• 한국보건간호학회지
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• 제3권2호
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• pp.47-76
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• 1989

The objectives of this study was to analyze the major causes of decreasing utilization rate of health care institutios in pilot-project area of regional medical insurance, Kwang-hwa and Kun-wi country. After the implementation of medical insurance, utilization rate of health institutions turned out' to be lower than it was estimated, when the pilot-project of regional medical insurance was planned. It might be due to changes in inhabitant's behavioral attitude toward medical insurance. So this study was made to find measures for financial stability by increasing utilization rate of health care institutions and to be available for basic demand-supply program of medical care. The hypothesis of this study was as follows; First. there is difference in understanding health care institutions between Kun-wi and Kwang-hwa. Second. respondesnts of inquiry survey have exact knowledge of their past experience of treatment taken prior to enforcement of medical insurance, Questionaire survey was made as to each 700 household among total 11, 884 households in Kun-wi and 20,919 households in Kwang-hwa. In case of Kun-wi, 70% of inquired households (491) gave their answers. In Kwang-hwa, the number was 560 households (80% of inquireds). Dollected data was processed and analyzed by way of using SPSS batch system. To evaluate facto rs distribution aspects of data and to make comparison between two area, percentage and $X^2$ distribution were applied. The results were as follows; L The utilization rate of health care institutions in Kun-wi and Kwang-hwa was lower than it was estimated. when pilot-project of medical insurance was planned. 2. Prior to the implementation of medical insurance. inhabitants in two area chose the medical institutions considering such factors. First was medical care fee cheap. second in habitant's residence, Third was the institutions conveniently easy of access. 3. After the implementation of medical insurance. 26.1% of inqurieds in Kun-wi and 41.6% in Kwang-hwa, changed medical institutions. In case of Kwn-wi, from health care institution (p 0.05), and in case of Kwang-hwa, vice versa, from general medical institutions to health care institutions. 4. Evaluation by factors were made such as follows. Inquired gave high marks to following facts: In case of Kun-wi, general medical institutions were difficult of access and relation between patients: was not friendly, but burden of medical expenditure was light. Effects of treatment and facilities was good. In case of Kwang-hwa, inquired gave high evaluation marks to the follow ing facts; facilities of medical institutions was not good, but the burden of medical expenditure was light. 5. After the implementation of medical insurance, the services was evaluated as good, but inquired hopec for lessening the burden of medical expenditure. 6. In case of exact understanding of cost-sharing, the evaluation rate in Kwang-hwa was higher than that of Kun-wi (p < 0.005). And positive attitude toward necessity of medical insurance was also good in Kwang-hwa (p < 0.05). 7. In case of inquired's attitude toward medical institutions, Kwang-hwa showed positive response (p < 0.05) 8. In the case of comparison between general medical institution and health care institution, two area showed similar positive response; medical manpower, facilities of medical institutions and effest: of treatement was good. 9. In comprehensive evaluation of benefit-service; the general medical institution's positiveness was higher than that of health care institutions in Kun-wi. But in Kwang-hwa vice-versa. 10. If the medical expenditure of general medical institution and health care institutions was equal 77% of inquireds in Kun-wi and 59.1% in Kwang-hwa answered that they chose general medical insurance. Considering results above mentioned, the conclusion of this study was made as follows. 1. In Kwang-hwa county, where the understanding of health care institutions's was good, the utilization's of health care institutions was shown high. Therefore, in case of Kwang-hwa, betterment: should be made to induce increasing utilization rate for negative factors of health care institutions. 2. In case of Kun-wi, where the understanding of health care institutions was on the decrease, measures for changing such negative factors should be taken by way of strengthening public relations. And cases of Kwang-hwa should also be studied. 3. On the side of financial stabilization and establishing health care delivery system, primary health care should be available. Therefore, the major cause of inhabitant's avoiding health care institutions should be known. And measures for activating that institutions have to be taken. So, the facilities of health care institution have to be improved up to the level of clinic. And supportive measures for securing equipment and improving health care services should also be taken. It is necessary that strategy for public relations should be employed with policy considerations and supports.

• 대한한의학회지
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• 제30권4호
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• pp.64-78
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• 2009

Objectives: To research Korean oriental medical doctors' use of uninsured herbal extracts and how to bring about the insurance coverage of such herbal extracts. Methods: We surveyed Korean oriental doctors about the following issues from October 17th to November 15th, 2008: (1) Korean oriental medical doctors' knowledge about herbal extract insurance and the circumstances of oriental medicine in Korea, (2) their opinion on the coverage of currently uninsured herbal extracts and the dispensing of herbal extracts from pharmacies rather than from their clinics, (3) their use of herbal extracts, and (4) how to bring about insurance coverage of uninsured herbal extracts. Results: Over 70% of the respondents said that herbal medicine prescriptions have been reduced recently and that the existence of herbal medicine is in danger. In addition, 63.64% respondents agreed with expanding insurance coverage to include currently uninsured herbal extracts in spite of the fact that patients might have to obtain herbal extracts from pharmacies rather than from Korean oriental medical clinics. The average patient number per month of uninsured herbal extracts was 13.64 people, the average dosage was 5.64g, the average cost per day was 3,859 won, and the average prescription period was 2.65 days. Korean oriental medical doctors asked an average of 12,486 won for the medical examination-prescription fee and 3,292 won in fees for prescriptions obtained outside the hospital. If insurance coverage expands to include these herbal extracts, their usage is expected to increase 2.31 times. Conclusions: This study shows Korean oriental medical doctors' use of herbal extracts and their opinions about execution of herbal extracts' insurance. A periodic study such as this one will hopefully aid in establishing polices for uninsured herbal extracts' insurance.

