• Korea Journal of Hospital Management
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• v.26 no.3
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• pp.13-27
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• 2021

Purpose: We examined the relationship between operating income and volume of medical services provided at general hospitals in 2018 according to characteristics of general hospitals and measured as operating income(net income) and volume(adjusted inpatient days) covered or non-covered by National Health Insurance(NHI). Methodology: Finance data from income statement reports in 212 general hospitals and the national health insurance claim data of these hospitals were used. The characteristics of the general hospital were divided into structural, operational, financial, and patient aspects. Operating income and volume were divided into covered and non-covered by NHI. Findings: The results showed high volume hospitals tended to be more profitable than low volume hospitals, especially in non-covered services. Operating income was more likely to be sensitive to non-covered services volume than to covered services volume. Practical Implications: It is necessary to understand the volume of services in non-covered, in order to obtain reliable cost information to be used for the fee schedule. Researches on small size hospitals(<160 beds) are needed, with a large variation in the volume of services and a strong tendency to compensate for the loss in the covered part in non-covered part.

• Journal of Technologic Dentistry
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• v.34 no.4
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• pp.423-431
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• 2012

Purpose: The purpose of this study was to examine the recognition of dental technician's about including denture into the coverage of the national health insurance. Methods: This study carried out self-administered questionnaire survey from June 10, 2012 to June 20 by having research subjects as 230 dental technician. Except 22 copies with incomplete response, 208 copies were used as the materials of final analysis. Results: The recognition of dental technician on the national health insurance of denture was 48%, but there was a low recognition on the details. The rates of dental technician who approved of the inclusion of denture into the coverage of the health insurance respectively stood at 59%. Conclusion: The coverage of the health insurance should be extended to dental medicine in a manner to satisfy dental technicians, dental service providers and receivers. Also, further studies for the extending coverage of the details are needed.

• The Journal of the Korea Contents Association
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• v.14 no.1
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• pp.200-208
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• 2014

This study analyze long debate issues by the analysis of existing studies and the effect of private health insurance in the satisfaction of health service utilization. Then make developmental role of private health insurance. The analysis results of literatures, high-income earners are more subscriptions and the poor people in health status are excluded. Thus, enable private health insurance has the potential to lead the polarization of people. The medical use of private health insurance subscriber is more than non-subscriber and is likely to result in additional expenditure spending of public insurance. The contribution of private health insurance on improvement of the health option is clear. However, is not clear the contribution on health care quality improvement and health service customer satisfaction. The contribution on the national health care system efficiency of private health insurance is not clear. Private health insurance in the satisfaction of health service utilization is on effect. In short, supplementary private health insurance is desirable in our country.

• The Korean Society of Law and Medicine
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• v.13 no.1
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• pp.11-40
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• 2012

National Health Insurance Act has been enforced all over the People as part of the effort to assure the minimum constitutional human worth and dignity in the aspect of the right to pursue health for preventing misfortune that comes to death without even a chance to be received treatment for illness or injury. Meanwhile auto insurance is compulsory in certain parts in order to promote benefits of everyday life and the rapid recovery of the damage caused by traffic accident when one have negligently driven a car which has become the necessities in daily life. Any injured driver in a traffic accident can be treated by National Health Insurance without getting an auto insurance in various circumstances, but Article 3 paragraph 2 of Traffic Accident Act don't allow exception of criminal punishment when he has driven a car without license, drunken, or tresspassing the centerline, etc. When the injury occured by his own certain negligence is judged to 'when he has intentionally or through gross negligence caused a criminal conduct or intentionally contributed to the occurrence of an accident' of National Health Insurance Act, insurance benefits can be restricted. Such a restriction could harm the right to pursue happiness and health of People by depriving the poor, who cannot afford to pay, of chances to get treatment. Here we will see benefit restriction by 'gross negligence' of National Health Insurance Act Article 48 paragraph 1, which has largest portion of such restriction. It is desirable to delete 'gross negligence' clause from above paragraph and to interpret 'when' clause restrictively for diminishing confusion of interpreting and guaranteeing the right of health.

• Journal of Korean society of Dental Hygiene
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• v.16 no.2
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• pp.185-193
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• 2016

Objectives: The purpose of the study was to examine the recognition and satisfaction of dental care customers after 1 year national health insurance coverage of dental scaling. Methods: A self-reported questionnaire was completed by 477 dental care customers in Gyeongbuk, Busan, Yangsan, and Gyeonggido from July 18 to September 30, 2014 after receiving informed consents. The questionnaire consisted of general characteristics of the subjects(5 items), subjective awareness of oral health(4 items), recognition of scaling(5 items), and recognition and satisfaction of scaling health insurance(5 items). Data were analyzed using SPSS version 20.0 program. Results: Those who recognized the national health insurance coverage of dental scaling accounted for 80.1 percent and 47.2 percent of them got the health insurance coverage via media advertisements. Those who received the scaling service by health insurance coverage accounted for 73.8% and 66.2% of them were very satisfied with the service. Among the customers, 91.8% were satisfied with scaling health allotment. There was a statistical significance between scaling health insurance and subjective oral condition recognition(p<0.01). Through the health insurance coverage scaling service, the oral health in Korea will improve much. Conclusions: The expansion of health insurance coverage of scaling service will provide the universal oral health care for all people. Owing to low cost service, people will actively try to come in contact with public health service in the future.

