• 보건행정학회지
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• 제30권2호
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• pp.192-198
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• 2020

Background: Korea National Health Insurance Service (NHIS) is operated as a social insurance system in which people pay a portion of their monthly income as insurance premiums and receive benefits when they experience illness or injury. Since 2005, the national health insurance remained surplus accumulating cumulative reserves each year. However, as of 2018, NHIS revenue recorded 62.11 trillion won and spending of 62.29 trillion won. The deterioration of NHIS finances is expected to accelerate with the aging population, income growth, new medical technology development, and enhanced security policies. Methods: To examine the financial health and sustainability of NHIS, we estimated the future revenue and spending until 2030 using the data from Korea Health Insurance Review and Assessment Service statistical yearbook. 2004-2018 average percentage change in NHIS revenue and spending was calculated. We estimated the future NHIS financial status using two methods. In the first method, we calculated the revenue and spending of the future NHIS by applying the 2004-2018 average percentage change to the subsequent years consecutively. In the second method, we estimated the future NHIS financial status after adjusting for the predicted demographic changes such as the aging population and declining birth rate in South Korea. Results: The estimates from this study suggest that the NHIS's cumulative reserves will run out by 2024. Conclusion: In terms of spending on current health insurance, there should be a search for ways of more efficient spending and funding options.

• 한국치위생학회지
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• 제18권5호
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• pp.771-783
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• 2018

Objectives: This study aimed to identify methods that help medical consumers to be aware of relevant information regarding changes in dental health insurance policy. Methods: The following results were obtained from a survey regarding awareness and satisfaction with dental health insurance policy among the general public aged 20 years or older in Seoul, Gyeonggi Province, and other areas from August 1, 2017 to August 23, 2017. Results: The correlation between adults' awareness of and satisfaction with dental health insurance was 0.471, where satisfaction with dental health insurance was enhanced with increasing awareness of dental health insurance (p<0.001). Factors that significantly affected awareness of dental health insurance were marriage (married p<0.05), medical service (dental university hospital, p<0.01), and satisfaction with dental health insurance (p<0.001); these factors explained 29.2% of the variance. Factors that significantly affected satisfaction with dental health insurance were final education (high school graduation, p<0.05), medical service (dental hospital, p<0.05), and awareness of dental health insurance (p<0.001); these factors explained 27.8% of the variance. Conclusions: Importantly, awareness of the government's operation of dental health insurance and the benefits of such dental health insurance were low, suggesting that the government and national health insurance agency should improve the level of transparency in dental health insurance operations and continuously promote dental health insurance benefits to the public.

• 대한두경부종양학회지
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• 제39권1호
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• pp.15-18
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• 2023

A plunging ranula is a pseudocyst caused by mucus secreted from the sublingual glands, and it is mainly observed on the mouth floor. Nowadays, sclerotherapy using picibanil has been performed instead of invasive surgical treatment, and studies are reporting safe and effective outcomes. In our study, more than 92% of the 25 patients had marked response after picibanil sclerotherapy, and no serious complications were observed. Picibanil sclerotheraphy can be considered as the primary treatment of plunging ranula for patients who refuse surgery under general anaesthesia.

• 지역사회간호학회지
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• 제23권4호
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• pp.415-426
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• 2012

Purpose: This study aimed to investigate trends in home-visit nursing care by agencies' characteristics under the national long-term care insurance system. Methods: Cochran-Mantel-Haenzel tests were conducted, using data drawn from the nationwide long-term care insurance claim database of the Korean National Health Insurance Corporation from 2009 to 2011. Results: The number of home-visit nursing care agencies has decreased continuously since 2009. There were also similar trends in the total amount of service provided by home-visit nursing care agencies, the number of recipients, the number of employees, and payments. This study showed that there were statistically significant differences in the trends in home-visit nursing care by agencies' characteristics. Despite the overall downward trend, there were some increases in the percentage of home-visit nursing care provided by agencies which were established by individuals, located in large cities, and which combined home-visit care with home-visit bathing. Conclusion: Home-visit nursing care agencies are responsible for providing community-based healthcare services. For past three years, however, they have not been utilized to their full potential. Understanding the trends in home-visit nursing care by agencies' characteristics is important to develop utilization strategies for home-visit nursing care.

• 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.

• Journal of Preventive Medicine and Public Health
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• 제50권5호
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• pp.294-302
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• 2017

