• Journal of Chest Surgery
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• v.49 no.sup1
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• pp.28-36
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• 2016

Background: This study aimed to develop the models for regional cardiac surgery centers, which take regional characteristics into consideration, as a policy measure that could alleviate the concentration of cardiac surgery in the metropolitan area and enhance the accessibility for patients who reside in the regions. Methods: To develop the models and set standards for the necessary personnel and facilities for the initial management plan, we held workshops, debates, and conference meetings with various experts. Results: After partitioning the plan into two parts (the operational autonomy and the functional comprehensiveness), three models were developed: the 'independent regional cardiac surgery center' model, the 'satellite cardiac surgery center within hospitals' model, and the 'extended cardiac surgery department within hospitals' model. Proposals on personnel and facility management for each of the models were also presented. A regional cardiac surgery center model that could be applied to each treatment area was proposed, which was developed based on the anticipated demand for cardiac surgery. The independent model or the satellite model was proposed for Chungcheong, Jeolla, North Gyeongsang, and South Gyeongsang area, where more than 500 cardiac surgeries are performed annually. The extended model was proposed as most effective for the Gangwon and Jeju area, where more than 200 cardiac surgeries are performed annually. Conclusion: The operation of regional cardiac surgery centers with high caliber professionals and quality resources such as optimal equipment and facility size, should enhance regional healthcare accessibility and the quality of cardiac surgery in South Korea.

• The Journal of the Korean dental association
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• v.57 no.9
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• pp.496-503
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• 2019

A dental implant has been covered by National Health Insurance (NHI) in Korea since 2014. Every year the age group covered was extended and the out-of-pocket payment was decreased. This study analyzed the dental implant utilization rate by the National Health Insurance customized DB during the last 5 years. As a result, the utilization rate has been rapidly increasing steeply. The differences by age and sex in the utilization rate of dental implants were explored. The inclusion of a dental implant in the NHI system contributed to improving the dental accessibility of the elderly in Korea. However, a deep discussion is needed whether it is appropriately provided to necessary patients. The utilization rate will increase further in the future. Therefore, continuous monitoring and critical policy review should be continued.

• Journal of Periodontal and Implant Science
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• v.49 no.3
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• pp.158-170
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• 2019

Purpose: This study investigated the association between health status and tooth loss based on data from the National Health Insurance Service-Health Examinee Cohort in 2002-2015. Methods: Multivariate Cox proportional hazards regression analyses were applied to a longitudinal retrospective database, which was updated and newly released in 2018, to assess the association between health status and tooth loss while adjusting for potential confounders among sociodemographic and economic factors (sex, age, household income, insurance, and presence of disability), general and oral health status (body mass index [BMI], smoking and drinking status, periodic dental visits and scaling, and brushing before sleep), and comorbid disease (hypertension, diabetes mellitus [DM], and Charlson comorbidity index [CCI]). Results: Among 514,866 participants from a South Korean population, 234,247 (45.5%) participants satisfying the inclusion criteria were analyzed. In the adjusted multivariate analysis, sex, age, household income, insurance, presence of disability, BMI, smoking and drinking status, periodic scaling, tooth brushing before sleep, DM, and CCI showed statistically significant associations with the loss of at least 1 tooth. The risk of experiencing a loss of ${\geq}4$ teeth was associated with an increase in age (in those 50-59 years of age: hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.93-2.03; in those 60-69 years of age: HR, 2.93; 95% CI, 2.85-3.02; and in those 70-79 years of age: HR, 2.93; 95%, CI 2.81-3.05), smoking (HR, 1.69; 95% CI, 1.65-1.73), and DM (HR, 1.43; 95% CI, 1.38-1.48). Conclusions: The results of this study showed that the risk of experiencing tooth loss was related to multiple determinants. DM and smoking were especially significantly associated with tooth loss.

