• The Korean Society of Law and Medicine
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• v.10 no.2
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• pp.37-82
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• 2009

Korea has gained the much more performances in the fields of pubic health laws and related policies on the basis of the substantial economic achievements. In 1977, the social medical insurance was established for companies with more than 500 employees, and in 1989, Korea successfully achieved the national medical insurance system covering the total population within only 12 years beginning with multiple insurers. There remained some problems, however, to be improved such as both the low level of contribution rates and benefit packages due to the inefficiency in utilizing limited medical resources. In 2000, all insurers were unified into a single insurer (National Health Insurance Corporation), and special independent Health Insurance Review & Assessment Service (HIRA) was also established. From the origin of medical insurance system in 1977, the Korean reimbursement system has been fee-for-service system, and after the establishment of HIRA, it has been providing objective and expert medical cost review services and health quality assessment services.

• Health Policy and Management
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• v.20 no.2
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• pp.104-127
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• 2010

To vitalize the link program of Korean long-term care insurance system to community-based services for non-eligible people, we analysed the claim data from the Korean National Health Insurance Corporation (NHIC), and conducted a questionnaire survey to charging employees of elderly service department at local governments. The subjects were all 81,377 people, 57,454 of them were arranged to community-based services. The link program was more necessary among the missed subjects rather than the arranged people due to the need for physical or psychological assistance. By the result of the survey to the local government employees, 59.5% of subjects responded their proportion of link service was over 10% and under 20%, and 54.3% of them responded their job boundary are not clear. Major type of linking was notification the subject list to local government, 91.4%; proportion of periodical notification on the status of their service link were 57.1%, only 7.1% were followed to manage after the link. Difficult factors at the link process were pointed out the overload by other side work, deficiency of resources, rigidity of priority of link, and so on. Considering these results, to vitalize the community-based services to the non-eligible people, it may be essential the active participation of the subjects, construction of parts working in coordination among the institutions including NHIC, local governments, and service providers; development of various services for maintenance or promotion of the non-eligible peoples' health and functional status; and active participation of institutions from the third sector, and so on.

• Journal of Digestive Cancer Reports
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• v.9 no.2
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• pp.43-49
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• 2021

Background/Aims: Colonic stenting as a bridge to elective surgery is an alternative for emergency surgery in patients with acute malignant colonic obstruction. However, since its benefits are uncertain, we aimed to establish whether it has better clinical outcomes. Methods: The patients with acute malignant left-sided colon obstruction enrolled from January 2009 to December 2018 in National Health Insurance Service Ilsan Hospital. The patients were enrolled to undergo colonic stenting as a bridge to elective surgery or emergency surgery. The following oncological outcomes were assessed: incidence of complete remission, disease progression, local recurrence, and systemic recurrence. Results: Out of 40 patients, 33 received self-expanding metallic stent (SEMS) as a bridge-to-surgery, and 7 underwent emergency surgery. More stoma was made in case of emergency surgery with statistical significance (p < 0.001). There were no significant differences in complete remission rate in curable left-sided malignant colonic obstruction between SEMS as a bridge-to-surgery and emergency surgery. Complete remission was achieved for 3 patients (42.9%) in the non-stent group and 27 patients (81.8%) in the stent group. There was no statistically significant difference in oncologic outcomes between the two groups (p = 0.069). According to multi-variate analysis, advanced TNM stage, Adjuvant chemotherapy, and SEMS bridge-to-surgery were significantly associated with disease-free survival. Disease-free survival rate differed significantly between the two groups (p = 0.024). Conclusions: SEMS as a bridge-to-surgery might be an effective strategy and reduce stoma formation in acute malignant left-sided colon obstruction.

• Journal of Korean society of Dental Hygiene
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• v.15 no.6
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• pp.1099-1105
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• 2015

Objectives: The purpose of this study was to investigate parents' recognition and attitudes toward national health insurance coverage of sealant by the dental hygienists. Methods: A self-reported questionnaire was filled out by 329 elementary school children parents in G metropolitan city and N city from July 11 to 27, 2015. The questionnaire consisted of general characteristics of the subjects, recognition and attitudes toward national health insurance coverage of sealant and sealant by the dental hygienist, and recognition toward national health insurance. The data were analyzed by a descriptive analyses, multiple regression and logistic regression analysis using SPSS 12.0 program. Results: Recognition of national health insurance coverage was 2.52 times higher in high school and 4.97 times higher in recognition toward purpose of sealant. Factor affecting recognition of national health insurance was subscription of private health insurance, recognition of sealant treatment by dental hygienist (DH) and recognition of national health insurance coverage of sealant. Attitude toward sealant treatment by DH was positive in experience of sealant, recognition of sealant treatment by DH and experience of sealant treatment by DH. Factor affecting satisfaction on the sealant by DH was recognition of sealant treatment by DH and recognition of purpose of sealant. Conclusions: To increase national health insurance coverage of sealant, it is necessary to expand positive public relations of sealant by the dental hygienist.

