• 보건행정학회지
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• 제30권2호
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• pp.192-198
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• 2020

Background: Korea National Health Insurance Service (NHIS) is operated as a social insurance system in which people pay a portion of their monthly income as insurance premiums and receive benefits when they experience illness or injury. Since 2005, the national health insurance remained surplus accumulating cumulative reserves each year. However, as of 2018, NHIS revenue recorded 62.11 trillion won and spending of 62.29 trillion won. The deterioration of NHIS finances is expected to accelerate with the aging population, income growth, new medical technology development, and enhanced security policies. Methods: To examine the financial health and sustainability of NHIS, we estimated the future revenue and spending until 2030 using the data from Korea Health Insurance Review and Assessment Service statistical yearbook. 2004-2018 average percentage change in NHIS revenue and spending was calculated. We estimated the future NHIS financial status using two methods. In the first method, we calculated the revenue and spending of the future NHIS by applying the 2004-2018 average percentage change to the subsequent years consecutively. In the second method, we estimated the future NHIS financial status after adjusting for the predicted demographic changes such as the aging population and declining birth rate in South Korea. Results: The estimates from this study suggest that the NHIS's cumulative reserves will run out by 2024. Conclusion: In terms of spending on current health insurance, there should be a search for ways of more efficient spending and funding options.

• 한국직업건강간호학회지
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• 제16권1호
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• pp.58-66
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• 2007

Purpose: A national long-term care system for elderly and the disabled has its unique evolution in each country. Japan, Germany and the United States may be the typical examples of respective social insurance system. This paper reviews the counterpart examples of Japan, Germany and the United States and looks at their accumulated long-term care system experiences and personal care system under workers' compensation. Methods: Literature review and website searching were conducted. Key words as 'workers' compensation insurance', 'personal care benefit' and 'long term care' were used in searching the related literatures. Results: Though the personal care benefit under current Workers'Compensation in Korea is very similar to Japan's, the long-term care system of Korea is not as well established. Germany and the United States have the provision of personal care benefit for injured workers within long term care system. Conclusions: We recommend some key issues to take into account for improving personal care benefit system in workers' compensation in Korea as follows: providing a comprehensive coverage through the linkage of long term care, introducing an assessment & evaluation system for the appropriate benefits, establishing insurer's role for quality management of personal care service, and developing a policy for family caregivers.

• 보건행정학회지
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• 제28권4호
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• pp.360-368
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• 2018

Background: The proportion of pharmaceutical expenditure out of total health-care expenditure in South Korea is high. In 2016, 25.7% of national health insurance (NHI) spending was for pharmaceuticals. Given the increasing demands for the access to newly introduced medicines and following increase in pharmaceutical spending, the management of NHI pharmaceutical expenditure is becoming more difficult. Methods: This study analyzed the data claimed to NHI for pharmaceutical reimbursement from 2010 to 2016. Results: The policy implications with respect to the trends and problems in spending by drug groups were elicited. First, the proportion of off-patent drugs spending which were treated to chronic disease was much higher than anti-cancer drug spending. Second, the spending to the newly introduced high-costed medicine increased, however, current price-reduction mechanism was not sufficient to manage their expenditure efficiently. Conclusion: Our system seems to need several revisions to improve the efficiency of pharmaceutical expenditure and to cope with high-costed medicines. This study suggested that the prices of off-patent drugs need to be regularly readjusted and the Price-Volume Agreement System should be operated more flexibly as well.

• Journal of Preventive Medicine and Public Health
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• 제31권3호
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• pp.471-480
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• 1998

This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows : 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I. : 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (41.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and fortieg age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.

• 보건행정학회지
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• 제24권2호
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• pp.109-119
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• 2014

In accordance with the government's plan to expand the national health insurance (NHI) coverage for severe diseases such as cancer, heart disease, cerebrovascular disease, and rare and incurable disease, the diagnostic ultrasound services have been covered by NHI from October 1, 2013. The quality is very important factor in providing diagnostic services because they influence on the diagnosis, treatment, and outcome of diseases. In particular, equipments and health care providers plays an important role in providing qualitative services. The purpose of this paper is to examine the major feature of ultrasound services covered by health security system and to review quality assurance policies in other countries such as Australia, Japan, the USA, and Canada. In addition, we assessed the implication of those policies. We especially put emphasis on the types and qualifications of healthcare professionals and measures to manage equipments. All countries have reviewed on policies to promote the quality such as educational requirements of professionals or restrictions on the duration of equipment usage. Various measures should be implemented to assure the qualitative ultrasound service.

