• Journal of Korean Academy of Nursing
• /
• v.34 no.2
• /
• pp.278-289
• /
• 2004

Purpose: The purpose of this study was to classify the elderly in long-term care facilities using the Resource Utilization Group(RUG-III) and to examine the feasibility of a payment method based on the RUG-III classification system in Korea. Method: This study measured resident characteristics using a Resident Assessment Instrument-Minimum Data Set(RAI-MDS) and staff time. Data was collected from 530 elderly residents over sixty, residing in long-term care facilities. Resource use for individual patients was measured by a wage-weighted sum of staff time and the total time spent with the patient by nurses, aides, and physiotherapists. Result: The subjects were classified into 4 groups out of 7 major groups. The group of Clinically Complex was the largest (46.3%), and then Reduced Physical Function(27.2%), Behavior Problems (17.0%), and Impaired Cognition (9.4%) followed. Homogeneity of the RUG-III groups was examined by total coefficient of variation of resource use. The results showed homogeneity of resource use within RUG-III groups. Also, the difference in resource use among RUG major groups was statistically significant (p<0.001), and it also showed a hierarchy pattern as resource use increases in the same RUG group with an increase of severity levels(ADL). Conclusion: The results of this study showed that the RUG-Ill classification system differentiates resources provided to elderly in long-term care facilities in Korea.

• Health Policy and Management
• /
• v.17 no.1
• /
• pp.1-27
• /
• 2007

This study is designed to estimate an appropriate level of patient's cost-sharing for oriental medical services in the Korean National Health Insurance. The findings of this study can be summarized as follows: 1) The current co-payment system for oriental medical services does not reflect its cost structure in clinical practice due to inconsistency of cost-sharing plan in the NHI. 2) Both oriental medical institutions and their patients, as a result, are at a relative disadvantage in financial burden, compared with other services. 3) The substantial proportion of patients' cost-sharing depends on the amount of co-payment and the range of medical cost that a flat rate is applied to. 4) The extension of the range doesn't make any substantial decrease in patient's cost-sharing. 5) The fixed amount of co-payment is more sensitive than a range to total variations of patient's cost-sharing. Based on the above, the budget impacts of a new co-payment system were estimated for each co-insurance rate, according to given scenarios. The results range from -59 billion Won (-8.5%) to 16 billion Won(2.3%).

• Journal of Society of Preventive Korean Medicine
• /
• v.10 no.2
• /
• pp.95-120
• /
• 2006

The purpose of this paper is to investigate the structure of cost-sharing for oriental medical services in the national health insurance. Out-of-pocket payment in ambulatory oriental medical care is a co-payment of KRW3,000 up to total expenses of KRW15,000, and co-insurance rate of 30% thereafetr. The empirical analysis based on medial claims data shows that the frequency of medical claims for outpatient care are mostly concentrated just below a total expenses of KRW15,000, and it decreases beyond a total expense of KRW15,000, while it rebounds between KRW17,000${\sim}$20,000. This means the current co-payment(KRW3,000) in oriental medical services should be applied up to a total payment of KRW17,000${\sim}$20,000, or the level of co-payment should be adjusted upward to KRW45,000 in order to be consistent in cost-sharing, between co-payment and co-insurance.

• Journal of Korean Academy of Nursing Administration
• /
• v.5 no.2
• /
• pp.281-295
• /
• 1999

The purpose of this study is to provide the basic data for the development of new pay system of hospitals by analyzing the status and problems of current pay system. The pay systems of 20 nationwide hospitals were analyzed and compared with the average pay level in Korea. In addition, the annual trend of pay system was analyzed. Based on this study, the following suggestions can be made. First, the pay levels of hospitals are, in some types of workers, lower than average. Hospitals should take much efforts to improve the payment capability through the effective management. Second, the effort to raise the proportion of basic pay to the total pay and to simplify the pay system on the basis of basic pay rather than the allowance and bonus should be made. Third, the pay system based on the length of service should be revised into the one based on work capability, achievement and performance in case of professional, clerical and managerial jobs. Fourth, the pay system determined depending on the power relationship between the labor unions and the management should be improved into the one, with which workers can feel reliable and satisfied through the revealing of the payment ability and the management improvement.

• Perspectives in Nursing Science
• /
• v.6 no.1
• /
• pp.77-83
• /
• 2009

The number of nurses per bed at acute-stage hospitals is quite low in Korea compared with other OECD countries. In order to prevent the degradation of the quality of inpatient nursing services due to insufficient nurse staffs, the national health insurance introduced the differentiated nursing care fee system. This did not work as a motive for inducing the employment of nursing staff due to insufficient cost compensation. Because of insufficient nursing staff, family members have to stay with the patient or patients have to hire a personal care attendant. This increases the burden and cost to families. For the activation of hospitals without guardians, there should be policies for raising additional nursing staff such as standardizing jobs among nursing staff, particularly between nurses and nursing assistants, setting adequate standards of staffing in nursing according to medical service, substantiating the cost of nursing under the differentiated nursing care fee system, improving the medical fee system of hospitals without guardians including health insurance payment, supplying nursing staff stably through improving their working conditions such as providing child rearing services and salary increase, clarifying the qualification of personal care attendants working at acute.stage hospitals, developing indexes for assessing the quality of nursing care services, and monitoring for the management of uniform quality.

