• Health Policy and Management
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• v.11 no.4
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• pp.1-20
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• 2001

Korean government had introduced copayment system as cost sharing to office-based medical care in order to reduce the demand for care in 1986. This review focuses on trends and characteristics of copayment on office-based medical care from 1991 to the end of Jan. 2001. Objectives of this study is ${\circled}1$ to analyse historical trends of copayment on office-based medical care during the last decade, ${\circled}2$ to analyse the effect of copayment introduced to office-based medical care on NHI finance, ${\circled}3$ to analyse the changing trends of the size of copayment in utilizing office-based medical care for the past 10 years, ${\circled}4$ to evaluate the meaning of copayment alteration implemented after the introduction of new prescription system and finally ${\circled}5$ to draw a some policy implications from the results of this review. We found that the main purpose of copayment introduction had been reduction in the expenditure of NHI finance. But, the reduction effect of insurer's expenditure has turned out to be negative and NHI finance has been in crisis after the introduction of new prescription system. Also, the copayment level of the insured has increased actually on a large scale. It seems that the introduction of new prescription system has changed the meanings and its policy implications of copayment system.

• Journal of Technologic Dentistry
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• v.40 no.2
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• pp.73-82
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• 2018

Purpose: The purpose of this study was to investigate the production environment of crown prosthesis for National Health Insurance(NHI) benefit. Methods: This study carried out self-administered questionnaire survey from September 1, 2016 to October 31 by having research subjects as 261 dental technician. Except 100 copies with incomplete response, 161 copies were used as the materials of final analysis. Results: Unlike gold crowns, the material cost of metal crowns was paid at the dental laboratory(86.3%). Total material consumption for making metal crown was more than gold crown(63.4%), especially for the finishing and polishing processes(78.3%). The subjects responded that a routine dental laboratory fee of crown prosthesis is unreasonable, and it is necessary to adjust and improve it(metal crown 96.2%, gold crown 96.9%). NHI coverage dental prosthesis was not marked on the order form(46.0%), and the dental laboratory fee of that was nor received(64.0%). Conclusion : It is necessary to estimate the NHI cost level of the crown prosthesis by reflecting the production environment and engineering process in dental laboratories. In addition, institutional arrangement should be backed up so that dental laboratories can receive appropriate dental laboratory fee.

• Korean Journal of Health Education and Promotion
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• v.24 no.1
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• pp.127-138
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• 2007

Objectives: This study aims to examine if the follow-up management service by National Health Insurance (NHI) for person at health risk leads to significant modification of the lifestyle and change of health status. Methods: Of persons who underwent health screening and were classified as having health risks after periodic health screening by NHI in 2003, persons who took the follow-up management service were selected as case group and persons who took no service were selected as control group. The DW database of NHI was used to explore the effect of the follow-up management service on the modification of health status and lifestyle. Chi-square tests were conducted with SAS 9.1 to examine the differences of health promotion effect between case vs. control group. Results: It was shown that of lifestyle behaviors, only exercise was significantly improved for case group compared with control group as the effect of the follow-up management service by NHI (2.98%p) (p<.0001). Further, morbidity rate for control group was 2% higher than that of case group (p <.0001), which indicates that persons who received the follow-up management service better maintained their health significantly than persons who did not. Conclusions: The present study shows that the appropriate follow-up management services need to be provided for maximizing potential effect of periodic health screening by NHI.

• Korean Journal of Health Education and Promotion
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• v.26 no.3
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• pp.75-83
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• 2009

Objectives: This study aims to examine if the follow-up management service by National Health Insurance (NHI) for obesity persons leads to significant modification of the lifestyle and change of health status. Methods: Of persons who underwent health screening and were classified as obesity after periodic health screening by NHI in 2004, persons who took the follow-up management service were selected as case group and persons who took no service were selected as control group. The DW database of NHI was used to explore the effect of the follow-up management service on the modification of lifestyle and health status. Chi-square tests and t-tests, pairs t-tests were conducted with SAS 9.1 to examine the differences of health promotion effect between case vs. control group. Results: It was shows that of lifestyle behaviors, only exercise is significantly improved for case group compared with control group as the effect of the follow-up management service by NHI (2.11%p) (p=0.0435). Further, morbidity rate for control group was 2.05% higher than that of case group (p=0.0002). These results indicate that persons who received the follow-up management service better maintained their health significantly than persons who did not. Conclusion: The present study shows that the appropriate follow-up management services need to be provided for maximaizing potential effect of periodic health screening by NHI.

• Journal of Korean Academy of Oral Health
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• v.41 no.1
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• pp.43-49
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• 2017

Objectives: In this study, we strived to determine the possibility of socioeconomic welfare in oral healthcare by analyzing the National Health Insurance (NHI) coverage rate. To date, efforts to realize the "social economy" of healthcare are active. While oral disease is common and chronic among Koreans, the rate of NHI coverage of dental clinics is substantially lower than that of the medical clinics. Methods: We defined the NHI coverage of dental clinics as a proxy for "social skills" to improve oral health problems. The data were collected through a comparative analysis of the NHI coverage of dental clinics and that of non-dental clinics, in health welfare social cooperatives. Results: The NHI coverage rate of the dental clinics in health welfare social cooperatives ranged from 0.97 to 2.62 times that of the non-dental clinics in health welfare social cooperatives. Conclusions: In conclusion, responsible management is recommended for making health welfare social cooperatives meaningful as a social economy.

