• Journal of Gastric Cancer
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• 제13권4호
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• pp.247-254
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• 2013

Purpose: In Korea, the entire population must enroll in the national health insurance system, and those who are classified as having a lower socioeconomic status are supported by the medical aid system. The aim of this study was to evaluate the association of the medical insurance status of gastric cancer patients with their survival after gastrectomy. Materials and Methods: A total of 247 patients who underwent surgical treatment for gastric cancer between January 1999 and December 2010 at the Seoul Medical Center were evaluated. Based on their medical insurance status, the patients were classified into two groups: the national health insurance registered group (n=183), and the medical aid covered group (n=64). The survival rates were calculated using the Kaplan-Meier method. Results: The median postoperative duration of hospitalization was longer in the medical aid covered group and postoperative morbidity and mortality were higher in the medical aid group than in the national health insurance registered group (P<0.05). The overall 5-year survival rate was 43.9% in the medical aid covered group and 64.3% in the national health insurance registered group (P=0.001). Conclusions: The medical insurance status reflects the socioeconomic status of a patient and can influence the overall survival of gastric cancer patients. A more sophisticated analysis of the difference in the survival time between gastric cancer patients based on their socioeconomic status is necessary.

• Journal of Preventive Medicine and Public Health
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• 제42권1호
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• pp.5-11
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• 2009

Objectives : This study was conducted to estimate the socioeconomic cost of injuries in South Korea. Methods : We matched claims data from national health insurance, automobile insurance and industrial accident compensation insurance(IACI), and mortality data obtained from the national statistical office from 2001 to 2003 by patients unique identifier. Socioeconomic cost included both direct cost and indirect cost: the direct cost was injury-related medical expenditure and the indirect cost included loss of productivity due to healthcare utilization and premature death. Results : The socioeconomic cost of injuries in Korea was approximately 1.9% of the GDP from 2001 to 2003. That is, 12.1 trillion KRW(Korean Won) in 2001, 12.3 trillion KRW in 2002, and 13.7 trillion KRW in 2003. In 2003, direct medical costs were 24.6%(3.4 trillion KRW), the costs for loss of productivity by healthcare utilization were 13.0%(1.8 trillion KRW), and the costs for loss of productivity by premature death were 62.4%(8.6 trillion KRW). Conclusions : In this study, the socioeconomic cost of injuries in Korea between 2001 and 2003 was estimated by using not only health insurance claims data, but also automobile insurance, IACI claims and mortality data. We conclude that social efforts are required to reduce the socioeconomic cost of injuries in Korea, which represented approximately 1.9% of the GDP for the time period specified.

• 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.

• 한국콘텐츠학회논문지
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• 제11권4호
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• pp.263-272
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• 2011

본 연구는 국내외 문헌고찰을 통하여 건강보험과 산재보험, 자동차보험을 중심으로 선진국의 국민의료비 관리제도를 살펴보고, 우리나라 국민의료비 관리제도의 문제점을 파악하여 올바른 국민의료비 관리방안을 제안하는데 목적이 있다. 분석결과 첫째, 선진국의 경우 국민의료비를 단일기관에서 통합해 운영하면서, 동일한 수가와 급여기준을 가지고 운영하고 있었다. 즉, 의료비 발생원인에 관계없이 동일한 기관에서 동일한 기준으로 통합관리하고 있었다. 둘째, 우리나라의 경우 국민의료비를 보험제도별로 다른 기관에서 분리운영하면서, 서로 다른 의료비 심사·평가, 수가를 적용하고 있었다. 이로 인해 동일증상과 상병임에도 불구하고 관리주체에 따라 의료이용량의 차이가 매우 컸다. 이러한 문제를 근본적으로 해결하기 위해서는 의료비발생의 원인이 무엇이든지 하나의 기관에서 동일한 수가체계와 기준에 근거해 통합관리해야 한다.

• 대한치과의사협회지
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• 제50권7호
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• pp.407-419
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• 2012

The aim of this study was to investigate the recognition on the national health insurance and the actual condition of denture among the elderly in Seoul city. This survey was performed on 710 of the elderly aged over 60 years and visited the senior welfare centers. The recognition of the elderly on the national health insurance of denture was 61.7%, but there was a low recognition on the details. The elderly had started using dentures from 66.24 years old. The average used period of the past denture was 7.09 years. In conclusions, the provider is required to promote the insurance coverage of denture to increase the coefficient of utilization of the elderly. Also, further studies for the extending coverage of the details are needed.