• 보건행정학회지
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• 제26권4호
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• pp.343-351
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• 2016

Background: This study aims to analyze the effects of insurance types on the medical service uses for heart failure inpatients using propensity score matching (PSM). Methods: 2014 National inpatient sample based on health insurance claims data was used in the analysis. PSM was applied to control factors influencing the service uses except insurance types. Negative binomial regression was used after PSM to analyze factors that had influences on the service uses among inpatients. Subjects were divided by health insurance type, national health insurance (NHI) and medical aid (MA). Total charges and length of stay were used to represent the medical service uses. Covariance variables in PSM consist of sociodemographic characteristics (gender, age, Elixhauser comorbidity index) and hospital characteristics (hospital types, number of beds, location, number of doctors per 50 beds). These variables were also used as independent variables in negative binomial regression. Results: After the PSM, length of stay showed statistically significant difference on medical uses between insurance types. Negative binomial regression provided that insurance types, Elixhauser comorbidity index, and number of doctors per 50 beds were significant on the length of stay. Conclusion: This study provided that the service uses, especially length of stay, were differed by insurance types. Health policy makers will be required to prepare interventions to narrow the gap of the service uses between NHI and MA.

• 한국기계기술학회지
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• 제13권1호
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• pp.1-9
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• 2011

The present study aimed to compare and analyze the particulars of and difference in medical expenses and their composition ratio for 2,026 patients hospitalized at 2 types of medical institutions (443 at a clinic and 1,583 at a hospital) in Jeonju-si, Jeollabuk-do under coverage of automobile insurance during 2009. From the analysis, it became evident that there were differences in individual characters of inpatients covered by automobile insurance, and details, composition and composition ratio of medical treatment for them depending on types of medical institutions. There was no difference, however, between the total and average medical expenses per capita even when markup rate was applied to the automobile insurance by types of hospitals. The ratio of radiotherapy and physical therapy in the composition of medical expenses was found to be extraordinarily high in clinics compared to that of hospitals. The composition ratio of the fixed cost including charge for hospitalization also turned out to be fairly high in all medical institutions.

• Journal of Preventive Medicine and Public Health
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• 제31권3호
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• pp.471-480
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• 1998

This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows : 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I. : 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (41.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and fortieg age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.

• 보험의학회지
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• 제21권
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• pp.173-181
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• 2002

• 보험의학회지
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• 제21권
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• pp.149-156
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• 2002

• 보험의학회지
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• 제21권
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• pp.157-171
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• 2002

• 보건행정학회지
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• 제33권3호
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• pp.295-310
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• 2023

Background: The long-term care (LTC) group has higher rates of chronic disease and disability registration compared to the general older people population. There is a need to provide integrated medical services and care for LTC group. Consequently, this study aimed to identify medical usage patterns based on the ratings of LTC and the characteristics of benefits usage in the LTC group. Methods: This study employed the National Health Insurance Service Database to analyze the effects of demographic and LTC-related characteristics on medical usage from 2015 to 2019 using a repeated measures analysis. A longitudinal logit model was applied to binary data, while a linear mixed model was utilized for continuous data. Results: In the case of LTC ratings, a positive correlation was observed with overall medical usage. In terms of LTC benefit usage characteristics, a higher overall level of medical usage was found in the group using home care benefits. Detailed analysis by medical institution classification revealed a maintained correlation between care ratings and the volume of medical usage. However, medical usage by classification varied based on the characteristics of LTC benefit usage. Conclusion: This study identified a complex interaction between LTC characteristics and medical usage. Predicting the requisite medical services based on the LTC rating presented a challenge. Consequently, it becomes essential for the LTC group to continuously monitor medical and care needs, even after admission into the LTC system. To facilitate this, it is crucial to devise an LTC rating system that accurately reflects medical needs and to broaden the implementation of integrated medical-care policies.

• 보건의료산업학회지
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• 제11권3호
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• pp.51-64
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• 2017

Objectives : This study examined the effect of private health insurance on medical care utilization by subscription type. Methods : The data used were the six waves of the Korea Health Panel (2009-2014), and 16,187 persons were the subjects of the analysis. We performed a panel regression with a fixed effects model. Results : Indemnity private health insurance was positively related to the number of physician visits, number of admissions, and total length of stays. However, fixed-benefit private health insurance was not related to medical care utilization. Conclusions : The result of this study, which shows the difference by subscription type in the effect of private health insurance on medical care utilization, suggests that continuous monitoring of indemnity private health insurance is needed in the future.