• 제목/요약/키워드: National Healthcare Insurance

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The Characteristics and Service Utilization of Home Nursing Care Beneficiaries Under the Korean Long Term Care Insurance (장기요양방문간호 이용자의 특성 및 이용실태)

  • Lee, Jung-Suk;Han, Eun-Jeong;Kang, Im-Ok
    • Research in Community and Public Health Nursing
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    • v.22 no.1
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    • pp.33-44
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    • 2011
  • Purpose: This study examined the characteristics and service utilization of home nursing care beneficiaries under the Korean Long-Term Care Insurance (LTCI). Methods: We used assessment data and claim data of National Health Insurance Corporation from July to August 2008. Data were composed of subjects who were the beneficiaries of home nursing care. Results; A total of 634 subjects were analyzed. Of the subjects, 57.1% were 75 years and over. The average score of nursing care need was only 0.71 and the percentage of those whose nursing care need score was zero was 58.0%. More than half of the subjects had partially dependent musculoskeletal conditions, and 75.5% had two or more comorbidities. A third of them usedonly home nursing care, and another third used both home nursing care and general home care at the same time. Those who needed sore care used the largest home nursing care benefits. Conclusion: Home nursing care of LTCI performs community-based healthcare services under LTCI. Throughout the past two years, however, it has not been active. Understanding the characteristics of its users is important in order to develop effective strategies for activating home nursing care.

Changes in Health Care Utilization during the COVID-19 Pandemic (코로나19 유행 시기 의료이용의 변화)

  • Oh, Jeong-Yoon;Cho, Su-Jin;Choi, Ji-Sook
    • Health Policy and Management
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    • v.31 no.4
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    • pp.508-517
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    • 2021
  • Background: After the first case of coronavirus disease 2019 (COVID-19) in January 2020, Korea has experienced three waves in 2020. This study aimed to analyze changes in health care utilization according to the period of the 1st to 3rd waves of the COVID-19 pandemic. Methods: We analyzed 3,354,469,401 national health insurance claims from 59,104 medical facilities between 2017 and 2020. Observed-to-expected ratios (O:E ratio) with data from 2017 to 2019 as expected values and data from 2020 as observed values were obtained to analyze changes in medical utilization. T-test was used to test whether the difference of observed and expected values was statistically significant. Results: In 2020, the O:E ratio was 0.894, indicating a decrease in health care utilization overall during the pandemic. The O:E ratio of the 1st wave was 0.832, which was lower than those of the second (0.886) and third (0.873) waves. Health care utilization decreased relatively more among outpatient, women, children and adolescents, and health insurance patients. And health care utilization decreased more in small medical facilities and in Daegu and Gyeongbuk during the first wave. During the pandemic, the O:E ratios of respiratory diseases were 0.486-0.694, while chronic diseases and mental diseases were more than 1.0. Conclusion: Health care utilization decreased during the COVID-19 pandemic overall, and there were differences by COVID-19 waves, and by the characteristics of patients and medical facilities. It is necessary to understand the cause of changes in health care utilization in order to cope with the prolonged COVID-19 pandemic.

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.

The Utilization of Health Service by Psychiatric Outpatients (정신과 외래환자들의 의료이용에 관한 연구)

  • Kim, Chae-Bong;Hwang, Sung-Wan
    • The Korean Journal of Health Service Management
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    • v.6 no.1
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    • pp.77-86
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    • 2012
  • Objective of the study represents experiences of medical utilization of Psychiatric Outpatients. This research draws on information obtained from the 2008 National-wide sampling study of the Korean Healthcare Panel(KHP) conducted. The results of our study suggest the significance of variables such as the gender(p<.001) in the social demographical characteristics, the medical security type(p<.016), medical institution utilization(p<.012) treatment type(p<.004) in the utilization factors. In the case of medical utilization cost, the financial support factor(p<.018) showed a significant relationship. Depending on the particularities of gender, medical security type, financial support, medical institution utilization, treatment type were determined through a multiple logistics regression analysis. Gender showed that, among Psychiatric outpatient age of 30-59 level was 5.358 times and 60 years and older, their the second medical examination level was 4.490 times higher than Psychiatric outpatients under the age of 29. Health insurance type showed for the others medical allowance was 6.712 times higher than job health insurance and the other treatment was 0.395 times lower than drug treatment. Psychiatric outpatients utilization are rooted in the thoughts and factor levels of the Psychiatric patients and must be understood from the Psychiatric outpatients's perspective. The point is not only to gauge the patients research during Psychiatric medical utilization. The important of social community mental healthcare services levels goes beyond the goal of enhancing healthcare.

Designing a Global Budget Payment System for Oriental Medical Services in the National Health Insurance (건강보험 한방의료의 총액계약제 도입방안)

  • Kim, Jin-Hyun;Kim, Eun-Hye;Kim, Yoon-Hee
    • Journal of Society of Preventive Korean Medicine
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    • v.14 no.1
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    • pp.77-96
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    • 2010
  • Objectives : This paper recommends a global budget based payment system for reimbursing oriental medical services in the national health insurance. Methods : We analyzed previous research outcomes related to oriental medical services and payment system We reviewed the experiences of other countries' global budget system in terms of their strength and weakness. In addition, we developed a reimbursement method for oriental medical services based on global budget. Results : Our reviews focused on global budget system of Germany, the Netherlands, the United Kingdom, Canada, France, and Taiwan. The estimation of global budget in the national health insurance was described in two scenarios. First scenario was to allocate oriental medical services in scale after signing a contract for global budget. In this case, 4.16% of the national health insurance expenditure was allocated for the oriental medical services. Second scenario was to estimate the global budget in a historical context. As a result, the first scenario in total budget was higher than the second, and we proposed a retrospective adjustment method for the gap between the budget and the actual expenditure Conclusions : The payment system for oriental medical services is recommended to shift from fee-for-service to global budget.

