• 보건행정학회지
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• 제27권3호
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• pp.256-266
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• 2017

Background: Primary health care (PHC) plays a major role to ensure the basic right and equal distribution of the essential health care services. This study presents comparative analyses of PHC in Korea and Uzbekistan, discusses the existing scenario and the challenges, and provides recommendations. Methods: This study reviewed secondary data from Korea's National Statistical Information Service and the State Committee of the Republic of Uzbekistan on Statistic, regulatory legislation, research reports, and policy papers by research and international institutions. We focus on comparing input and outcome health data, PHC structure, and health expenditure. Results: Overall health status of the population in Korea is better than in Uzbekistan; both countries achieved more than 95% immunization coverage. The reforms implemented in both countries provide initial health care service delivery. However, there are several challenges such as the distribution of the staff between urban and rural areas and interest of the graduates on specialization rather than working in PHC system. Conclusion: PHC plays an important role in the provision of medical services to the population, addressing both health and social problems; it is the best tool for achieving universal coverage for basic health needs of the population. The community health practitioners in Korea and nurses in Uzbekistan plays main role in universal coverage through providing essential health care services. Continuous reform of the PHC system should be directed to strengthen the capacity of the PHC staff in health promotion knowledge and activities as well as to encourage population to improve their own health.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.9015-9019
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• 2014

The study aimed to compare the 2 main types of insurance used by colorectal cancer (CRC) patients in a university hospital in Thailand: universal coverage (UC) and 'Civil Servant Medical Benefit Scheme' (CSMBS) in terms of hospital expenditure and survival outcomes. CRC cases in stages I-IV who were operated on and had completed their adjuvant therapy in Songklanagarind Hospital from 2004 through 2013 were retrospectively reviewed regarding their hospital expenditure, focusing on surgical and chemotherapy costs. Of 1,013 cases analyzed, 524 (51.7%) were in the UC group while 489 (48.3%) belonged to the CSMBS group. Cases with stage IV disease were significantly more frequent in the UC group. Average total treatment expenditure (TTE) was 143,780 Thai Baht (THB) (1 US$ =~ 30 THB). The TTE increased with tumor stage and the chemotherapy cost contributed the most to the TTE increment. TTE in the CSMBS group was significantly higher than in the UC group for stage II-III CRCs. The majority of cases in the UC group (65.5%) used deGramont or Mayo as their first line regimen, and the proportion of cases who started with a capecitabine-based regimen (XELOX or $Xeloda^{(R)}$) was significantly higher in the CSMBS group (61.0% compared to 24.5% in the UC group, p-value < 0.01). On survival analysis, overall survival (OS) and progress free survival in the CSMBS group were significantly better than in the UC group. The 5-year OS in the CSMBS and UC groups were 84.3% and 74.6%, respectively (p-value < 0.01). In conclusion, the study indicates that in Thailand, the type of insurance influences resource utilization, especially the choice of chemotherapy, in CRC cases. This disparity in treatment, in turn, results in a gap in treatment outcomes.

• 보건행정학회지
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• 제26권4호
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• pp.333-342
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• 2016

Background: The use of therapeutic materials based on new health technology has increased in recent years in the field of medicine, raising concerns for medical practitioners regarding increased spending on the new therapeutic materials amid the rapid population ageing and increase of chronic diseases in Korea. While therapeutic materials have significant importance in the health care system, they have not been given appropriate attention in the academic world of Korea. The purpose of this study is to identify factors that affect the growth of expenditure on therapeutic materials and to derive implications for an effective management considering the diversity of therapeutic materials. Methods: Using the claims data of the National Health Insurance Services, specific utilization patterns of groups of therapeutic materials in the middle classification level of Health Insurance Review and Assessment Service from 2007 to 2014 were analyzed. Four categories (J5083: drug eluting coronary stent, D0302: nonmetallic anchor, K6014: gauze, K6023: gauze) that exhibit unique patterns with respect to price and volume were selected. Then, decomposition analysis was performed to identify the largest contributor to the spending growth by dividing the products into existing, new, and abandoned products for the period between 2010 and 2013. Results: The effect of new products had larger impact on spending growth than the effect of core items in drug eluting coronary stent (J5083) and nonmetallic anchor (D0302). In addition, existing products in general included items priced relatively lower when compared with another item manufactured by the same company. In the gauze category, however, existing products had the largest impact on expenditure and the effect of volume was greater than that in other categories. Conclusion: This study provides evidence that appropriate management measures classified by the characteristics of therapeutic materials are required for therapeutic materials pricing and reassessment in Korea.

