• Title/Summary/Keyword: National Health Insurance Service (NHIS)

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Comparison of Severe Disease Incidence among Eligible Insureds to Expand Coverage for Substandard Risks (유병자 보험의 보장성 확대를 위한 유병자들의 중증질환 발생률 비교)

  • Baek, Hyeyoun;Son, Jihoon;Shin, Jimin
    • Journal of health informatics and statistics
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    • v.43 no.4
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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.

A Target Selection Model for the Counseling Services in Long-Term Care Insurance (노인장기요양보험 이용지원 상담 대상자 선정모형 개발)

  • Han, Eun-Jeong;Kim, Dong-Geon
    • The Korean Journal of Applied Statistics
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    • v.28 no.6
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    • pp.1063-1073
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    • 2015
  • In the long-term care insurance (LTCI) system, National Health Insurance Service (NHIS) provide counseling services for beneficiaries and their family caregivers, which help them use LTC services appropriately. The purpose of this study was to develop a Target Selection Model for the Counseling Services based on needs of beneficiaries and their family caregivers. To develope models, we used data set of total 2,000 beneficiaries and family caregivers who have used the long-term care services in their home in March 2013 and completed questionnaires. The Target Selection Model was established through various data-mining models such as logistic regression, gradient boosting, Lasso, decision-tree model, Ensemble, and Neural network. Lasso model was selected as the final model because of the stability, high performance and availability. Our results might improve the satisfaction and the efficiency for the NHIS counseling services.

Data Analytic Process of a Nationwide Population-Based Study on Obesity Using the National Health Information Database Presented by the National Health Insurance Service 2006-2015

  • Kim, Yang-Hyun;Han, Kyungdo;Son, Jang-Won;Lee, Seong-Su;Oh, Sang Woo;Kwon, Hyuk-Sang;Shin, Soon-Ae;Kim, Yeon-Yong;Lee, Won-Young;Yoo, Soon Jib;Taskforce Team of the Obesity Fact Sheet of the Korean Society for the Study of Obesity
    • Journal of Obesity & Metabolic Syndrome
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    • v.26 no.1
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    • pp.23-27
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    • 2017
  • Background: In Korea, the prevalence of obesity has steadily increased, and the socioeconomic burden of obesity has increased along with it. In 2015, the National Health Insurance Service (NHIS) signed a memorandum of understanding with the Korean Society for the Study of Obesity (KSSO), providing limited open access to its databases so that the status of obesity and obesity management could be investigated. Methods: Using NHIS databases, we analyzed nationwide population-based studies for obesity using the definition of obesity (body mass index ${\geq}25kg/m^2$) in subjects over the age of 20. Age and sex standardization were used for all data. Results: The KSSO released the 'Obesity Fact Sheet 2016' using the 2006-2015 NHIS Health Checkup database. The prevalence of obesity steadily increased from 28.7% in 2006 to 32.4% in 2015, and the prevalence of abdominal obesity also steadily increased from 18.4% in 2009 to 20.8% in 2015. The prevalence of class II obesity steadily increased from 2006 to 2015, such that the total prevalence was 4.8% in 2015 (5.6% in men and 4.0% in women). The highest prevalence of obesity was found in Jeju Island, while the lowest prevalence was found in Daegu City. The highest prevalence of abdominal obesity was also found in Jeju Island, while the lowest prevalence was found in Gwangju City. Conclusion: Based on the Obesity Fact Sheet 2016, a strategy for reducing the prevalence of obesity is needed, especially in Korean men.

Analysis of the incidence of dementia in complete edentulous patients using the National Health Insurance Service-Elderly Cohort Database (NHIS-ECD) (국민건강보험공단 노인 코호트 자료를 이용한 완전 무치악 환자의 치매 발병률 분석)

  • Koo, Bonsuk;Yoo, Jin-Joo;Kim, Manyong;Lim, Hyunsun;Yoon, Joon-Ho
    • The Journal of Korean Academy of Prosthodontics
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    • v.58 no.3
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    • pp.193-200
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    • 2020
  • Purpose: To investigate the relationship between dementia and complete tooth loss on both sides or one side using large demographic data. Materials and methods: A retrospective cohort study was designed using the National Health Insurance Service-Elderly Cohort Database (NHIS-ECD) which was established for people over the age of 60. The experimental group was the complete edentulous cohort, which had a history of treatment for national health insurance covered complete denture on both sides or one side from July 1, 2012 to December 31, 2013. And the control group was the dentulous cohort, which had a history of conservative dental treatment for the same period. All subjects had no history of diagnosis or treatment of dementia during this time. These cohorts were matched 1:1 by age, gender, and place of residence according to the propensity score matching method. Then the incidence of dementia was compared between these cohorts. Results: Compared with those groups, the incidence of dementia was significantly higher in the experimental group (12.13%) than in the control group (9.74%) (P<.05). No clear association between other factors has been identified. Conclusion: The analysis of large-scale demographic data shows that the incidence of dementia is high in complete edentulous patients on both sides or one side.

