• 한국노년학
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• v.32 no.2
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• pp.467-485
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• 2012

National Health Insurance Corporation initiated Home and Community Long-term care Agency Quality Assessment(HCLA-QA) program in 2010. This study aims to explore long-term care agencies' perceptions and attitudes toward HCLA-QA program, focused on the home-visit care agencies. Total 473 agencies completed the questionnaires(response rate 13.6%), using the e-mail and fax survey methods with high-capacity web-fax server of NHIC. On the results of this study, we found the agencies' different perceptions and attitudes on HCLA-QA program according to their quality ratings as QA results. Compared to the agencies with low quality ratings, the agencies with high quality ratings tend to have more time for preparation, better understandings about HCLA-QA program, more positive perceptions that quality indicators generally are valid, and more affirmative attitudes that the notifications of QA results are helpful for agencies. Our findings can be very useful for establishing strategies for improving the HCLA-QA program. The policy makers, the insurer, and the agencies need to consider the opinions of the agencies with high quality ratings as well as the ones with low quality ratings.

• The Korean Journal of Applied Statistics
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• v.22 no.6
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• pp.1229-1237
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• 2009

In the long-term care insurance(LTCI) system, the question of how to provide the most appropriate care has become a major issue for the elderly, their family, and for policy makers. To help beneficiaries use LTC services appropriately to their needs of care, National Health Insurance Corporation(NHIC) provide them with the individualized care plan, named the Long-term Care User Guide. It includes recommendations for beneficiaries' most appropriate type of care. The purpose of this study is to develop a recommending system for care plan(Res-CP) in LTCI system. We used data set for Long-term Care User Guide in the 3rd long-term care insurance pilot programs. To develop the model, we tested four models, including a decision-tree model in data-mining, a logistic regression model, and a boosting and boosting techniques in an ensemble model. A decision-tree model was selected to describe the Res-CP, because it may be easy to explain the algorithm of Res-CP to the working groups. Res-CP might be useful in an evidence-based care planning in LTCI system and may contribute to support use of LTC services efficiently.

• Research in Community and Public Health Nursing
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• v.20 no.2
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• pp.134-142
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• 2009

Purpose: This study was to present the process of web-based educational program (WEP) development and to identify factors affecting satisfaction with WEP for the certificate of healthcare managers working at the National Health Insurance Corporation (NHIC). Methods: Subjects were healthcare managers and voluntary participants of WEP. A total of 1,449 respondents were surveyed through an online questionnaire about their satisfaction with the educational contents and system. Results: The mean contents satisfaction was 3.75 (SO 0.54), and system satisfaction 4.68 (SD 0.54). According to statistical analysis, the type of certification, experience and professional career of health care management affected contents satisfaction. And factors affecting system satisfaction were the type of certification and gender. Conclusion: WEP was utilized as a pre-requisite course for the certificate program of healthcare managers. However, the development of advanced WEP is suggested to meet the educational needs of healthcare managers who have certificate or license and their job related to healthcare management.

• Health Policy and Management
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• v.19 no.1
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• pp.1-30
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• 2009

Korean medical fee contract system between the insurer and healthproviders was introduced in 2000. However, a continuous discord among contracting parties concerned and an irrational operation of an arbitration committee of Ministry for Health, Welfare and Family Affairs (MIHWAF) have made it difficult for them to reach to an agreement over last 8 years. The purpose of this study is to observe the current problems of contract system from the view of health insurance law and actual examples. Furthermore, I examined the of breakdown of negotiation by analyzing the eligibility of contracting parties, rationality of Resource Based Relative Value System (RBRVS) and contracting method and fairness of arbitration method in case of negotiation rupture. The results were as follows: First, since the introduction of medical fee contract system, there has been a problem in that both the president of National Health Insurance Corporation (NHIC) and health care provider association have not held strong negotiation power. Second, the frequent changes and notifications of Relative Value Units (RVUs) without any mutual consent between the insurer and provider association negatively have influenced the conversion factors and finally hindered the agreement of contract. Third, a current process that the conversion factors are mediated and determined at the arbitration committee of MIHWAF in the case of contract breakdown between contracting parties has some flaw in that the irrational composition of committee provoked the lack of fairness and objectivity of mediation. Fourth, we can not prospect a satisfactory outcome of arbitration committee because the mediation always has failed to proceed smoothly due to boycott of both committee members from insurer and providers over last 8 years. As a result, we have to make an every effort to resolve problems mentioned above and then dream of an advanced national health insurance system.