• Journal of Society of Preventive Korean Medicine
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• v.10 no.2
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• pp.147-158
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• 2006

The purpose of this paper is to review the empirical study results of conversion factors(unit prices) for relative values of health care services in the national health insurance system and establish optimal classification of health care institutions for feasible contract of conversion factors between National Health Insurance Corporation(NHIC) and provider groups, based on legal backgrounds and types of health care service delivery system. some empirical research evidences shows the validity of applying multiple conversion factors to annual contract for reimbursement in the national health insurance. Policy recommendations suggest that clinic, hospital, general hospital, tertiary hospital, dental clinic, oriental medical clinic, pharmacy, and public health centers would be a basic category of provider groups for a meaningful price contract between the NHIC and providers.

• The Korean Journal of Health Service Management
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• v.6 no.4
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• pp.83-98
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• 2012

The objective of this study is to analyze the utilization patterns of national health insurance and medical aid inpatients in tertiary hospitals. For the analysis, the study utilize the nationwide data on '2010 Survey of Patients' of Ministry of Health & Welfare. The statistical methodology used in the study is the logistic regression model. This study has three major findings. First, utilization rate of national health insurance inpatients was higher than medical aid inpatients in tertiary hospitals. Second, the significant affecting demographic factors in utilizing tertiary hospitals were sex, age, surgery case, treatment result, inpatients residence region and short length of stay. Third, compared to other disease groups, the inpatients on 'congenital malformation, deformity and chromosomal abnormalities', 'factors influencing health status and contact with health services' and 'neoplasm' groups are more likely to utilize tertiary hospitals. Finally, according to residence region, Seoul residence inpatients in both of national health insurance and medical aid more likely to utilize tertiary hospitals than other region inpatients.

• Health Policy and Management
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• v.10 no.1
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• pp.57-94
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• 2000

Korea's social health insurance system was introduced in 1977, which has made a universal coverage possibly by July 1989. Korean government had pursued a single objective for the last decade to put the whole population under the coverage of medical security, and the objective was achieved within 12 years. The rapid accomplishment is primarily due to such factors as limited benefits, high copayment rate, low contributions as well as rapid economic growth. There are several sources of pressure for the implementation of social health insurance such as health professional group, labor unions, politicians, international organizations etc.. However it is important to look at the feasibility of social health insurance. Among other things, it is necessary to identify the administrative infrastructure of insurance system and to assess income for source of fund. As many developed countries, Korea began to apply health insurance to the employees of the large firms, and the expansion based on employment status. Thus the several funds system was inevitable according to the gradual expansion strategy. However many persons had criticized several funds system in respect with equity and efficiency aspects. In the short history of the Korean health insurance, whether one fund or sever or funds had been the most controversial issue. In Febrary 1999, the National Assembly passed the act of one fund system. From July 2000 separate funds will be unifed under new health insurance scheme. In this study we will analyze the policy making process on implementation, expansion and integration of health insurance system of Korea. And also analyse problems related to policy making.

• Health Policy and Management
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• v.33 no.2
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• pp.166-172
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• 2023

Background: To improve the support low-income individuals' medical expenses, it is necessary to think about ways to enhance the Catastrophic Health Expenditure Support Program. This study proposes expanding support criteria and changing the income standard. Methods: This study conducted simulations using national data from the National Health Insurance Service. Simulations performed for people who have used health services (n=172,764) in 2022 to confirm the Catastrophic Health Expenditure Support Program's size based on changes to the subject selection criteria. Results: As a result of the simulation with expanded criteria, the expected budget was estimated to increase between Korean won (KRW) 13.2 (11.5%) and 138.6 billion (37.4%), and the number of recipients increased between 41,979 (48.9%) and 150,317 (76.1%). The results of the simulation for the change in income criteria (applied to health insurance levels below the 50th percentile) estimated the expected budget to increase between KRW -8.9 (-7.8%) and 55.6 billion (15.0%) and the number of recipients to increase between -8,704 (-10.1%) and 41,693 (21.1%) compared to the current standard. Conclusion: The 2023 Catastrophic Health Expenditure Support Program's criteria were expanded as per the 20th Presidential Office's national agenda to alleviate the burden of medical expenses on the low-income class. In addition, The Catastrophic Health Expenditure Support Program needs to be integrated with other medical expense support policies in the mid- to long-term, and a foundation must be prepared to ensure the consistency of each system.

• Tuberculosis and Respiratory Diseases
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• v.64 no.5
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• pp.369-373
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• 2008

Tuberous sclerosis (TS) is an autosomal dominant disorder that is characterized by cutaneous lesions, seizures, mental retardation and hamartomas in various organs including the skin, kidney and brain. Pulmonary involvement is extremely rare, and occurs in approximately 0.1 to 1% of TS cases. Recent reports have indicated multiple micronodular pneumocyte hyperplasia (MMPH) as another rare form of pulmonary involvement of tuberous sclerosis. We report a case of a 35 year-old-male patient who had no pulmonary symptoms but showed multinodular pulmonary shadows on his chest CT scan. The patient was finally diagnosed with TS with MMPH of the lung. MMPH does not appear to have any malignant potential but the clinical significance of MMPH in TS patients is unknown.