• 혜화의학회지
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• 제14권2호
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• pp.93-105
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• 2005

Objective : We investigated the actual condition of oriental medical office in a public health center. Methods : We classified patients who visited an oriental medical office iin a public pealth center of Dalseong-gun, Daegu Metropolitan City during recent 3 years by KCPJMAIN(data processing system), according to location, age, time(month, year), sex, disease, insurance, etc. Results : As a local category, the residents in Hyeunpung-Myeon higher than 80% of the patients who visited the public health center. The patients aged over 60 occupied 80% of the patients. The frequency of the treatment was more than 10 in those patients aged over 60. The number of the patients was the highest in May when there was a change for the past 36months, whereafter the number has sustained decline for 3-5 months and repeated decreasing. As a gender category, the female inpatients were 10732(82%). This statistics shows that these musculoskeletal system disease occupied large part in them. As a heath insurance category, the patients who were insured by health care were 12454(96.30%). Conclusion : It should need to enable the rural residents who have difficulty benefitting from medical service to reach the service by making their access to the oriental medical office in public health center easier. Most of all, the support from both government and municipality should be urged to accomplish it. plus, it should be included not only boosting doctors' reliance but also improving the capability and services of doctors in public heath center. In conclusion, the treatment service in public health center should be diversified beyond musculoskeletal system disease and the identity transform of public health center should be needed to appeal to young generation.

• 대한예방한의학회지
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• 제23권1호
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• pp.1-13
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• 2019

Backgrounds : The market of Complementary Alternative Medicine(CAM) in the United State(U.S.) accounts for a large proportion of the global CAM market and has a high growth rate. The recent introduction of Obama Care has brought the change in the health insurance system for CAM, and we need to analyze it for its implication to Korean system. Objectives : The purpose of this study is to investigate the current status of acupuncture and chiropractic health insurance in the U.S., and to draw implications for expanding the health insurance coverage for Korean traditional medicine through the comparison between the U.S. and Korean health insurance systems. Methods : We examined the data through the literature search and from the websites of both U.S. government departments and related organizations for the health insurance policy. Based on the collected data, we analyzed its CAM health insurance system in Korea. Results : The acupuncture covered by public health insurance in the U.S. has a limit in the number of treatments and a range of applied diseases compared with Korea. In addition, the practice of acupuncture is not subdivided. However, the chiropractic in the U.S. which also has a limited number of coverage and only three categories of practices are similar to that of Korea. Conclusions : Although the use of CAM by public health insurance is not active in the U.S., but the organizations such as Veterans Health Administration in Vermont is already discussing the use of acupuncture to solve the problem of opioid overuse. Thus Korea also needs to discuss to promote the expansion of the insurance system for CAM.

• 대한한의학회지
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• 제28권3호통권71호
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• pp.244-260
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• 2007

Objectives : The purpose of this study was to provide lawmakers with basic data for the purpose of establishing a policy on health insurance for packed herbal medicine. Methods : To properly execute an insurance system for packed herbal medicine, we surveyed the following questions from May 1st to June 15th, 2006: (1)the way to pay the insurance benefits (2)specific impression (disease) names as related to insurance (3)the range of insurance coverage. We obtained answers from 304 Korea traditional doctors. Results : 89.4% respondents were agreed on execution of health insurance for packed herbal medicine. 93.86% respondents answered that the way to pay insurance benefits and the range of insurance coverage have to be changed properly. Most respondents answered that the coverage should be based on a specific disease being treated, not the current symptoms method which relates to the prescription. The execution of health insurance for packed herbal medicine is expected to increase the number of patients and make the Korean medical system more popular. Conclusion : The findings are expected to make it easier for the general public to get treatment by providing basic data with policy makers that will cover packed herbal medicine in insurance. Also, a proper Korea traditional health insurance program should be set up as soon as possible to widen the choice of medicine for the general public.

• 대한예방한의학회지
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• 제23권3호
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• pp.109-119
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• 2019

Background : Germany is the first country in the world to introduce modern systems of public health insurance, and the country which most widely uses complementary alternative medicine(CAM) in Europe. In early 21^st century, a large evaluation studies were conducted to include acupuncture in health insurance payments, which were eventually decided. Objectives : This study is to investigate and analyze the process of public policy determination on insurance coverage for acupuncture in German health insurance system. Methods : We collected the data and information through the literature search and from the websites of German government departments and health insurance organizations. To obtain contextual information, German experts of health insurance and acupuncture clinical study were interviewed. Results : As use of acupuncture had been growing, German public health insurers wanted to evaluate the validity of acupuncture coverage and sponsored three evaluation projects for clinical effectiveness of acupuncture using randomized clinical trials, systematic reviews, and pragmatic trials from 2001 to 2005. For some pain condition, acupuncture was founded not to be effective than sham acupuncture, but more effective than standard care. The federal joint committee of health insurance decided to cover acupuncture for chronic pain of lumbar spine and chronic pain in at least one knee joint due to gonarthrosis. Conclusions : Considering the controversial subject matter in the process of acupuncture's health insurance coverage in Germany, expanding the benefits of Korean medicine in Korea needs to come up with ways to overcome the difficulties of placebo effect, standardization and lack of literature evidence.