• 한국병원경영학회지
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• 제26권3호
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• pp.1-12
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• 2021

Purpose: This study aims to examine the effect of the copayment reduction policy on the health care utilization of patients under age 15 after the policy started in 2017. (이하는 아래 methodoloty로 이동) Methodology: Data on the ALOS, the average admission cost, and the out-of-pocket expenditure for patients under 15 years of age from 2015 to 2019 were obtained from the National Health Insurance database. Policy effects were measured by analyzing three dependent variables before and after policy: the average length of stay (ALOS), the average admission cost, and the out-of-pocket expenditure for patients under 15 years of age. The collected data were analyzed using the SAS package, and the analysis methods used in this study were the mean difference test and linear regression analysis. Findings: The study results reveal that, after the copayment reduction policy in the year 2017, the ALOS and the out-of-pocket expenditure were significantly decreased, but the average admission cost was significantly increased. Practical Implications: These results imply that the policy of copayment reduction for the patients under the age of 15 has contributed to mitigating the patients' financial burden with little concern about growing medical utilization.

• 한국콘텐츠학회논문지
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• 제21권4호
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• pp.96-110
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• 2021

우리나라는 세계에서 가장 빠른 속도의 저출산·고령화와 저성장·저금리의 시대에 적응해야 하는 직면해 처해 있다. 저출산, 고령화로 인하여 건강보험 재정수입 요인은 감소하고 있으며, 국민의 건강에 관한 관심, 고비용 의료기술 및 의약품의 개발은 건강보험 재정 지출은 증가하게 있다. 본 연구에서는 건강보험의 보장성 강화와 재정의 안정화, 의료의 형평성에 대하여 검토해보고자 한다. 첫째, 국내의 정책보고서, 국내외 문헌, 선행연구를 통해 건강보험의 현황과 한계를 파악하였다, 둘째, 외국의 건강보험정책인 재정 안정화 대책에 대하여 구분하여 검토하였다. 이 연구를 근거로 건강보험의 보장성 강화와 재정 안정화를 통하여 지속 가능한 건강보험을 유지하기 위해서는 현재 건강보험의 재정수입 구조를 혁신하여야 할 것이다. 또한, 정부지원금의 확대, 새로운 조세 수입을 발굴하여야 할 것이다. 진료비 지불제도, 의료전달체계를 개편하여 재정을 절감하는 정책도 필요할 것이다.

• 한국보건간호학회지
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• 제10권2호
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• pp.15-36
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• 1996