• The Journal of Korean Medicine
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• v.44 no.2
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• pp.10-19
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• 2023

Objectives: This study aimed to find out the characteristics of patients with facial palsy based on the National Health Insurance(NHI) statistical yearbook and provide the information pertaining to supplement Coverage of NHI. Methods: Based on the data of NHI between 2004 to 2021 for facial palsy(G51) obtained from the Ministry of Health and Welfare, the analyses were carried out according to the distribution of gender and the number of patients, visits, reimbursed days, and medical expenses by using the SAS 9.4. Results: The crude rate of facial palsy was reported as 361.71(2021) comparable with 419.60(2004) and 534.11(2009). The rate of men increased from 293.96(2004) to 302.27(2021) but the rate of women decreased from 450.88(2014) to 420.80(2021). The number of patients maintained around 190,000, however, it declined for patients treated Korean medicine(KM) after 2010. As the medical expenses were elevated, especially Western medicine(WM), that of WM exceeded KM's since 2018. The expenses of women were higher than men's in KM. By contrast, there was no difference with gender in WM. For reimbursed days per visits, it has been increased in WM but there was no difference in KM. Conclusion: Although the rate of patients with facial palsy in KM was high with no difference in the whole number of patients and reimbursed days per visits in KM annually, the number of patients in KM decreased but medical expenses elevated. According to this, it is necessary for reinforcing Coverage of NHI to research other factors related to KM.

• Journal of the Korean Society of Radiology
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• v.81 no.5
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• pp.1083-1095
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• 2020

Since 2019, ultrasound and magnetic resonance imaging for evaluation of urogenital disorders have been covered by the National Health Insurance (NHI) in Korea. Patients with urogenital malignancies were already insured by NHI for ultrasound and MRI. With the expansion of NHI coverage, patients with suspected prostate or gynecologic cancer, uterine fibroids before myomectomy and some other benign disease such as congenital anomaly can receive benefits of NHI. In consideration of these changes, radiologists and other clinicians should be aware of the indications and standard images of each examination and the required reporting forms. Clinical application based upon thorough understanding of the NHI guidelines will aid in improving the standard care of patients.

• Health Policy and Management
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• v.27 no.4
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• pp.372-374
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• 2017

Korea is one of the fastest aging country in the world. The increase in health expenditure is an inevitable problem in an aging country. We examined trend of benefit expenditure in National Health Insurance (NHI) by age group during 2001 to 2016. The benefit expenditure of NHI was 13.0 trillion won (2001) and 48.7 trillion won (2016); that is 3.76 times to 2001. This rapid increase was mostly due to people aged 65 and over. Proportion of beneficiaries aged 65 and over was 6.9% (2001) and 13.7% (2016), benefit expenditure per capita aged 65 and over was 279 thousand won (2001) and 960 thousand won (2016), and utilization days per capita aged 65 and over 21.44 (2001) and 30.23 (2016). This phenomenon was more pronounced in 75 or 85 aged and over. To contain the health costs for older people, the NHI system should be reformed.

• Journal of dental hygiene science
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• v.15 no.6
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• pp.703-711
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• 2015

The high dental treatment cost has been considered as one of the major reasons for inappropriate dental treatment in Korea. The aim of this study was to investigate the opinions of expansion of National Health Insurance (NHI) in dental treatment fields not covered with NHI and buying private dental insurance. This survey was carried out targeting 266 adults from their 30s to 50s with convenience sampling. The higher orders in stress of dental treatment cost were orthodontic treatment, dental implant, prosthodontic treatment, and caries treatment not covered with NHI. The higher orders in needs of expansion of NHI were caries treatment not covered with NHI, prosthodontic treatment, and orthodontic treatment. The agreement percentages with age restriction in NHI were scaling 57.1%, denture 23.3%, implant 14.3%, respectively. The subjective oral health had impact on the stress of dental treamtent cost and expansion on NHI. Although only 8.3% subjects had private dental insurance, 68.4% of the subjects had positive opinions buying private dental insurance. The correlation coefficients between stress of dental treatment cost and buying private dental insurance were implant 0.408, caries treatment not covered with NHI 0.404, denture 0.394, crown and bridge 0.375, and orthodontic treatment 0.313. Expansion of NHI in dental treatment and development of private dental insurance was suggested to treat dental disease in appropriate time.

• Health Policy and Management
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• v.18 no.4
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• pp.23-48
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• 2008

Although the universal health insurance, National Health Insurance (NHI), have improved access to health care and financial burden of health care costs for Koreans, limited coverage of the NHI leads to high out-of-pocket payment for health care. This study examines financial burden of household health expenditures by income level. Data from the Urban Household Expenditure Survey from 1985 through 2005 is analyzed and household expenditure is used as a proxy measure for income. Health expenditures include spending for inpatient care, ambulatory care and pharmaceuticals. If a household spends health expenditure above 40% of household consumption except for foods, that is defined as catastrophic health expenditure. Access to health care for the lowest income group had been improved for two decades relative to other income groups as well as in absolute term. However, both financial burden of health expenditures and the proportion of households that experienced catastrophic health expenditure had been increased in the lowest income group. Study findings have several policy implications. First, in terms of financial burden of health expenditures. the differences among income groups decreased until 2000 but it was worsen in 2005. This suggests that recent policies for extending NHI coverage are not enough to improve the disparity by income level. Second, a differential catastrophic coverage by income level would be an effective strategy that relieves financial burden for low income group. Third, since the catastrophic coverage is applied to only covered services by the NHI, additional strategy for uncovered services should be considered.