• Korean Journal of Social Welfare Studies
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• v.44 no.3
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• pp.421-450
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• 2013

One of the challenging tasks of the National Health Insurance Corporation(NHIC). the only public insurance institution administrating the Korea's compulsory national health insurance(NHI) system, is to make those NHI beneficiaries who fail to make a scheduled monthly premium payment to pay. For this purpose, the NHIC has been using a measure known as 'Benefit Limit Measure(BLM)' in which those who miss premium payment for six or more month's in total are classified as 'late payer' and are sent warnings and late payer status notices. If the late payers fail to make a full payment of missed premiums even after receiving the written notices, the NHIC can order a temporary seizure of the late payer's property until all missed premiums plus interest are paid. Recently, the BLM has been criticized by the public of its cruel nature, and its effectiveness has been questioned because no empirical evidence has been collected. In this study, the authors using the NHIC data set attempted to analyze the effectiveness of the BLM. Those late payers for whom the BLM was administered were compared to those not in terms of the likelihood of paying missed premium payments with a series of logistic regression analyses models. Data analyses results showed that the likelihood of paying one or more month's unpaid premium of the former group was 14 to 46 times higher than the latter. It, however, was also found that the BLM was only effective to make no more than 12% of the late payers to pay at all. Based on the study findings, the authors made a few recommendations regarding the BLM.

• Research in Community and Public Health Nursing
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• v.14 no.4
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• pp.559-567
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• 2003

Background: We first launched the case management program for diabetic patients who were registered in NHIC (National Health Insurance Corporation) in Korea and conducted this study to assess the effectiveness of the program. Methods: During the period from October in 2002 to March in 2003, 30 case managers performed the program for 71 diabetic patients. We evaluated the effectiveness of the program based on the results of fasting blood sugar level, two hour post-prandial blood sugar level, knowledge for diabetes, difficulty index in diabetes management, and the health risk factor changes of them. We analyzed results related to these factors through $x^2$ test and paired t-test. Results: The ave rage age of the subjects was 58.9. and the numbers of women and men were 43 and 28 respectively. The fasting blood sugar level and two hour post-prandial blood sugar level decreased from 164.3mg/dl to 146.5mg/dl and from 224.0mg/dl to 203.0mg/dl respectively. The knowledge for diabetes and difficulty index in diabetes management changed from 8.13 to 9.10 and from 3.52 to 2.91 respectively, and these changes were the positive. We observed improvement in self-test of sugar level, foot management, oral hygiene and proper medication but not in self-test of nutritional management. Conclusions: This study revealed that the case management program for diabetic patients who were registered in NHIC is significantly effective. However, the program need to study further to understand its long-term effects.

• Korean Journal of Clinical Laboratory Science
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• v.42 no.2
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• pp.92-96
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• 2010

The National Health Insurance Corporation (NHIC) was performed population health checkup survey program with especially two target ages, 40 years and 66 years old that were called as "life transition period" for national collective prophylaxis of cardiovascular diseases in Korea. We were investigated and compared between two age groups with the serum levels of cholesterol and triglyceride from data of the survey in Daegu province, Korea at April, 2007. Data of one hundred persons per each age (40 years and 66 years old) were collected and investigated for risk factors for chronic degenerative diseases including serum lipid concentration, health habits of drinking, smoking, exercise etc. In spite of the definite difference of life transition of the each age, the transition from adolescence to adulthood at 40 years old, and from adulthood to senescence at 66 years old, there were no significant difference of total cholesterol and triglyceride between two age groups.