• Journal of Society of Preventive Korean Medicine
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• v.14 no.2
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• pp.57-66
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• 2010

Backgrounds : Since December 1, 2009, National Health Insurance began to reimburse for three physical therapies of Korean medicine. The extension of insurance coverage is demanded by Korean medicine societies. Objectives : This study aimed to measure the resource-based relative value scale (RBRVS) scores for thirty four physical therapies of Korean medicine and to estimate the insurer's expenditure for them in National Health Insurance. Methods : To measure the physician's work and the practice expense, the 'magnitude estimation method (MEM)' and the 'fully distributed cost - attributable cost method (FDC-ACM)' were applied respectively. We collected the frequency data of physical therapies from Korean medicine hospitals and clinics to estimate the total expenditure. Results : The resource-based relative value scale scores of physical therapies were measured from 23.44 to 160.66. Total insurer's expenditure was calculated to be 95.5 billion won as of 2009. Conclusions : Based on the result that showed minor increase of total expenditure, most physical therapies of Korean medicine need to be reimbursed in the National Health Insurance.

• Journal of the Architectural Institute of Korea Structure & Construction
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• v.35 no.1
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• pp.29-36
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• 2019

In the past, social insurance premiums, such as national pension and national health insurance, is contained within the costs of construction projects, have been lowered due to price competition of companies participating in the bidding. The government is implementing the "Ex-post settlement system" to improve the problem. Therefore, the purpose of this study is to examine the concept of an Ex-post settlement system and background of its introduction and to identify problems in the management of the system. The problems of the Ex-post settlement system are: 1) avoiding the participation of construction workers, 2) the rigidity of the insurance premium settlement method in construction field, and 3) the cause of direct construction cost reduction. The ways to improve these problems are: 1) excluding social insurance premiums from construction project cost, 2) securing flexibility of the settlement method of insurance premiums in construction field, and 3) expanding the scope of persons eligible to participate in social insurance.

• Journal of Preventive Medicine and Public Health
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• v.33 no.2
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• pp.150-156
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• 2000

Objective : To analyze the factors affecting the participation rate in the health screening program of medical insurance. Method : We investigated the factors associated with the participation rate in the health screening program in Korea. Data were collected at the aggregate level from 145 employee health insurance societies and 227 self-employed health insurance societies from 1995 to 1997 Data were also collected at the individual level from four health insurance societies. This study hypothesized that the participation rate of the health screening program was related to 1) the characteristics of its members and the size of the health insurance society; 2) the specifications of the health screening program; 3) the venue of the health screening institution and the interests of individuals in the health screening program; and 4) the activities of the health insurance society. We used bivariate and multiple regression models to examine the factors on the participation rate of the health screening program. Results : First, in the case of dependents of on employee health insurance society, the ratio of dependents 40 years old and over, the average monthly contribution per household, the interest and satisfaction level of individuals in health screening, and the level of refunds for over-payment were all associated with the participation rate in the health screening program, accounting for 54.4% of the participation rate. Second, in case of those insured by the self-employed health insurance society, the interest and satisfaction level of individuals in health screening, the level of refunds for over-payment, and the performance level of on-the-spot health screening were statistically significant, accounting for 40.1% of the participation rate. Conclusion : The factors concerning the participation rate in the health screening program of medical insurance, in both a health insurance society and for individuals, were closely related to the age and gender of individuals and household contributions.

• Journal of Korean society of Dental Hygiene
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• v.16 no.4
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• pp.539-548
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• 2016

