• Journal of Digital Convergence
• /
• v.15 no.12
• /
• pp.625-633
• /
• 2017

The purpose of this study is to investigate the effect of private insurance revenues and household spending on household income inequality. To this end, we conducted a concentration index and concentration curve analysis for the income level of medical panel survey data in 2015. The main results are as follows. First, the household income concentration ratio is 0.3580, which means that income is concentrated in the high income group, and the degree of inequality is considerably large. Second, although the portion of the private insurance benefits was small on the high-income household, it helped to strengthen the benefits concentration on this group. Third, the low income group has a large self-pay medical expense. Finally, the index of the income excluding the burden of the total medical expenses in the household income was 0.3676, so that even accounting for medical expenses, the income was concentrated in the high income class. Therefore, private insurance benefits and medical expenses were all contributing factors to the inequality of household income, and this study provides the essential materials for research and policy planning which could lead to the convergence of different fields.

• Health Policy and Management
• /
• v.15 no.3
• /
• pp.79-93
• /
• 2005

The purpose of the study is to identify Ambulatory Care Sensitive Conditions (ACSC) and their potential health insurance applicability in Korea, using the correlation and regression analysis with the empirical data provided by Korean Health Insurance Review Agency(KHIRA). Here, ACSC would be thought of as conditions that when timely and effectively treated in the outpatient medical services can help reduce the risk of hospitalizations. As for ACSC, reducing accessibility for outpatient visit results in increasing hospitalization. In this respect, the ACSC concept is popularly adopted as one of the performance indicators of the national health system. As one of main results, fortifying the accessibility to necessary health care in a way of sharing appropriately the role with private health insurance can lead to the efficiency of national health care delivery systems in view of total health care expense, in particular in a case of ACSC children. Lastly, we would like to strongly suggest that the disease treatment data set reported to KHIRA needs to be opened to private insurance companies only for illness experience investigation.

• The Journal of the Korean dental association
• /
• v.48 no.6
• /
• pp.459-468
• /
• 2010

International Classification of Disease (ICD-10) is widely used as a crucial reference not only in the medical diagnosis of diseases but also within the health insurance system. It makes possible for medical personnel to make decisions systematically and for the people working in the health insurance or public health industries to better understand medical issues. However, this classification is often not enough or acceptable in a clinical setting. Many countries amend in their own way to make it more appropriate for their people. Korean Classification of Disease (KCD-5) was made by adding a 5 digit code for some diseases to clarify the conditions of the patients. The authors found problems of KCD-5 in temporomandibular disorders and several related medical problems. Medical treatment for these problems had not been covered even by public health insurance until 2000 in Korea. For the last decade, private insurance companies have introduced new items for reimbursement of the treatment fees the patients actually pay. The authors assumed that many patients with these medical problems encountered difficulties in the reimbursement from private insurance companies because KCD-5 did not classify these medical conditions appropriately. An overview of KCD-5 and suggestions for improvement are introduced in this study.

• Journal of Society of Preventive Korean Medicine
• /
• v.28 no.1
• /
• pp.59-67
• /
• 2024

Objectives : This study aims to systematically examine the determinants of the intention to take herbal medicine among individuals with experience in Korean medicine. Methods : This study utilized the 3,245 respondents from the 2020 Korean Medicine Utilization and Herbal Medicine Consumption Survey who reported having used Korean medical services; the responses were selected through a complex sample analysis, and analytics techniques including frequency analysis, Rao-scott chisquare test, and logistic regression were used to analyze the responses. Results : The results of data analysis reveal that the intention to take herbal medicine in the future among these individuals was significantly influenced by factors such as enrollment in private health insurance, the facility environment of Korean medical institutions, and treatment outcomes. Conclusions : Therefore, it is imperative for Korean medical institutions to continuously try reasonable action strategies, including improving medical facilities/environments and building institutional mechanisms among medical staff and members to enhance the quality of Korean medical services. Additionally, the Ministry of Health and Welfare needs to make policy efforts to reduce patients' medical expenses, such as reducing the co-insurance rate in the pilot project of applying health insurance to herbal medicine.

