the high ADL score was closely related to low correspondence rate.

• Health Policy and Management
• /
• v.31 no.3
• /
• pp.364-373
• /
• 2021

Background: This study aims to examine the regressiveness of national health insurance (NHI) premium burdens for local subscribers. The government has established a restructuring of health insurance contributions in 2017. Therefore, insurance premium reform began in 2018 and the second national health insurance premium reform will be carried out in 2022. We will analyze local subscribers before and after the policy reform of 2018. Methods: This study used data from 'local premium imposition elements' in the health insurance statistics annual reports (2017-2019) on National Health Insurance Service (NHIS). This study was calculated contribution rates according to levels of income and property for local insured by the method of comparing. Simulations of primary and secondary reforms were conducted in the study to determine regressiveness. Results: Insurance premiums for local subscribers were analyzed separately by income and property insurance premiums. In the income premium analysis, the higher the income, the lower the premium rate, and then the fixed rate was maintained from a certain section. The regressiveness of income insurance premiums has been eased in part. On the other hand, the property insurance premium burden was found to be regressive still by income class. Conclusion: Regressiveness analysis showed that a decrease in income contributions was achieved to local insured in the first phase of reform. But in the second phase of reform, more consideration should be given to reductions of property premium portions of local subscribers. Based on the results, the author suggested policy discussions to reorganizing the new systems of NHI contribution of local Insured.

• The Korean Journal of Health Service Management
• /
• v.7 no.4
• /
• pp.143-151
• /
• 2013

The purpose of this study was to analyze the socio-economic factors, the factors affecting the private insurance, utilizing Korea National Health & Nutrition Examination Survey 2011. Findings of the study can be summarized as follows. First, participants with private insurance are young, high monthly income, low prevalence of chronic illness. Second, participants with private insurance and chronic illness were young and high monthly income. Third, Average monthly household income, the higher the age is younger. Private insurance and national health insurance was higher subscription rate. Consequently, participants with private insurance and uninsured of the major differences is the age and the average monthly income. Elderly, low income are needed health promotion and disease prevention for expanded medicare, welfare policies.

• Health Policy and Management
• /
• v.16 no.1
• /
• pp.73-94
• /
• 2006

This study was carried out to show how the Analytic Hierarchy Process technique could be used in setting the priority among selected diseases to increase the range of health insurance benefit. Thirty experts, including doctors (group1), experts for preventive medicine or public health(group2), and representatives of the insured(group 3), participated in the study panel that is conducted for priority setting. They were asked to evaluate the priorities among 6 selected criteria and then 42 selected diseases. The results were as follows; First, representatives of the insured think that the magnitude of out-of-pocket payment should have high priority while doctors think that effectiveness of treatment should have high priority. Second, all experts think that catastrophic diseases such as malignant neoplasm, major heart disease, and cerebral vascular disease should have high priority in health insurance coverage even though there is little difference among groups. These results can be useful to establish a systematic strategy for expanding health insurance benefit package.

• The Korean Society of Law and Medicine
• /
• v.10 no.2
• /
• pp.287-307
• /
• 2009

A person is injured in car accident caused by his/her slight negligence except he / she causes accident by his / her willfulness or gross negligence. Because the National Health Insurance Corporation (hereinafter called "Corporation") shall not provide any insurance benefit "when he has intentionally or through gross negligence caused a criminal conduct or intentionally contributed to the occurrence of an accident" referred to in Article 48 (1) 1 of the National Health Insurance Act. So, if he / she is insured by his / her own bodily injury coverage, he / she can be compensated for his / her medical expenses. The injured have the rights to file either National Health Insurance claim and Automobile Insurance claim but there is no clear and definite adjustment clause. The claim disputes between National Health Insurance (hereinafter called "NHI") and Automobile Insurance (hereinafter called "AI") in the own bodily injury coverage makes some problems. Firstly, there are some differences in co-payments which he / she chooses between NHI and AI. Profit per a patient is higher in the NHI than in the AI. Secondly, it can provoke criticism that people shall unnecessarily pay double contributions. Lastly, it can raise moral hazards. For example, if he / she can cover the compensations when the insured receives the compensations from his / her insurer, the Corporation can be claimed by medical care institution payment of the health care benefit costs. In conclusion, first of all, to improve the national health and preserve the insured's rights the Corporation shall keep notice these facts.

• Journal of Preventive Medicine and Public Health
• /
• v.57 no.1
• /
• pp.91-94
• /
• 2024

For nearly four decades, Ugandans have experienced a period marked by hope, conflict, and resilience across various aspects of healthcare reform. The health insurance system in Uganda lacks a legal framework and does not extend benefits to the entire population. In Uganda, community-based health insurance is common among those in the informal sector, while private medical insurance is typically provided to employees by their workplaces and agencies. The National Health Insurance Scheme Bill, introduced in 2019, was passed in 2021. If the President of Uganda gives his assent to the National Health Insurance Bill, it will become a significant policy driving health and universal health coverage. However, this bill is not without its shortcomings. In this perspective, we aim to explore the complex interplay of challenges and opportunities facing Uganda's health sector.