Objectives: The purpose of the study is to investigate the awareness and attitude toward health insurance coverage extension to scaling in dental service consumers. Methods: A self-reported questionnaire was completed by 349 adults in Jeonbuk from May 4 to 15, 2015. The questionnaire consisted of general characteristics of the subjects (7 items), Awareness of the dental health insurance system(8 items), Health insurance system coverage extension to scaling(8 items), Self-perception of oral health(7 items), Recognition toward yearly scaling benefit(10 items). Results: There were significant differences according to age in opinions on the appropriateness of the frequency of yearly scaling benefit, and the respondents who were in their 20s, who were unmarried and who brushed their teeth three times a day had significantly different opinions on the appropriateness of the fee of yearly scaling benefit. Their opinions on the expansion of scaling benefit was significantly affected by age. It implies that scaling should be added to the coverage list of the national health insurance in every age group since there is an increase in periodontal diseases with age. Concerning awareness of dental health insurance policy, the better-educated respondents took a better view of this system as they showed a more positive interest in its policies and shifts. Conclusions: It is desirable to provide more precise information as to eligible age, frequency and cost through public promotion of health coverage of scaling, and the effort to improve the health insurance coverage policy should be made in order to extend the scope of health coverage of scaling in the near future.

• Journal of Preventive Medicine and Public Health
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• v.43 no.3
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• pp.245-256
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• 2010

Objectives: This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. Methods: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). Results: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI = 0.43 - 0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb${\geq}$11 g/dL, blood pressure within the range of 100-140 /60-90 mmHg, calcium x phosphate${\leq}$55 $g^2/dL^2$ and albumin${\geq}$4 g/dL were not significantly different between the groups. Conclusions: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.

• Journal of Sasang Constitutional Medicine
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• v.23 no.1
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• pp.8-11
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• 2011

1. Objectives: Sixty eight kinds of single herbal medicine extracts and fifty six kinds of mixed herbal medicine extracts have been used under a national health insurance since 1987. The number of herbal medicine extracts under an insurance coverage remains unchanged. The demand for covering complex herbal medicine extracts and Sasang Constitutional medicine extracts in a national health insurance increases. This study is to investigate the needs for the insurance coverage. 2. Methods: Advantages and disadvantages between herbal medicine decoction and extracts were explained and Sasang Constitutional medicine extracts according to Sasang constitution were surveyed in production nowadays. 3. Results: Herbal medicine decoction has many advantages of treating patients but herbal medicine extracts have advantages of the rapid adminstration and being easy to carry. From eleven to twenty two products of Sasang Constitutional medicine extracts have been in production in several factories. There are eleven kinds of Soyangin medicine extracts, nine kinds of Taeeumin medicine extracts and five kinds of Soeumin medicine extracts. 4. Conclusions: Complex herbal medicine extracts and Sasang Constitutional medicine extracts have to be in use under a national health insurance as soon as possible.

• Health Policy and Management
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• v.33 no.3
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• pp.355-362
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• 2023

Background: Financial efficiency in monetary units and operational efficiency in non-monetary units are separately classified and evaluated. This is done to prevent the duplication of monetary units and non-monetary units in inputs and outputs. In addition, analyses are conducted to determine the factors that affect each aspect of efficiency. To prevent duplication of monetary and non-monetary units in inputs and outputs, financial efficiency, consisting of monetary units, and operational efficiency, comprising non-monetary units, are separately classified and evaluated. Furthermore, an analysis is conducted to identify the factors that affect each aspect of efficiency. Methods: This study conducted a panel analysis of 34 regional public hospitals and influencing factors on efficiency for 5 years from 2015 to 2019. Financial efficiency and operational efficiency were calculated through data envelopment analysis. Moreover, multiple regression analysis was conducted to identify the factors that influence both financial efficiency and operational efficiency. Results: The factors that affect financial efficiency include the number of medical institutions within the treatment area and the ratio of patients receiving medical care. Additionally, operational efficiency is influenced by the type of medical institution, the number of medical institutions within the treatment area, and the number of nursing positions per 100 beds. Conclusion: In order for regional public hospitals to faithfully fulfill their functions and roles as regional base public hospitals, several measures are necessary. Firstly, continuous monitoring and reasonable support are required to ensure efficient operation and performance. Secondly, a financial support plan tailored to the characteristics of local medical centers is needed. Additionally, local medical centers should strive to enhance their own efficiency.