Objectives: The objectives of this study were to investigate the agreement between medical history questionnaire data and claims data and to identify the factors that were associated with discrepancies between these data types. Methods: Data from self-reported questionnaires that assessed an individual's history of hypertension, diabetes mellitus, dyslipidemia, stroke, heart disease, and pulmonary tuberculosis were collected from a general health screening database for 2014. Data for these diseases were collected from a healthcare utilization claims database between 2009 and 2014. Overall agreement, sensitivity, specificity, and kappa values were calculated. Multiple logistic regression analysis was performed to identify factors associated with discrepancies and was adjusted for age, gender, insurance type, insurance contribution, residential area, and comorbidities. Results: Agreement was highest between questionnaire data and claims data based on primary codes up to 1 year before the completion of self-reported questionnaires and was lowest for claims data based on primary and secondary codes up to 5 years before the completion of self-reported questionnaires. When comparing data based on primary codes up to 1 year before the completion of selfreported questionnaires, the overall agreement, sensitivity, specificity, and kappa values ranged from 93.2 to 98.8%, 26.2 to 84.3%, 95.7 to 99.6%, and 0.09 to 0.78, respectively. Agreement was excellent for hypertension and diabetes, fair to good for stroke and heart disease, and poor for pulmonary tuberculosis and dyslipidemia. Women, younger individuals, and employed individuals were most likely to under-report disease. Conclusions: Detailed patient characteristics that had an impact on information bias were identified through the differing levels of agreement.

• 보건행정학회지
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• 제19권2호
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• pp.36-50
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• 2009

Korean Government had performed three pilot programs to introduce the long term care insurance system. Persons aged 65 or older who are dependent on others for daily living could use long term care services in the pilot program. The long-term care insurance covered nursing home services, home care services and cash benefits. The cash benefits are included that for elderly at home and for patients in geriatric hospital. This study investigated whether there had been any change in the medical care utilization according to cash benefits for geriatric hospitalization. This study used National Health Insurance claims and Long term Care Insurance claims 2003 through 2006. Data were composed of subjects who undertook both insurance coverage. The subjects was divided into two groups. Case group included participants with the cash benefits of geriatric hospitalization. Control group included persons without the cash benefits selected by random sampling according to the distribution of case group. This study showed that the amount of medical care utilization of the case group is more significantly increased than the control group after adjusted their health condition and functional condition. This result will be helpful for making decisions on whether the cash benefit of geriatric hospitalization can be introduced into long term care insurance system.

• 보건의료산업학회지
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• 제6권2호
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• pp.165-177
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• 2012

This study examined market size of private health insurance premium and individual characteristics associated with the market size change in Korea, using wave 1 (2008) and wave 2 (2009) of Korea Health Panel. The market size was 24.4 trillion Korean won in 2008 and 26.9 trillion in 2009. The increase rate of private health insurance premium among those who were the elderly, single, or the poor was higher than that among their counterpart respectively. Health status and utilization were insignificant in determining the increase rate of private health insurance premium. These findings were more obvious among the uninsured in 2008 than among the insured in 2008. The increase of private health insurance premium in Korea imply the increase of willingness-to-pay for health risk through private sector. The authors suggest policy intervention for accessability to health care for the underprivileged and weak through enlargement of Korean social health insurance benefit.

• 한국병원경영학회지
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• 제15권4호
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• pp.1-26
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• 2010

We achieved both industrialization and democratization during the shortest period in the world. We also achieved good performance in national health insurance: universal coverage, solidarity in financing, equitable access of health care. However, national health insurance system has faced the problem of sustainability: various expenditure and financing problems. The problem of sustainablity has two facets of economic sustainability and fiscal sustainability. Economic sustainability refers to growth in health spending as a proportion of gross domestic product(GDP). Rapid increasing rate of health spending exceeds the growth rate of domestic product. Growth in health spending is more likely to threaten other areas of economic activity. Concern on fiscal sustainability relates to revenue and expenditure on health care. Health care financing face demographic and technical obstacles. Democratic obstacle is aging problem. Technical obstacle is collection of contribution. Expenditure of health care has various problems in benefit structure and efficiency of health care system. In this article, I suggest several policy reforms to enhance sustainability: generating additional revenue from value added tax, changing method of levying contribution, increasing efficiency of health care system by introducing the competition principle. restructuring of benefit scheme of health insurance. contracting with health care institutions to provide health care services.

• 보건행정학회지
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• 제21권4호
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• pp.585-598
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• 2011

This study was conducted to examine the trend of national health insurance service use with relation to pregnancy, childbirth, and the puerperium among pregnant and postpartum women older than 35 over the last decade. A descriptive analysis was conducted, using the data which were drawn from the "nationwide claim database of Korean National Health Insurance Corporation(NHIC)". Data were composed of the total cases related to pregnancy, childbirth, and the puerperium (International Classification of Disease, $10^{th}$revision [ICD-10] codes O00-O99) from 2001 to 2008. During 2001-2008, the number of pregnant and postpartum women older than 35 had continuously increased and the percentage of them also had increased in both hospital and ambulatory care. There are similar trends in their total use of national health insurance service and total expenditure. According to demographic characteristics, there was the biggest increase of the percentage in residents in large cities, self-employed workers, ones in the highest income level. According to ICD-10 codes, there was the biggest increase of the percentage in O10-O16 (oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium). According to the major prevalent disease, there was the biggest increase of the percentage in O60 (preterm labor and delivery). Throughout the past decade, the necessity has been emphasized of supporting pregnant and postpartum women older than 35. But in maternal and child health care, they are in an early stage of development. The findings of this study would be helpful in developing the support programs for the aged pregnant and postpartum women.