• Health Policy and Management
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• v.27 no.3
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• pp.191-198
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• 2017

Moon Jae-in Government announced the Government's 5-Year Plan on July 19, 2017, President Moon directly announced the Government's Plan for Benefit Expansion in National Health Insurance on August 7, 2017. The main contents of the announced expansion include benefit coverage for all medically necessary services with control over non-covered service occurrence, a decrease in the cost-sharing upper limit, and monetary support for catastrophic medical costs. Although past governments have been continuously striving for benefit expansion in the last 15 years, this plan has its breakthrough aspect in that all medical services will be covered by the National Health Insurance. In alignment, there are important tasks to solve: attaining a proper fee schedule, reforming the healthcare delivery system, and improving healthcare quality. This plan is a symptom oriented action in that it is limited in reducing patients' out-of-pocket money, unlike the systematic approach of the National Health Insurance. The sustainability of the National Health Insurance is being threatened due to South Korea's low birth rate, rapidly aging society, and low economic growth, in addition to the unification issue of the Korean Peninsula, medical utilization of the elderly, management of non-communicable diseases, and so on. Therefore, the Government needs to plan the National Health Insurance system reformation including actions addressed toward medical consumers.

• Journal of Korean society of Dental Hygiene
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• v.17 no.3
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• pp.355-368
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• 2017

Objectives: The purpose of this study was to examine the recognition about scaling after health insurance benefit business for scaling by national health insurance corporation for the general public. Methods: In order to examine the recognition about scaling after health insurance benefit business for scaling by national health insurance corporation for the general public, study subjects were selected from those who are over 20 years old, living in Seoul and Gyeonggi province since December 2016. Among 300 selected subjects, data of 279 subjects were used for the analysis which is 93% of selected data, except 21 data with insufficient responses. Results: Results of examined factors affecting the recognition about scaling after health insurance benefit business for scaling by national health insurance corporation for the general public show that the recognition about scaling after national health insurance benefit is affected by female (p<0.05), past smoker (p<0.01), exercise more than 3 times a week (p<0.05) and 1-2 times a month (p<0.001) in order. Conclusions: It is necessary to prepare a plan to properly inform the national health insurance benefit for dental scaling and to raise the recognition about the necessity of scaling.

• Health Policy and Management
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• v.21 no.4
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• pp.599-616
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• 2011

This research was performed to investigate the determination factors of medical service to cover the fee for selecting a doctor which is one of the most important causes of debilitating national health insurance in Korea. Data was from Korea Health Panel and analyzed by Dutton(1986)'s medical service model which was an extended Anderson Model and was widely used in the researches on determination factors of medical service. The results were as follows; In the determinants of selecting a doctor in specialized medical institutions and general hospitals, patients with serious diseases selected doctors more often than other patients. By industrial accident compensation insurance law and enforcement ordinances, insurance covers the fee of selecting a doctor in the hospitals appointed by Labor Welfare Corporation for the patients in critical conditions under industrial accident compensation insurance, while health insurance patients pay the fee themselves for selecting a doctor in all cases. It is suggested that patients with serious diseases proved by medical opinion be provided with health care insurance in selecting a doctor and that the health insurance benefit coverage be enhanced by staged lowering of patient's cost-sharing.

• The Journal of the Korean dental association
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• v.54 no.8
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• pp.604-612
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• 2016

The aim of this study was to evaluate the effect of national health insurance coverage of periodontal scaling using the National Health Insurance Service-National Sample Cohort for 2009-2013. After the enforcement of periodontal scaling covered by national health insurance, the number of patients diagnosed with periodontal disease and received treatment, has increased from 35,234 to 99,576 people in the last 4 years. Further, the number of patients who received the treatment of periodontal disease more than once, have also increased to around 69% in 2013 when compared to 2012. Moreover, the number of patients receiving periodontal scaling has been steadily increasing every year. Among the patients who visited hospital for periodontal disease, there has been an increase of 280%. As a result, continuous public relations and long-term research on the effect of periodontal scaling as a prophylactic treatment is necessary.

• 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.