• 대한예방한의학회지
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• 제4권2호
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• pp.1-24
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• 2000

This study was conducted to examine utilization patterns and determinants of oriental medical services. Data were collected from 545 residents in Taegu city The results of this study are summarized as follows 1) 37.8% of subjects used oriental medical services in the past year. Especially, the female, the ages of 50 and 60 over, the single. low-educated. high-income class, white-collar class, medical insured tended to use more oriental medical services than another groups. 2) 46.7% of users of oriental medical services reported that number of visits in the past year was 2 - 5 times 37 1% of them was 1 times, and 4.5% over 10 times. 3) According to the reasons to choose the oriental medical facilities, most was 'on their own judgement'(48.8%) and 'by the advice of relatives and friends'(42.0%) Regarding to the objectives of using oriental medicine, 68.3% was 'treatment', 31.7% 'health counselling and promotion'. And among diseases of users, diseases of musculo-skeletal system was the highest(54.5%). 4) 57.9% of oriental medical services users had experience of utilizing western medicine on the same diseases. Among peoples with experiencing western medicine on the same diseases. 54.4% received oriental medical services 'in addition to western medicine', 45.6%'in place of western medicine 'And 41.2% of using both services reported that they had difficulty in deciding to choose the type of services -oriental medical services or western medicine-for their diseases. 37.3% of them answered that 'providing relevant information' was the most desirable measure to solve this problem, 27.3% 'establishment of effective referral system between oriental and western medical facilities '23.6% 'cooperative medical treatment systems in the same facilities', 11.8%'integration of oriental medicine into western medicine 5) According to the satisfaction level with each items of oriental medical services, the respondents had positive views on efficacy, kindness, and side-effects. They, however, had negative view on the cost of oriental medical services. 6) In regarding to the priority of improvement of oriental medical system,'expansion of insurance benefit package 'ranked first. 'expansion of insurance benefit Package 'ranked second, 'improvement of scientific methods and diagnostic technique 'third, and 'safety of herbal medicine' fourth in order. 7) The significant factors influencing the utilization of oriental medical services were kindness of oriental medical practitioners, efficacy , travel time, age To be brief, utilization rate of oriental medical services in urban area generally tends to be high. There, however, have been various barriers to limit oriental medical services, such as incomplete benefit package of oriental medical insurance and lack of coordination and referral system between oriental and western medical services, lack of scientific diagnostic procedures, high price etc . For the development of oriental medical services, Much attention to remove these limiting factors should be placed. In addition, kindness of oriental medical practitioners , which is expected to be more important factor in the consumer - focused health care environment than ever, should be kept high consistently. Since this study was conducted for specific residents of an urban city. further research including more sampling in different urban areas should be required to generalize the results of the study.

• 한국산학기술학회논문지
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• 제20권1호
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• pp.121-130
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• 2019

자동차보험 총 진료비는 2014년 대비 2015년 12% 증가하였으나 그 중 한방진료비는 36% 증가하였다. 본 연구 목적은 진료비 항등식을 이용하여 자동차보험 한방진료비의 급격한 증가 원인을 구체적으로 파악하는 것이다. 2014년~2015년 기간 중 진료하여 심사 완료된 34,351,120건의 데이터를 이용하여 분석한 결과 한방 환자수는 해당 기간 중 27%, 환자당 진료비는 7% 증가하였다. 환자당 진료비를 세분화하여 분석한 결과, 환자당 입(내)원 일수는 변하지 않았으며 일당진료비만 7% 증가하였다. 환자수 증가를 보면 한방진료만을 받은 환자는 32%, 의과와 한방을 함께 진료 받은 환자는 24% 증가한 반면 의과진료만을 받은 환자는 오히려 4% 감소하였다. 일당진료비 증가에 영향을 미치는 요인으로는 한방물리요법 등 표준화되지 않은 진료행위의 비용 상승이 있다. 그럼에도 불구하고 한방 진료비 증가에 가장 크게 영향을 미친 요인은 환자수의 증가였다.

