• 한국의료질향상학회지
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• 제7권2호
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• pp.190-202
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• 2000

Background : The objectives of this study were to examine patients' satisfaction with the DRG based payment method and its association with their awareness of the method, to examine patient reported changes in doctors' caring attitude, level of their out-of-pocket payments, providers' acceptance of patients' request for additional services after the program, and to examine changes in service utilization recorded in medical records. Method : One hundred-four patients who had cesarean sections before and after the demonstration program at two hospitals located in Seoul participated in the study. Patients were surveyed before discharges when their charges were finalized. Their medical records were reviewed as well to collect data for service utilization during hospital stays. The association between patients' satisfaction with the payment method and their awareness of the method was analyzed by ${\chi}^2$-test, and the significance of changes in providers' acceptance of patients' request for additional services and service utilization after the program were examined by ${\chi}^2$-test and t-test, respectively. Results : A large proportion of patients did not know of the DRG based payment method at the time of survey and a significantly larger proportion of patients who came to the hospitals with the knowledge satisfied with the method. About the same proportion of patients reported improvement and deterioration in doctors' caring attitude compare to the previous hospitalizations and a similar result was found concerning out-of-pocket payments. Providers' acceptance of patients' request for medication, PCA and painless delivery decreased significantly after the program whereas the acceptance for additional hospital days and laboratory and radiology tests did not. Length of stay, the numbers of days on antibiotics and antianemic medication, and the number of blood tests decreased significantly after the program, however, decreases in the rate of antianemic medication and the number of urine analyses were not statistically significant. Re-operation, in-hospital death, and complications were not observed before and after the program. Conclusion : The study findings indicated a need for better patient education and publicity about the newly introduced payment method to improve their satisfaction with the system. Other study findings concerning service utilization and quality of care indicators were consistent with the government funded evaluation studies.

• 보건행정학회지
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• 제29권3호
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• pp.374-378
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• 2019

After the announcement of Moon Jae-in Government's plan (Moon's Care) for Benefit Expansion in National Health Insurance in August 2017, it is necessary to monitor the effects of the policy, especially household out-of-pocket payments (OOP). This paper aims to observe the current status and trend of OOP in Korea. Current health expenditure (CHE) was 144.4 trillion won in 2018, which accounts for 8.1% of gross domestic product (GDP) increased 9.7% from the previous year. Although GDP's share of CHE has been close to the average of the Organization for Economic Cooperation and Development (OECD) countries, the public fund's share was 59.8% of the total in 2018, which was lower than the OECD average of 73.5%. OOP's share was 32.9% in 2018, which decreased from 37.4% in 2008. The share of OOP of non-covered services was 20.0% in 2018, which decreased from 22.9% in 2008. The share of cost-sharing with third-party payers was 12.9% in 2018, which decreased from 14.5% in 2008. The OOP of non-covered services was significantly decreased in hospital and inpatient curative care, but the OOP of non-covered services was significantly increased in the medical clinic. The effect of Moon's Care was not showed in OOP through the results of 2017 and 2018, but further monitoring is needed because the Moon's Care is progressing and the observational period is short.

• 국제학술발표논문집
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• The 4th International Conference on Construction Engineering and Project Management Organized by the University of New South Wales
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• pp.399-406
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• 2011

Various construction bonds and warranties critically burden the general contractor. Also, sporadic or cumulative delays of progress payment by the owner can further trap the contractor in a financial quagmire. Facing the possibility of cash flow deficiency and callous response from the banks, most construction firms may become financially incapable of market competition, and attractive project tenders become a bidding game among few deep-pocket players. The downside of such market environment is that the depth of pocket, rather than that of professional competency dictates the choice of market winners. In Taiwan, this has been a potential crisis to the construction industry after the financial crisis which started out since 2008. To encounter this problem, this research will examine the means to better manage the construction industry. Essentially, a credit guarantee system (CGS) is the prime solution to strengthen a bank's confidence in any particular construction firm. Thus establishing a national platform which evaluates and rewards a construction firm's overall credibility is pivotal, and this third-party rated credit can help a bank to render a loan more wisely. Finally, this paper will propose the ideal operating schemes of construction-specific CGS in Taiwan and a credit scoring prototype model for construction industry, as reference for the government and banks, respectively.