• Health Policy and Management
• /
• v.29 no.2
• /
• pp.184-194
• /
• 2019

Background: The extent of coverage rate of the public health insurance is still insufficient to meet healthcare needs. Private health insurance (PHI) plays a role to supplement coverage level of national health insurance in Korea. It is expected that reduce unmet need healthcare. This study was aimed to identify relationship between PHI type and the unmet healthcare need and its associated factors. Methods: Data were obtained from the 2014 Korea Health Panel Survey using nationally representative sample was analyzed. Respondents were 8,667 who were adults over 20 years covered by PHI but have not changed their contract. According to the enrollment form, PHI was classified into three types: fixed-benefit, indemnity, and mixed-type. To identify factors associated with unmet needs, multiple logistic regression conducted using the Andersen model factors, which are predisposing factors, enabling factors, and need factors. Results: Our analysis found that subjects who had PHI with mixed-type were less likely to experience unmet health care needs compared than those who did not have it (odds ratio, 0.80; 95% confidence interval, 0.66-0.98). As a result of analyzing what affected their unmet healthcare needs, the significant factors associated with unmet medical need were gender, marital status, residence in a metropolitan area, low household income, economic activity participation, self-employed insured, physically disabled, low subjective health status, and health-risk factors such as current smoking and drinking. Conclusion: The results of this study suggest that having PHI may reduce experience of unmet healthcare needs. Findings unmet healthcare needs factors according to various subjects may be useful in consideration of setting policies for improving accessibility to healthcare in Korea.

• The Korean Journal of Health Service Management
• /
• v.8 no.4
• /
• pp.25-34
• /
• 2014

This paper examined the effects of private health insurance (PHI) on the use of endoscopy, sonography, CT, MRI, and PET among Koreans. The data used was the four waves of the Korea Health Panel (2008-2011), and the number of subjects was 141,862 visits. We employed a pooled logistic regression mode which was corrected with cluster errors. The results showed that PHI was positively related to the use of endoscopy, but not related to the use of sonography, CT, MRI, and PET. It is, however, recommended that health policy makers pay attention to the effects of PHI on the use of sonography, CT, MRI, and PET.

• 대한예방의학회:학술대회논문집
• /
• 2005.10a
• /
• pp.349-349
• /
• 2005

• Health Policy and Management
• /
• v.22 no.1
• /
• pp.145-162
• /
• 2012

The purpose of this study is to understand magnitude and its related factors of user's cost-sharing for non-covered services in long-term care facilities. We corrected data for 1,016 subjects, based on the long-term care benefits cost specification. Eighteen subjects were excluded from the data analysis due to missing data on family care-givers characteristics. Finally, 998 subjects were included in the study. The average cost of non-covered services per month was 209,093 won and distributed from 0 to 1,011,490 won. There was a significant difference by the characteristics of family care-givers and long-term care facilities. The monthly average cost for meal materials per person was 199,181 won(0~558,000), average cost of additional charge caused by using private bed was 232,992 won (50,000~600,000), and costs for haircut and cosmetics were 8,599 won. For the rest, there were various programs costs(93,328 won), diaper and its disposal cost(109,628 won), purchase cost for daily necessaries(24,435 won) and etc. The related factors for the magnitude of non-covered services expenditures were education level of family care-givers, occupancy rate and location of LTC facilities, and the costs of using private bed, haircut and cosmetics, and various programs among non-covered services. These findings suggest that present level range of LTC facilities users' cost-sharing is wide and it is urgent to prepare the standard guideline for cost and level in non-covered services.

• Health Policy and Management
• /
• v.15 no.4
• /
• pp.65-80
• /
• 2005

This study examines the effects of supplemental insurance on health care utilization and expenditures among cancer patients, who were hospitalized in a general hospital in Korea 2003. We find that those who purchase the supplemental insurance in addition to the social health insurance use more health care services and pay more than those who do not, suggesting insurance effects. This paper, however, cannot distinguish the moral effects of the health insurance from the selection effects due to adverse selection.

• Journal of Preventive Medicine and Public Health
• /
• v.57 no.1
• /
• pp.91-94
• /
• 2024

For nearly four decades, Ugandans have experienced a period marked by hope, conflict, and resilience across various aspects of healthcare reform. The health insurance system in Uganda lacks a legal framework and does not extend benefits to the entire population. In Uganda, community-based health insurance is common among those in the informal sector, while private medical insurance is typically provided to employees by their workplaces and agencies. The National Health Insurance Scheme Bill, introduced in 2019, was passed in 2021. If the President of Uganda gives his assent to the National Health Insurance Bill, it will become a significant policy driving health and universal health coverage. However, this bill is not without its shortcomings. In this perspective, we aim to explore the complex interplay of challenges and opportunities facing Uganda's health sector.