• 대한안전경영과학회지
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• 제11권4호
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• pp.25-33
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• 2009

Since it's first adaptation in Germany in 1884, the industrial accident compensation insurance system has been on the most widely used social security systems, and in was first enforced in Korea in 1964. Today's society has been industrialized and number of business places for workers accident. As the welfare of workers improves in korea, the number of beneficiaries of industrial accident compensation insurance is increasing. Even though such trend is desirable in many respects, there is a growing social problem caused by abnormal insurance claims.

• 대한한의학회지
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• 제44권1호
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• pp.1-15
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• 2023

Objectives: National health insurance herbal prescription of Korean medicine has been serving important role in public healthcare in spite of continuous demand on revision of system. However, the categories of insurance herbal prescriptions are not equally distributed throughout the KCD-based major disease categories. We analyzed statistical database of claimed national health insurance classified as major disease categories by years. We classified all 56 herbal prescriptions as per their total medical indications into 22 major disease categories to analyze their distribution. Significant increase of M and S-T code claims were found, whereas decrease of U code claims by years. We figured out that the 56 prescriptions were unequally distributed along with enrichment of certain codes such as K and J. Meanwhile, the insurance claim of each prescription was positively correlated with number of code types of their indications. As a result, we believe that the reform of national health insurance herbal prescription list is necessary to promote use of it in clinic.

• 한국재난정보학회 논문집
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• 제10권2호
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• pp.230-237
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• 2014

자연재해로 인한 재해자 지원제도에는 크게 자조(自助)와 공조(共助)그리고 공조(公助)가 있다. 본 연구에서는 재해자 지원 제도 중의 공조(共助)(지진보험, JA공제, 전노제)를 대상으로 동일본 대지진의 사례를 분석하여 보급 현황과 함께 급부의 제약 등에 관련된 여러 문제점에 대해 검토하는 것을 목적으로 한다. 연구의 방법으로는 각종 간행물과 홈페이지를 활용한 자료 답사, JA건경이나 손해보험회사에 대한 히어링을 실시했다.

• 한방재활의학과학회지
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• 제19권3호
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• pp.101-109
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• 2009

Objectives : This study aimed to investigate the present status of physical therapies provided in the Korean medicine clinics, and to find out the priorities among and the estimated fees of physical therapies for the National Health Insurance plan. Methods : We administered nationwide survey to Korean medicine doctors using the on-line survey system. 16 physical therapies were listed in the Web-based questionnaires, and responders were asked to mark the therapies they used for their patients, and, for each therapy they marked, to fill in the form including the frequencies of service, service fees, target diseases, and priorities for health insurance coverage, etc. Results : Of 488 respondents, 93.7% provide more than one physical therapy for their patients, and each responder uses 5.9 physical therapies on average. 60-90% of physical therapies are being given to patients for free because they are not covered by the National Health Insurance. There is little evidence that the specialties of Korean medicine doctors are related with the use of physical therapies, but, in some therapies, the doctors with longer career years use the physical therapy more frequently. Most physical therapies are applied to the patients with musculoskeletal diseases, cardiovascular diseases, and nervous diseases, etc. Conclusions : Physical therapies are widely used among Korean medicine doctors without proper compensation. This could be the one of the main factors distorting the profit structure of Korean medicine clinics, and it encourages the National Health Insurance to cover physical therapies provided in the Korean medicine clinics.

• 보건행정학회지
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• 제29권2호
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• pp.206-219
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• 2019

This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2018 constructed according to the SHA2011, which is a manual for System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analyzing health accounts of OECD member countries. Particularly, scale and trends of the total CHE financing as well as public-private mix are parsed in depth. In the case of private financing, estimation of total expenditures for (revenues by) provider groups (HP) is made from both survey on the benefit coverage rate of National Health Insurance (by National Health Insurance Service) and Economic Census and Service Industry Census (by National Statistical Office); and other pieces of information from Korean Health Panel Study, etc. are supplementarily used to allocate those totals into functional classifications. CHE was 144.4 trillion won in 2018, which accounts for 8.1% of Korea's gross domestic product (GDP). It was a big increase of 12.8 trillion won, or 9.7%, from the previous year. GDP share of Korean CHE has already been close to the average of OECD member countries. Government and compulsory schemes' share (or public share), 59.8% of the CHE in 2018, is much lower than the OECD average of 73.6%. 'Transfers from government domestic revenue' share of total revenue of health financing was 16.9% in Korea, lower than the other social insurance countries. When it comes to 'compulsory contributory health financing schemes,' 'transfers from government domestic revenue' share of 13.5% was again much lower compared to Japan (43.0%) and Belgium (30.1%) with social insurance scheme.