It is clear that the women's participation in social activity is dramatically increased in civilian field as well as military profession. Because of the characteristics of military nursing service, there are many difficulties. Frequent move, medical insurance, baby care. and the education are typical forms of difficulties for nurse officers in the military. The purpose of this research is to contribute to the perfect execution of nursing service. guarantee the active attitude for research and improve the combat strength by solving those private and economic problems. The method of research was analysis of question survey and the review of related literatures. The subject of research was 300 active nurse officers who work at the Army Hospitals. The survey was conducted 14 days from Oct 15 to Oct 28. The collected data was processed by computer using SPSS(Statistical Package of Social Science). Frequencies and percentages were used to examine the demographic characteristics of subject, and T-test was also used in the case of necessity. The result showed as follows; As the general characteristics of subject group; 28.7 years of average age, 73.6 months of service period, 63.4% of married. In regard of specialty; General 57.7%. Intensive Care 12.7% and Psychiatries 8.8%. The dissatisfactory factors about military welfare system were the difficulties in children education (36.9%). disadvantages on the civil medical insurance system (27.3%), and little chance of self education and development (21.5%). The problems in performing their duties were shown as dwelling instability due to frequent move (67.7%), and bring up children (14.2%). The reasons for resigning their job were shown as the instability of living status (64.2%), bring up children (18.8%) and dissatisfaction to the service (11.2%). The residential status was shown that military offered houses (45.2%), rental houses (29.3%) and own houses(14.64). The average numbers of moving residencies were; 3-4 time(34.6%), less than 2 times(33.1%), and 5-7 times(21.5%). Higher than 94.7% of the subject group spent more than 50.000 Won. In regard of education, they wanted to attend graduate school with their own expense(26.2%), computer science(20%) and Office Job Training(20%). The ways of taking care of children were mother-in-low(49.6%), mother(14.6%), and others(25%). The average expenditure per month for children were 20-30 hundred Won(44.2%), 10-20 hundred Won(25%) and 30-40 hundred Won(22.3%). The places of children care selected were public or occupational care center(56.2%), religious organization(20.8%), and other center managed by social organizations(10.4%). The result of survey for general welfare of nurse officers are as follows; By and large they seem to be satisfied with their job. however. there are some dissatisfactory factors. They are children care facilties, promotion. income. welfare facilities. disadvantage in medical insurance and civil hospitals. house purchase. unfair chances in specialty training. influence on promotion by educational status. and insufficient role for their children and husbands. As conclusion. the recommendations for improving nursing service are as follows; 1. Children care center managed by occupation 2. Dormitory system for children by military personnel 3. Equal opportunities in education according to ability 4. Reasonable moving price according to the distance and scope of family and extra allowance

• 대한간호학회지
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• 제24권4호
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• pp.545-556
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• 1994

Medical insurance and health care delivery system enabled Korean people to get the necessary medical service, but it caused increased needs for medical service, and resulted in the occurence of some problems such as a lack of manpower and medical facilities. In order to solve these problems, many countries, which already had medical insurance system had developed home care system and it has been regarded effective both in reducing costs and in increasing the rates of turnover of bed. Recently, Korea has included home nursing care in its health care delivery system, and some models of the hospital based home nursing care had been tried and its effects had been evaluated. So, author tried to run a home nursing care for the Cesarean section mothers and evaluate Its effects both in the mother's health and costs. This study was designed as a Quasi-experimental study. Subjects were thirty mothers who got Cesarean section operation in hospital in Seoul. Experimental group consisted of 15 volunteers, and control group were selected by means of matching technique. Data were gathered from February 1st to March 26th by two assistants who were trained by author. Experimental group were discharged on the 4th day after their operation, and got nursing care and assessment about their home three times on the 5th, 6th, and 7th day. Control group stayed in the hospital until 7th day as usual and were checked on the same day as above mentioned To evaluate the state of physiological recovery, vital signs, H.O.F, presence of edema in the legs, bathing, appetite, sleep, presence of pain or discomfort in the breasts, amount of lochia, color of lochia, defecation urination. To compare incidence of complication in experimental group with that in control group, specific assessment was done such variables as smell of lochia, presence of inflammation of operation wound, dizziness, and presence of immobilization in the extremities. The activities of daily living were checked Satisfaction of nursing were checked To calculate costs, author asked subjects to specify expenditure including hospital charge, traffic enpenses, and food expenses. The results were as fellows. 1. On effectiveness of home nursing careThere were n significant differences between experimental and control group in incidence of abnormal symptoms and any complication. The number of taking a bath [POD #5 P=0.001, #6 P=0.0003, #7 P=0.001] and the degree of appetite [POD #5 P=0.03, #6 P=0.02, #7 P=0.013] were significantly higher in experimental group than in control group. Contrary to author's expectation, the degree of the activities of daily living in experimental group was not higher than that of control group. All of the experimental group said they were satisfied with the home nursing care. 2. Cost analysis 1) Hospital charge of experimental group was lower than that of control group. ［P=0.009］ By taking home nursing care, average period of hospitalization was shortened to 3.1 days, and family members could save 22.8 hours. Total amount of money saved by early discharge was 3,443,093 Won. It is estimated that total amount of money saved by early discharge in a year will be 40,398,956 Won. 2) Home nursing care charge of 15 mothers was 1,781,633 Won. It is estimated that total amount of money Saved by it in a year Will be 20,904,493 Won. It was lower altogether than hospital charge of the three days which is 5th, 6th, 7th day of operation. The average cost of single home visit was calculated 10,940 Won. It took 87 minutes per round and it costed 1,017.3 Won. The average hour of home care was 39.0 minutes. 3) It is expected that early discharge can bring forth the increase of hospital income. On the condition that the rate of running bed is 100%, the expected increase of hospital income will be 202,374, 026 Won in a year. Suggestions for further study and nursing practice are as follows : 1. For the welfare of patients and the increased rates of running bed, home nursing care system should be included in the hospital nursing care system. 2. Studies to test effect of home nursing care on the patients with other diseases are needed. 3. Establishment of law on the practice of home nursing care is strongly recommended.