• 한국전자통신학회논문지
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• 제12권2호
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• pp.401-410
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• 2017

본 연구는 일 종합병원 산부인과 환자를 대상으로 2013년 7월 1일 포괄수가제가 확대시행 전 후의 재원일수와 진료비를 비교 분석하여 포괄수가제 시행의 효과를 파악하고자 수행되었다. G광역시 소재 일 종합병원에서 2013년 1년간 산부인과 포괄수가제 질병군의 수술(자궁 및 자궁부속기 수술, 제왕절개술)을 받고 퇴원한 환자로, 행위별 수가제 적용 대상자는 2013년 1월~6월까지 입원한 환자 204명이었고, 포괄수가제 적용 대상자는 2013년 7월~12월까지 입원한 환자 194명으로 총 398명의 재원일수 및 진료비를 공분산분석(ANCOVA)하였다. 본 연구결과 재원일수는 행위별수가제에서 6.65(0.13)일, 포괄수가제에서 6.40(0.12)일로 감소하였고(p=0.013), 급여총진료비는 행위별수가제에서 1,726,333(46,331)원, 포괄수가제에서 2,271,115(37,069)으로 증가하였고(p<0.001), 보험자부담금은 행위별수가제에서 1,387,142(41,938)원, 포괄수가제에서 1,800,914(28,300)원으로 증가였다(p<0.001). 급여본인부담금은 행위별수가제에서 339,190(8,404)원, 포괄수가제에서 70,201(9,255)원으로 감소하였고(p<0.001), 비급여비용은 행위별수가제에서 642,243(22,039)원, 포괄수가제에서 197,507(9,091)원으로 감소하였고(p<0.001), 환자 총본인부담금도 행위별수가제에서 981,433(25,947)원, 포괄수가제에서 667,708(13,286)원으로 감소하였다(p<0.001). 본 연구결과 산부인과 환자에 대한 포괄수가제 적용은 재원일수, 비급여비용, 총본인부담금을 감소시켰고, 급여본인부담금, 보험자부담금, 급여총진료비를 증가시키는 효과를 보였다.

• Journal of Preventive Medicine and Public Health
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• 제53권6호
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• pp.455-464
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• 2020

Objectives: The distribution of hospitals in Korea is unbalanced in terms of accessibility. Many local public health centers (PHCs) exempt out-of-pocket payments (OOPs) based on local government laws to increase coverage. However, this varies across administrative regions, as many make this exemption for the elderly, while others do not. This study aimed to evaluate the effects of the OOP exemption at local PHCs among elderly individuals. Methods: This study used online data on Korean national law to gather information on individual local governments' regulations regarding OOP exemptions. Individual-level data were gathered from the 2018 Community Health Survey and regional-level data from public online sources. Results: The study analyzed 132 regions and 44 918 elderly people. A statistical analysis of rate differences and 2-level multiple logistic regression were carried out. The rate difference according to whether elderly individuals resided in areas with the OOP exemption was 1.97%p (95% confidence interval [CI], 1.07 to 2.88) for PHC utilization, 1.37%p (95% CI, 0.67 to 2.08) for hypertension treatment, and 2.19%p (95% CI, 0.63 to 3.74) for diabetes treatment. The regression analysis showed that OOP exemption had an effect on hypertension treatment, with a fixed-effect odds ratio of 1.25 (95% CI, 1.05 to 1.48). Conclusions: The OOP exemption at PHCs can affect medical utilization in Korea, especially for hypertension treatment. The OOP exemption should be expanded to improve healthcare utilization in Korea.

• 대한치과의사협회지
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• 제57권9호
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• pp.496-503
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• 2019

A dental implant has been covered by National Health Insurance (NHI) in Korea since 2014. Every year the age group covered was extended and the out-of-pocket payment was decreased. This study analyzed the dental implant utilization rate by the National Health Insurance customized DB during the last 5 years. As a result, the utilization rate has been rapidly increasing steeply. The differences by age and sex in the utilization rate of dental implants were explored. The inclusion of a dental implant in the NHI system contributed to improving the dental accessibility of the elderly in Korea. However, a deep discussion is needed whether it is appropriately provided to necessary patients. The utilization rate will increase further in the future. Therefore, continuous monitoring and critical policy review should be continued.