A Study for The Pharmaceutical Pricing Standard of the National Health Insurance in Japan (일본의 건강보험 약가 산정기준에 관한 연구)

  • Ryu, Chung-Kul
    • Korea Journal of Hospital Management
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    • v.14 no.4
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    • pp.52-70
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    • 2009
  • This study is to analyse the reimbursement prices of drugs in Japan. Japan has the world's second-largest pharmaceutical market, and the world's largest price-controlled pharmaceutical market. The reimbursement prices of new drugs in Japan are determined by confidential negotiations between the manufacturer and the Japanese Ministry of Health, Labor, and Welfare. Pharmaceuticals account for a larger share of total healthcare expenditures in Japan than in most other major pharmaceutical markets such as France, Germany, United Kingdom and United States. Prescription drugs' share of total healthcare spending has slightly increased in recent years, from 20.2% in 2000 to 21.5% in 2004, the most recent year for which data are currently available. This trend is attributable to the effect of the Japanese rapidly aging population that stimulates demand for healthcare services. There are several method of price setting for drugs as below. First, on the initial pricing of branded drugs, is the similar-efficacy pricing method and cost calculation method. Second is postmarketing price changes which are biennial price revisions under the rule of National Health Insurance. Third is the rule of the generics price. Recently, the generics market is expanded because there are increasing numbers of hospitals by DPCs(Diagnosis-procedure Combinations).

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Development and Reconsideration of Korea Healthcare System (보건의료체계의 발전과 성찰)

  • Lee, Kyu Sik
    • Health Policy and Management
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    • v.23 no.4
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    • pp.303-313
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    • 2013
  • During last 65 years, Korea has achieved very rapid economic growth and social reformation including healthcare system. Many foreigners have praised that Korea healthcare system is very good in the respect of ease accessibility to healthcare under the lowest cost among the industrialized countries. Whole population are covered by the National Health Insurance. Also utilizations of healthcare among different income classes are even. However Korea healthcare system faced with several challenges, in terms of the an aging population and a rise in chronic disease problem, new threats of communicable disease due to globalization, the rapid increase of healthcare expenditure and high financial burden of patients even though they are insured. To cope with these challenges, we need reconsider the healthcare system as followings; to set up ideology of healthcare as normative public goods, to rebuild paradigm of healthcare for 21 century, to reform public health for strengthening health promotion, to develop new method for healthcare management including quality improvement and consumer responsiveness, to build new governance for health and to view new perspective on healthcare as a kind of industry.

Implications of Price Setting Strategies for New Health Technologies from Five Countries (신의료기술에 대한 진료비 지불: 외국사례와 시사점)

  • Chung, Seol-hee;Kwon, Ohtak;Choi, Yeonmi;Moon, Kyeongjun;Chae, Jungmi;Lee, Ruri
    • Health Policy and Management
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    • v.30 no.2
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    • pp.164-177
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    • 2020
  • This study aims to compare the experience of selected countries in operating separate payment system for new healthcare technology and to find implications for price setting in Korea. We analyzed the related reports, papers, laws, regulations, and related agencies' online materials from five selected countries including the United States, Japan, Taiwan, Germany, and France. Each country has its own additional payment system for new technologies: transitional pass-through payment and new technology ambulatory payment classification for outpatient care and new technology add-on payment for inpatient care (USA), an extra payment for materials with new functions or new treatment (C1, C2; Japan), an additional payment system for new special treatment materials (Taiwan), a short-term extra funding for new diagnosis and treatment (NUB; Germany), and list of additional payments for new medical devices (France). The technology should be proven safe and effective in order to get approval for an additional payment. The price is determined by considering the actual cost of providing the technology and the cost of existing similar technologies listed in the benefits package. The revision cycle of the additional payment is 1 to 4 years. The cost or usage is monitored during that period and then integrated into the existing fee schedule or removed from the list. We conclude that it is important to set the explicit criteria to select services eligible for additional payment, to collect and analyze data to assess eligibility and to set the payment, to monitor the usage or cost, and to make follow-up measures in price setting for new health technologies in Korea.

Election Pledge and Policy Tasks of President Moon Jae-in in Healthcare Sector (문재인 대통령의 보건의료 공약과 과제)

  • Shin, Sung-Shik
    • Health Policy and Management
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    • v.27 no.2
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    • pp.97-102
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    • 2017
  • On May 10, 2017, Moon Jae-in's Government launched. The election pledges of Moon's Government in healthcare sector were extracted from those of president election camp and Democratic Party. The main pledges were enhancing the coverage of healthcare costs, management of healthcare costs for elderly, restructuring the health insurance contribution system, and improving the public nature of healthcare system. There are many policy tasks to realize the electoral pledge, especially, financial task is main. The National Planning and Advisory Committee are setting the policy priorities and making the detailed plans. Although this paper deals the initial evaluation of main election pledges, the precise evaluation is needed for the final plan of healthcare policy.