A Panel Study on the Determinants of the Regional Variation in the Rate of Certification in Long-Term Care Insurance (노인장기요양보험 지역별 인정률 결정요인에 대한 패널분석)

  • Sakong, Jin;Song, Hyunjong
    • Health Policy and Management
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    • v.27 no.1
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    • pp.56-62
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    • 2017
  • Background: There have been deviations in the regional rate of certification in Korean long-term care insurance (LTCI). This study aimed to explore the determinants of the rate of certification in LTCI. Methods: The panel data of the year 2010-2014 of the 227 National Health Insurance Service (NHIS) regional office were used. Making use of 26 explanatory variables (socio-demographic factors, access to the long-term care services, etc.), we estimated the random effects model using STATA SE ver. 13.0 program (Stata Corp., College Station, TX, USA) and tried to find out the determinants of the regional rate of certification. Results: Estimation results showed that the most important determinants of the regional rate of certification in LTCI are the long-term care infrastructure such as capacity or number of the homecare service institution, sanatorium, or convalescent hospital. The number of the elderly who lives alone and the dimentia patients were positively related to the regional rate of certification in LTCI. Conclusion: The estimation results implied that the regional variation in the rate of certification in LTCI has nothing to do with the NHIS regional offices or their employees. To alleviate the deviation in the regional rate of certification in LTCI, we suggested the analysis of the deviation in the survey checklist. We also proposed to found the regional comprehensive support center to prevent the geriatric illness and to improve the residents' health, etc.

A Study on Risk of the Incidence of Lung Cancer in a Horse Trainer Using National Health Insurance Service (마필관리사에서 발생한 폐암 위험도 연구: 건강보험공단 빅데이터 12년 추적 연구)

  • Lee, Seunghyun;Kim, Seunghan;Yun, Sehyun;Kim, KyooSang;Yoon, Jin-Ha
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.31 no.4
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    • pp.378-384
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    • 2021
  • Objectives: Horse trainers ensure the horses they are training and monitor horse's health, hygiene. While most of the studies on horse trainer's health focused on musculoskeletal disorders, few studies have examined the health effect of occupational exposure. This study aimed to investigate the risk of lung cancer in Korean Horse trainers. Methods: Among the largest health screening program of health screening service of the National Health Insurance Corporation, 2,246 workers were selected for study. We utilized data from the National Health Insurance Service (NHIS) National Cohort Data Base 2005-2017. We performed analyses using a Cox's proportional hazards model to identify the risk of lung cancer in Horse trainers. Results: This study found that the horse trainers group had a higher risk of lung cancer 10.07 (95% CI :2.38-42.64) compared to other occupational group. Additionally, there was 6.5 times higher risk of lung cancer in non-smoker horse trainers group. Conclusions: We, thus, verified horse trainers could have relation with increase of lung cancer risk. As lung cancer is known as a cancer with a high contribution of occupational factors compared to other cancers, it is necessary to determine the efficacy of continuous attention and active management of occupational exposure.

Financial Projection for National Health Insurance using NHIS Sample Cohort Data Base (국민건강보험 표본코호트 DB를 이용한 건강보험 재정추계)

  • Park, Yousung;Park, Haemin;Kwon, Tae Yeon
    • The Korean Journal of Applied Statistics
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    • v.28 no.4
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    • pp.663-683
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    • 2015
  • The change of the population pyramid due to low fertility and rapid aging threatens the financial sustainability of National Health Insurance. We construct statistical models for prevalence rates and medical expenses using National Health Insurance Service (NHIS) sample cohort data from 2002-2013. We then project yearly expenditures and income of national health insurance until 2060 that considers various assumptions in regards to future population structure and economic conditions. We adopt a VECM-LC model for prevalence rates and the double exponentially smoothing method for the per capita co-payment of healthcare expense (in which the two models are institution-disease-sex-age specific) to project of national health insurance expenditures. We accommodate various assumptions of economic situations provided by the national assembly and government to produce a financial projection for national health insurance. Two assumptions of dependents ratios are used for the projection of national health insurance income to conduct two future population structures by the two assumptions of aging progresses and various assumptions on economic circumstances as in the expenditure projection. The health care deficit is projected to be 20-30 trillion won by 2030 and 40-70 trillion won by 2060 in 2015 constant price.