• 보건행정학회지
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• 제24권3호
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• pp.228-241
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• 2014

Background: The purpose of this study is to evaluate the effect of health insurance coverage expansion for cancer patients on equity in health care utilization and catastrophic expenditure. Methods: To analyze the causal relationship between the policy to expand benefit coverage and the change in health care utilization and out-of-pocket payments of cancer patients, this study employed a difference-in-differences (DID) method. In the DID model, the change in health care utilization, such as health care expenditure, visit days and length of stay, of cancer patients was compared with that of liver disease patients, using Korea Health Panel Data in 2009 and 2010. Results: The policy of reducing cost sharing from 10% to 5% for cancer patients did not have significant effects on equity in health care utilization. The results of this study were different from those of the previous study that showed that the reduction of cost sharing from 20% to 10% significantly improved the equity in health care utilization of cancer patients. In addition, the result of catastrophic expenditures analysis showed the policy did not change the probability of catastrophic expenditures. Conclusion: The results of this study imply that payment for non-covered services account for high out-of-pocket payments, and the reduction in cost sharing for covered services alone may have a limited effect on total financial burden on patients.

• 보건행정학회지
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• 제15권2호
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• pp.16-36
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• 2005

Due to the existence of asymmetry of information between doctor and patient, it has been believed that doctor might affect patient's decision making process of purchasing medical care. Based on this notion, doctor's reimbursement method has been suggested as an effective policy device of improving efficiency of patient's medical care use by way of its affecting doctor's practice pattern. By using the Community Tracking Study (CTS) household and physician data set, which includes not only various information on patient's medical care use, but doctor's practice arrangements and sources of practice revenue, this paper investigates the effect of community doctor's characteristics of reimbursement method on community patient's medical care use under the control of patient's socio-demographic characteristics and community doctor's practice type. In the process of estimating econometric model, the endogeneity problem of individual health insurance purchase was corrected by using 2818. And due to the existence of sample selection problem, Heckman's two-step estimation method was used for strengthen the robustness of estimation which was adversely affected by sample selection problem The empirical results show that as the average value of community doctor's portion of practice revenue determined by prospective method out of total revenue increases, the community patient's total out-of-pocket medical cost decreases. This results suggest, as doctor's practice revenues are mainly determined by prospective method, such as capitation, doctors would be more conscious about practice cost, which might affect doctor's practice pattern and by which his/her patient's use of medical care would decrease.

• Journal of Preventive Medicine and Public Health
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• 제35권1호
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• pp.1-12
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• 2002

Objective : To estimate the socioeconomic costs of obesity in Korea,1998. Methods : The 1998 National Health and Nutrition Examination Survey(1998 NHNES) data was used and 10,880 persons who had taken health examinations were selected for study. Essential hypertension, NIDDM(non insulin-dependent diabetes mellitus), dyslipidemia, osteoarthritis, coronary heart disease, stroke were included as obesity related disease. The data of direct costs of obesity was obtained from the National Federation of Medical Insurance. The category of indirect costs was the loss of productivity caused by premature death and admission, time costs, traffic costs, nursing fees due to obesity. Multiple logistic regression model was developed to estimate prevalence odds ratio by obesity class adjusted demographic and socio-ecnomic factors and calculate PAF(Population Attributable Fraction) of obesity on obesity related disease. And we finally calculated the socioeconomic costs of obesity in relation to BMI with PAF. Results : The direct costs of obesity were 2,126 billion${\sim}965$ billion Won in considering out of pocket payment to uninsured services, and the indirect costs of obesity were 2,099 billion${\sim}1,086$ billion Won. Consequently, in considering out of pocket payment to uninsured services, the socioeconomic costs of obesity were 4.225 billion${\sim}2,050$ billion Won, which corresponded to about $0.094%{\sim}0.046%$ of GDP and $1.88%{\sim}0.91$ of total health care costs in Korea. Conclusions : Obesity represents a major health problem with significant economic implications for the society. This results are conservative estimates as far as all obesity related disease and all health care and indirect costs were not included due to missing information. further studies are needed to caculate socioeconomic costs of obesity more exactly.

• 보건행정학회지
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• 제16권1호
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• pp.73-94
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• 2006

This study was carried out to show how the Analytic Hierarchy Process technique could be used in setting the priority among selected diseases to increase the range of health insurance benefit. Thirty experts, including doctors (group1), experts for preventive medicine or public health(group2), and representatives of the insured(group 3), participated in the study panel that is conducted for priority setting. They were asked to evaluate the priorities among 6 selected criteria and then 42 selected diseases. The results were as follows; First, representatives of the insured think that the magnitude of out-of-pocket payment should have high priority while doctors think that effectiveness of treatment should have high priority. Second, all experts think that catastrophic diseases such as malignant neoplasm, major heart disease, and cerebral vascular disease should have high priority in health insurance coverage even though there is little difference among groups. These results can be useful to establish a systematic strategy for expanding health insurance benefit package.