• Journal of Korean Academic Society of Home Health Care Nursing
• /
• v.27 no.3
• /
• pp.241-249
• /
• 2020

Purpose: This study aimed to investigate possible ways to expand the services of home-visit nursing through a review of the progress, achievements, and obstacles of home-visit nursing; a pilot project of an integrated home-service; the application of the Omaha System; as well as a case analysis of providing home-visit nursing services. Method: An integrated review was conducted using various source materials, including laws, previous studies, and a case analysis. Results: In case analysis of providing visiting nursing service, rehabilitation nursing, end-of-life nursing, and dementia care showed high nursing needs. It was necessary that the various home visit nursing services in the intervention area of the Omaha System, administrative services, case management, and center operation activities were all included in the payment systems of long-term care insurance. Conclusion: In the future, home visit nursing services of long-term care insurance should be reborn in the form of a center for integrated case management in the community, which would set long-term goals until the time of a client's death and encompass the realm of human rights for health, quality of daily life, and a dignity of life.

• Korea Journal of Hospital Management
• /
• v.7 no.1
• /
• pp.105-120
• /
• 2002

In the United States, the prospective payment system(PPS), under which diagnosis related groups (DRGs) are used to reimburse hospitals for the care of Medicare patients since 1983, Study results showed that the PPS is having a major impact on the quantity of services especially of hospital length of stay. The PPS has increased the likelihood that a patient will be discharged home in an unstable condition and the use of nursing homes or long term care facilities increased. Still, it is insufficient to conclude that the PPS has decreased the Medicare total expenditure, but relatively sufficient to conclude that the quality of care hasn't changed. The maintenance of the quality resulted from the systemic "check-and-balance" composed of three factors; (1) The doctors are reimbursed based on the fee-for-service system, (2) hospitals contact with doctors under the attending system, and (3) there are some public hospitals. In Korea, the reimbursement for hospitals and doctors are not divided, the hospitals have doctors as employees, and 90% of hospitals are private. These differences may weaken the "check-and-balance" existing in the U.S. system. And there are few long term care facilities and the diagnostic coding system using in pilot test are not suitable for Korean situation. In conclusion, for successful implementation of the DRG payment system in Korea, the government should establish the "check-and-balance" system in the health sector to make sure the quality of care before the implementation.

• Korean Journal of Occupational Health Nursing
• /
• v.16 no.2
• /
• pp.222-231
• /
• 2007

Purpose: This study aims to suggest political alternatives for nursing care costs for PCAs to provide qualitative medical benefit for patients with occupational disease by investigating present situation and problems of the nursing care cost system of Korea's Industrial Accident Compensation Insurance. Methods: Data was collected from 6 workers' accident medical corporation and 275 nurses affiliated with Korea labor welfare corporation using self reported questionnaire. Result: Research results were as follows; Character of nursing care cost of the Korea's Industrial accident Compensation Insurance changed as if it aims to support for living expenses for the family; As possible problems which could be caused under current system, administrative problems, decrease of service quality were made as objects of criticism. Some patients did not make every effort in rehabilitation to be beneficiaries continuously. Some patients were supplied with whole one PCA or all-night PCA even though they did not need as much caring as such. Conclusion: The research suggested that PCAs payment system improvement is necessary, and the presented nurses' opinion for the improvement method could be applied for policy making.

• Research in Community and Public Health Nursing
• /
• v.8 no.2
• /
• pp.314-326
• /
• 1997

In Korea, the nosocomial infection control program is not well developed. This situation is created by a lack of interest from medical personnel and the medical payment system. This study identifies current problems and develops a model for nosocomial infection control. The studies of Lee & Kim(1995), Lee (1993) and SENIC project model were used to construct this model. 1. The problems of nosocomial infection control were identified as the following: dis approval by hospital authorities, lack of sources for program direction, lack of overall structure and function in the program, inadequate direct action, lack of education and training, and so on. 2. The problems are reorganized according to the 5 elements of system theory. 3. As a result, the new nosocomial infection control model was developed. The inputs of the model were the elements, resources and boundaries of nosocomial infection. With the new model, each hospital can evaluate their current programs and plan a new program for the better control of nosocomial infection.

• Journal of Korean Academic Society of Home Health Care Nursing
• /
• v.15 no.1
• /
• pp.37-43
• /
• 2008

This paper provides the guidelines from which to develop a visiting health care program at the Public Health Center in Korea and involves an expanded payment compensation system of preventive services based on the new long-term health insurance system in Japan. The function and management methods to achieve the goals practiced in a community contact center for elderly support which have recently been established will guide the specific directions and strategies that the Public Health Center should pursue. That is to say, comprehensive and continuous efforts will be put forth in preventive home visiting care targeting the elderly in certain jurisdictions. At this point in time in which the visiting care nursing program has not yet started, visiting health care provided by the Public Health Center oversees chronic diseases of a vulnerable population. But after it has been developed nationwide, the visiting health care system at the Public Health Center will be distinctive and focused on health promotion and prevention.