• 보건행정학회지
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• 제24권3호
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• pp.261-270
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• 2014

Background: This study examined what factors affected a complete examination of infant health checkup. Methods: We used Korean national health insurance claim data of 2,936,650 infants, taking examination in 2012. These claim data included enrollment status of householders and records of infant health checkup from 2008 to 2013. Results: Our results shows that for infant characteristics, the likelihood of complete examination of infant health checkup is significantly lower in female, older aged, and handicapped ones. For householder characteristics, the likelihood of complete examination of infant health checkup is also significantly lower in female, older group and self-employed ones. For household characteristics, the likelihood of complete examination is also significantly lower in single-parent families, multi-cultural families, parent with unexperienced health checkup and lower monthly premiums. Conclusion: It is necessary to support an additional use-guide and follow-up management services to improve incomplete examination of infant health checkup.

• Journal of health informatics and statistics
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• 제43권4호
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• pp.318-328
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• 2018

Objectives: People are living longer, but often with diseases or chronic conditions. As a consequence, interest in resolving insurance blind spots is growing. This study provides substandard risk-relevant statistics to help substandard risks who are likely to fall in insurance blind spots obtain insurance coverage, such as the reimbursement of medical costs, as well as to stimulate insurance product development. Methods: This study uses National Health Insurance Service (NHIS) cohort data to determine the relevant statistics. The incidence rates of severe diseases are derived and compared against standard risks to establish a set of relative risk factors. These incidence rates of standard and substandard risks are then compared. Results: Currently, an individual's cancer history is used in the underwriting process for simplified issue insurance. However, underwriting focusing on hospitalization and procedures related to serious illnesses could lower premiums for substandard risks. Moreover, the statistical results could be used to expand the coverage of health insurance products. Conclusions: This study's relative risk factors can be used to derive simplified issue premium rates for substandard risks. They can also be used to implement discount and loading schemes for medical reimbursement insurance and help insurance companies implement proactive risk management.

• Environmental Analysis Health and Toxicology
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• 제30권
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• pp.12.1-12.7
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• 2015

Objectives In South Korea, health insurance data are used as material for the health insurance of national whole subject. In general, health insurance data could be useful for estimating prevalence or incidence rate that is representative of the actual value in a population. The purpose of this study was to apply the concept of episode of care (EoC) in the utilization of health insurance data in the field of environmental epidemiology and to propose an improved methodology through an uncertainty assessment of disease course and outcome. Methods In this study, we introduced the concept of EoC as a methodology to utilize health insurance data in the field of environmental epidemiology. The characterization analysis of the course and outcome of applying the EoC concept to health insurance data was performed through an uncertainty assessment. Results The EoC concept in this study was applied to heat stroke (International Classification of Disease, 10th revision, code T67). In the comparison of results between before and after applying the EoC concept, we observed a reduction in the deviation of daily claims after applying the EoC concept. After that, we categorized context, model, and input uncertainty and characterized these uncertainties in three dimensions by using uncertainty typology. Conclusions This study is the first to show the process of constructing episode data for environmental epidemiological studies by using health insurance data. Our results will help in obtaining representative results for the processing of health insurance data in environmental epidemiological research. Furthermore, these results could be used in the processing of health insurance data in the future.

• 대한족부족관절학회지
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• 제9권2호
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• pp.184-187
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• 2005

Purpose: To evaluate the efficiency of fibular groove deepening and superior retinacular reconstruction for peroneal tendon subluxation. Materials and Methods: Six patients who were treated by fibular groove deepening and superior retinacular reconstruction for peroneal tendon subluxation from March 2000 to August 2004 were reviewed retrospectively. Results: No recurrent subluxation of peroneal tendons had occurred. All patients were return to sports by 4 months after surgery and also gained nearly normal range of motion. Five patients were completely pain free, but one patient had mild occasional pain that limit his sports activities. Conclusion: Fibular groove deepening and superior retinacular reconstruction was believed to be a reliable procedure for peroneal tendon subluxation in spite of some minor complications.

• 대한두경부종양학회지
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• 제27권2호
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• pp.230-233
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• 2011

Head and neck abscess usually requires hospitalization, intravenous antibiotic therapy, and surgical incision and drainage. Open surgical drainage may result in unsightly scars. We report two cases of a 56-year-old man with a facial abscess and a 47-year-old man with a parotid abscess. The patients were successfully treated with ultrasound-guided angiocatheter irrigation and drainage without scar. Ultrasound-guided angiocatheter irrigation and drainage can be a simple, safe and effective alternative procedure to open surgery in the management of the selected head and neck abscesses.