Current status of and trends in post-mastectomy breast reconstruction in Korea

  • Song, Woo Jin;Kang, Sang Gue;Kim, Eun Key;Song, Seung Yong;Lee, Joon Seok;Lee, Jung Ho;Jin, Ung Sik
    • Archives of Plastic Surgery
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    • v.47 no.2
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    • pp.118-125
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    • 2020
  • Since April 2015, post-mastectomy breast reconstruction has been covered by the Korean National Health Insurance Service (NHIS). The frequency of these procedures has increased very rapidly. We analyzed data obtained from the Big Data Hub of the Health Insurance Review and Assessment Service (HIRA) and determined annual changes in the number of breast reconstruction procedures and related trends in Korea. We evaluated the numbers of mastectomy and breast reconstruction procedures performed between April 2015 and December 2018 using data from the HIRA Big Data Hub. We determined annual changes in the numbers of total, autologous, and implant breast reconstructions after NHIS coverage commenced. Data were analyzed using Microsoft Excel. The post-mastectomy breast reconstruction rate increased from 19.4% in 2015 to 53.4% in 2018. In 2015, implant reconstruction was performed in 1,366 cases and autologous reconstruction in 905 (60.1% and 39.8%, respectively); these figures increased to 3,703 and 1,570 (70.2% and 29.7%, respectively) in 2018. Free tissue transfer and deep inferior epigastric perforator flap creation were the most common autologous reconstruction procedures. For implant-based reconstructions, the rates of directto-implant and tissue-expander breast reconstructions (first stage) were similar in 2018. This study summarizes breast reconstruction trends in Korea after NHIS coverage was expanded in 2015. A significant increase over time in the post-mastectomy breast reconstruction rate was evident, with a trend toward implant-based reconstruction. Analysis of data from the HIRA Big Data Hub can be used to predict breast reconstruction trends and convey precise information to patients and physicians.

Regressiveness Analysis of Contribution Rate of National Health Insurance Insured (건강보험 지역가입자의 보험료 역진성 분석)

  • Na, Young-Kyoon;Moon, Yongpil
    • Health Policy and Management
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    • v.31 no.3
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    • pp.364-373
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    • 2021
  • Background: This study aims to examine the regressiveness of national health insurance (NHI) premium burdens for local subscribers. The government has established a restructuring of health insurance contributions in 2017. Therefore, insurance premium reform began in 2018 and the second national health insurance premium reform will be carried out in 2022. We will analyze local subscribers before and after the policy reform of 2018. Methods: This study used data from 'local premium imposition elements' in the health insurance statistics annual reports (2017-2019) on National Health Insurance Service (NHIS). This study was calculated contribution rates according to levels of income and property for local insured by the method of comparing. Simulations of primary and secondary reforms were conducted in the study to determine regressiveness. Results: Insurance premiums for local subscribers were analyzed separately by income and property insurance premiums. In the income premium analysis, the higher the income, the lower the premium rate, and then the fixed rate was maintained from a certain section. The regressiveness of income insurance premiums has been eased in part. On the other hand, the property insurance premium burden was found to be regressive still by income class. Conclusion: Regressiveness analysis showed that a decrease in income contributions was achieved to local insured in the first phase of reform. But in the second phase of reform, more consideration should be given to reductions of property premium portions of local subscribers. Based on the results, the author suggested policy discussions to reorganizing the new systems of NHI contribution of local Insured.

Association of Alzheimer's Disease with the Risk of Developing Epilepsy: a 10-Year Nationwide Cohort Study

  • Lyou, Hyun Ji;Seo, Kwon-Duk;Lee, Ji Eun;Pak, Hae Yong;Lee, Jun Hong
    • Dementia and Neurocognitive Disorders
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    • v.17 no.4
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    • pp.156-162
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    • 2018
  • Background and Purpose: Previous studies have reported conflicting results about the prevalence of seizures in Alzheimer's disease (AD). There are few epidemiological studies on this topic in Asia. Thus, the objective of this study was to examine demographic and clinical characteristics as well as incidence for seizures in AD patients compared to non-AD patients in a prospective, longitudinal, community-based cohort with a long follow-up. Methods: Data were collected from National Health Insurance Service-National Elderly Cohort (NHIS-elderly) Database to define patients with AD from 2004-2006 using Korean Classification Diseases codes G30 and F00. We performed a 1:5 case-control propensity score matching based on age, sex, and household income. We conducted Cox proportional hazards regression analysis to estimate the risk of epilepsy in AD patients. Results: In the cohort study, patients with AD had higher risk for epilepsy than those without AD, with hazard ratio of 2.773 (95% confidence interval [CI], 2.515-3.057). This study also showed that male gender and comorbidities such as hypertension, hyperlipidemia, diabetes, and chronic kidney disease increased the risk of developing epilepsy. Patients with AD had 1.527 (95% CI, 1.375-1.695) times higher mortality rate than those in the control group. Conclusions: AD patients have significantly higher risk of developing epilepsy than non-AD patients.