• 대한예방한의학회지
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• 제15권1호
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• pp.71-87
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• 2011

Objective : The present study is aimed at providing basic data to help oriental medical hospitals devise efficient operational plans by analyzing the medical expenses of in-patients in an oriental medical hospital and the factors affecting such expenses. Methods : PASW 18.0 was used to analyze the medical insurance program data of 929 patients who were discharged from a university oriental medical hospital(with 105 sick-beds) during the period from January 1 to December 31, 2010 after treatment under the coverage of health insurance and medical aid. Results : 1) Of all the patients hospitalized, 63.3% were females, their mean age was 52.73 years old, and 87.7% was covered by the health insurance program. The biggest number or 31.2% of the patients were treated by the department of acupuncture, 31.5% suffered mainly from the diseases of musculoskeletal system and connective tissues, and the average length of stay at the hospital was 19.49 days. 2) There were statistically significant differences in total medical expenses by age, clinical department in charge, principal diagnosis, and number of days hospitalized while daily average medical expenses differed depending on age, type of medical security, clinical department, principal diagnosis, and number of days staying at the hospital. 3) Total medical expenses were found significantly influenced by age, type of medical security, clinical department, principal diagnosis, and number of days hospitalized(explanatory power : 95.9%), whereas type of medical security, clinical department and principal diagnosis turned out to exercise significant influence on the daily average medical expenses(explanatory power : 26.9%). Conclusion : Oriental medical hospitals are suggested to make efforts to ensure geographical and economical accessibility for their main clients, the elderly and middle-aged, as well as to improve satisfaction of the clients with the medical service provided. They are also encouraged to work out systems to specialize in treatment with a focus on chronic degenerative and adult diseases. In addition, they are expected to try to enhance people's awareness of oriental medicine in an attempt to diversify the brackets of clients and increase frequency of their utilization.

• 대한한방내과학회지
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• 제35권3호
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• pp.309-316
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• 2014

Objectives: This study aimed to analyze the status of Kampo medicine services in Japan. Methods: We surveyed the literature or reports regarding health insurance, clinics for Kampo medicine, human resources and medical fees for Kampo medicine services. Results: The Japanese government abolished the system of the Oriental doctor in 1874, but Kampo medicine has been maintained and developed continuously. The national health insurance covers Kampo medicine services including acupuncture and moxibustion, and 674 products of 149 herbal drugs are now involved in items for health insurance. A total of 78 university medical schools or hospitals have Kampo clinics. As of 2012, 1,775 Kampo specialists, 100,881 acupuncturists and 99,118 moxibustion therapists provide Kampo medical services. Conclusions: Japan has a unique system of Kampo medicine which is much different from Korean medicine or traditional Chinese medicine. This study provides basic information about Kampo medicine, and can be useful to establish a globalization-strategy for Korean medicine for Japan.

• 척추신경추나의학회지
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• 제11권1호
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• pp.53-64
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• 2016

Objectives : The aim of this study is to assess the usage of diagnosis codes for somatic dysfunctions and the general characteristics of patients diagnosed with the code, by analyzing health insurance data provided by the Health Insurance Review & Assessment Service(HIRA) of Korea. This investigation is intended to outline future and willing to contribute to further use of diagnosis code and the approach of Oriental Medicine to somatic dysfunction. Materials and Methods : By analyzing HIRA data, those diagnosed with M99 codes, a code attributed to somatic dysfunction, were selected for analysis. Patients included were assessed for the relevant general characteristics, and the specific diagnostic criteria. The current usage rates and noteworthy characteristics of diagnostic codes of somatic dysfunctions were assessed. A comparative analysis between clinical departments and subcategories, and a comparative analysis to data of 2014 was conducted. Results : Patients given M99 codes constituted a small minority of all patients diagnosed in 2011 as shown by HIRA data. The codes were more frequently to older patients, females, outpatients, and those who filed for Health Insurance compensation. Medical institutions participating in the diagnosis were mostly primary care facilities, usually specializing in orthopedic(Western medicine sector) and internal medicine (Oriental Medicine sector). The most registered code in 2011 and 2014 was M995. The same trend can be observed in Oriental/Western medicine institutions and Public health center, on the other hand, between them, have some different patterns both 2nd and 3rd. Conclusions : This investigation is that of current usage of diagnostic codes of somatic dysfunction. HIRA insurance claim data was analyzed. Based on the current results, more precise diagnostic standards of somatic dysfunction are warranted. This study will provide a foundation for future Oriental Medicine approach to somatic dysfunctions.

• 대한예방한의학회지
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• 제20권2호
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• pp.27-38
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• 2016

Backgrounds : Taiwan has similar national health insurance (NHI) system for traditional medicine with South Korea. Recently, new quality improvement policies for traditional medicine is being attempted in Taiwan. Objectives : This study aimed to review the Taiwanese NHI system for Chinese Medicine (CM) and introduce quality improvement policies. Methods : Research articles, reports, government publications and year books which handled traditional medicine system and NHI system in Taiwan were searched and collected. The authors analyzed and summarized the contents in a qualitative manner. Results : In Taiwanese NHI system, CM procedures and medication for outpatients are reimbursed through a mix of fee-for-service and global budget payment system. CM shares 4% of total expenditure of NHI in Taiwan. Mostly, the expenses for procedures are reimbursed regardless of disease type, however, in the specialized program for quality improvement, CM doctors have to comply with standard operating procedures (SOPs). Conclusions : Taiwanese NHI system implemented SOP-based new reimbursement system for CM. Yet, the scientific evidences for SOPs are not sufficient, it can be useful references when we develope disease related reimbursement system for Korean Medicine in South Korea.