• Journal of Preventive Medicine and Public Health
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• v.38 no.1
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• pp.93-100
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• 2005

Background : Cancer is the leading cause of death and one of the largest burdens of disease in Korea. In 1996, the Ten year Plan for Cancer Control was formulated and the government then adopted the plan as a national policy. As part of this plan, the National Cancer Screening Program (NCSP) for Medicaid recipients was formulated, and the government adapted this in 1999. For low-income beneficiaries of the National Health Insurance Corporation (NHIC), the screening program has been in place since 2002. In 2002, the target cancers of NCSP were stomach, breast and cervical cancer. This study was conducted to examine the relationships between the participation rate, the abnormal screening rate and the socio-demographic factors associated with participation in the screening program. Methods : To analyze the participation rate and abnormal rate for the NCSP, we used the 2002 NCSP records. The information on the socio-demographic factors was available from the database of the beneficiaries in the NHIC and Medicaid. Results : The participation rate of the Medicaid beneficiaries for the stomach, breast and cervical cancer screening were 9.2%, 15.5% and 15.0%, respectively, and 11.3% and 12.5%, except cervical cancer which wasn't be included in the NCSP, for the beneficiaries of the NHIC. The abnormal rate of stomach, breast and cervical cancer screening were 25.7%, 11.2% and 21.0%, respectively, for the beneficiaries of Medicaid and 42.6% and 19.4% for the beneficiaries of the NHIC. On the multiple logistic regression analysis, gender, age and place of residence were significantly associated with participation rates of the NCSP. For stomach cancer, women participated in the NCSP more than men. The participation rate was higher among people in their fifties and sixties than for those people in their forties and those people over seventy years in age. For the breast and cervical cancer, people in their fifties were more likely to participate in the NCSP than people in their forties and people over sixty. For the place of residence, people in the rural areas participated more than those people in any other places. Conclusions : The above results show that the participation rate and abnormal rate were significantly associated with the socio-demographic factors. To improve the participation rate for the NCSP, more attention should be given to the underserved groups.

• Korean Journal of Health Education and Promotion
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• v.27 no.2
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• pp.69-78
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• 2010

Objectives: The purpose of this study was to investigate the basic grounds for the policies of health promotion on the elderly by analyzing lifestyle. Methods: This study recruited 500 seniors aged over 65 years participating in exercise programs for the elderly provided by four branch offices of NHIC in Daegu. Results: 'Ideal type' was a group thinking that exercise programs for the elderly made their life healthy and energetic and living a happy life and 'social type' was a group answering that they helped to manage their health condition and to relieve stress and activated relationship with family members and friends to gain self-confidence. ‘Passive type’ and 'lethargic type’ said that the programs did not influence their life overall. Conclusion: Entrance into an aging society has changed values of the elderly. Their lifestyle becomes various and the effect of exercise programs for the elderly was also different according their lifestyle. Therefore, exercise programs considering lifestyles of the elderly will maximize their effect.

• The Journal of Korean Medicine
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• v.23 no.4
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• pp.91-97
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• 2002

Objective: This study was conducted to know the survival probability of the patients with cerebrovascular disease. Method: 1,341 patients who were suspected of having cerebrovascular disease clinically were investigated by telephone and NHIC (National Health Insurance Corporation) data. Conclusion: 1. The study population was grouped as 'Negative Brain CT findings' (11.8%), 'Hemorrhage' (12.4%) and 'Infarction' (75.7%). 2. The survival probabilities calculated by the Life Table method were statistically significant among brain CT finding groups (P<0.01). 3. The mean survival time calculated by the Kaplan-Meier method were also statistically significant among brain CT finding groups (P<0.01). 4. The result of Cox regression model was that sex (OR=0.7), age (OR=1.07), diabetes mellitus (OR=1.38), and heart disease (OR=1.69) affected the survival of the patients with cerebrovascular disease.