• Journal of Preventive Medicine and Public Health
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• 제25권4호
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• pp.399-412
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• 1992

This study was designed to investigate factors relating to fiscal deficit for regional health insurance. The financial statements for the fiscal year 1990 of nationwide 254 regional medical insurance societies were analyzed. Important findings are summarized below: 1. There were differences in the main reason fur the financial deficit among regions when deficit and surplus societies were compared by regions. The total revenue per enrollee, especially revenue from the premium contribution of a deficit society was significantly smaller than that of a surplus society in large cities and counties. On the other hand, the total expenditure per enrollee of a deficit society was larger than that of a surplus society in small cities. 2. Both low premium rate at the beginning of health insurance program and less effort to increase the premium rate were main factors for the smaller revenue from the contribution of a deficit society in large cities and counties. 3. Larger expenditures per covered person of a deficit society in small cities were explained with larger medical expenditures especially for out-patients services rather than larger administrative expenses. 4. A regression analysis showed that utilization rates in out-patient services were significantly associated with income and numbers of total medical care institution per capita within a region where a health insurance society located. Also expenses paid by insurer per visit were associated with the proportion of utilization for tertiary care hospitals as well as the proportion of utilization of public health centers.

• 한국건강관리협회지
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• 제2권2호
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• pp.160-166
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• 2004

The aging of population in Korea is proceeding in such a fast speed that other developed countries kaven't experienced. Korea already emerged in the aging society in 2000, and expected to become an aged society in 2019.There(ore, making effort to improve the quality of life of the aged people tv prolonging their social, economic activity, resulting in retrenchment of expenditure on health is very important. Developing nutrition and exercise programs to improve the quality of life of the elderly people, resulting in prolonged independent life is as important as medical care after onset of diseases. As a national preventive measure to save elderly people from becoming in need of assist, comprehensive program including teaching computer to prevent senile dementia, nutritional and exercise programs, along with programs of everyday life activity for the risk-group people should be carried out,

• 농촌의학ㆍ지역보건
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• 제25권2호
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• pp.217-230
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• 2000

For the longest time, our government has played an inconsiderable role in the public health services of Korea, especially as it relates to their investment. Voices have cried out against increases in national health expenditure and for more establishment of public medical facilities. In light of this, the necessity and importance of public medical facilities have come into focus amidst the recent medical crisis. When public medical facilities filled in the gap created by the suspension or closure of private hospitals and clinics as a result of this national crisis and acted as a safety net, the demand for more establishment of such facilities increased. Although patient diagnosis and treatment are the first priority of public medical facilities, they must also deal with scopes that private medical facilities do not deal with, dislike, or have difficulty with. In this respect, the closure or privatization of public hospitals to reduce their number just because of their low profits or financial burdens that must be carried by the government is to ignore their innate importance and social role; therefore, we must do all we can to block such efforts and further empower these public health facilities according to demands of the time. The improvement of public health services can be realized by redefining its goals and roles, increasing government funding, strengthening of existing public health facilities and reorganizing the public health services system. Even if public health facilities were to increase their medical services and be reinforced, they cannot take on all the services related to public health services, Therefore, in a country like ours where public health services come second to private health services in the health care system, the health of citizens can be safeguarded only when private and public facilities cooperate and private medical facilities share the social responsibilities. Only the show of interest and effort by government, politicians, health professionals, professional organizations and public can initiate the improvement that is sought.