• KDI Journal of Economic Policy
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• v.12 no.3
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• pp.47-69
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• 1990

The measures taken to reform the Dutch health insurance system hold valuable lessons for countries such as Korea, where there has been increased concern regarding the efficiency and effectiveness of the health services provided. The growing literature on comparative health insurance policies suggests that nations can learn from each other. In addition, Korean policymakers have shown great interest in the health insurance systems of foreign countries, particularly in Japan. The development of Korea's health insurance scheme during the past 12 years has made a significant contribution to the increased accessibility of health care services. Although the insurance coverage is universal, the health insurance system today in Korea is by no means a product of systematic and planned efforts. Moreover, it lacks due considerations of insured's needs as well as the long-term objectives of the social security health care system. There are growing gaps in premium burdens and benefits between the rural health insurance program and the employee's health insurance programs. Furthermore, the regional health insurance program is experiencing financial difficulties in spite of the fact that the amount of the government subsidy has been sharply increased in recent years. Under the present payment method solely based on the fee-for-service schedule, both consumers and providers are encouraged to utilize and prescribe more services. The combination of the utilization-inducing reimbursement system and continuous pushes for expanding health insurance has played a crucial role in raising the country's medical bills. Current trends in Korea's health care sector and those anticipated in the near future necessitate changes in the structure and funding of health care. As indicated in the above, there are various shortcomings in this context, the health policy authority in Korea can draw valuable lessons from the Dutch experiences in reforming their health insurance system. The main elements of the Dutch reform measures are a restructuring of the insurance system and a greater role for market forces in the health care system. On this basis a new system will be created which reflects the social nature of health care while at the same time containing sufficient mechanisms to allow the health care sector to operate in a cost-effective and efficient manner.

• Journal of Preventive Medicine and Public Health
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• v.25 no.3 s.39
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• pp.312-329
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• 1992

The purpose of this study is to estimate cesarean section rate in Korea and analyze the socioeconomic variables and health resources which affect regional variation in the rate. Samples were drawn from the record of vaginal and cesarean section deliveries based upon insurance claim bills which have been submitted to the National Federation of Medical Insurance for the first three months, January through March, 1991. The results are obtained as follows : It was found that. cesarean section rate was increasing rapidly up to 23.1% in 1991. Cesarean section per 10 thousand insured people was 4.8 and the number of cesarean section per 10 thousand insured eligible($15{\sim}49$ years old) female was 7.6. The fee for normal delivery was 109,489 won and that for cesarean section was 390,024 won. The average days of hospitalization in normal delivery was 2.3 days, and those in cesarean section was 7.6 days. On the average cesarean section has a longer of stay as much as by 4.3 days and cost 3.6 times more than normal deliveries. Cesarean section rates vary among medical facilities 19.8% at clinics 37.6% in small-scale hospitals, and 29.1% in general hospitals. The regional variation of cesarean section rates was also fairly prominent. The South Cheju Gun has the highest rate of cesarean section, 56.2%. Meanwhile no cesarean section cases has been reported in Sunchang Gun during the period of this study. The variation is noted among provinces. The rate for Cheju province has been 3.4 times higher than that for Chunnam. The number of cesarean section per 10 thousand insured people vary greatly among regions, too. This study has found that there exists significant regional variations among various geographic units in terms of average length of stay, average cost, number of obsretricians and number of beds. Multiple regression analysis was done to identify factors explaining the regional variance of various cesarean section rates : In the urban areas, no significant explaining variables were noted except the number of beds for the dependent variable of cesarean section cases per 10 thousand insured eligible females. The smaller the number of bed, the more cases of cesarean section was noted for an urban area. The is mostly because the rate of cesarean section is higher in medium-size hospitals than in large general hospitals. In the rural areas, the factor of education has been found significant for all three deplendent variables. The higher the educational level, the rate of cesarean section is most likely to rise. An income variable measured by the amount of monthly insurance contribution has been identified a powerful predictor in explaining the valiance of cesarean section rates. The same has been noted for the number of obstetricians. Similar findings are observed for the country as a whole. The income level has veen found as the most powerful explaining factor in the regional variance of cesarean section rates. In general the rate is higher in the urban areas, and lower in the area with more small hospitals. As this is the initial attempt to identify the factors relevant to the regional difference in the rates of cesarean section, more elaborated study is urgently required.

• Journal of The Korean Society of Clinical Toxicology
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• v.1 no.1
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• pp.59-64
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• 2003

Objective: This study was conducted for the nationwide statistical survey of poison exposure to provide the rationale for establishing and developing the poison control center (PCC) in Korea. Design: Study group for Korea PCC in National Medical Center reviewed the medical literature on poison exposure of Korea from death reports of National Statistical Office (NSO), the toxic exposure statistics from the report of National Health Insurance Corporation (NHIC), and poison related data from 119 ambulance services (FD) for the purpose of obtaining the poison and its related data. We also conducted questionnaire from the expert who work in emergency medicine department at the designated 320 emergency medical centers in Korea for the preparedness and acknowledgement about necessity of PCC and their need for that. Results: We reviewed the reliable data from the death report of NSO, poison exposure data from NHIC, and running report from FD. Poisoning death occured at home ($36.7\%$) and hospital ($46.3\%$). Poisoning are more common in rural area than the city area. Patients were seen more frequently in the local clinics than in any hospital. The drugs ($45.7\%$) and pesticide ($18.1\%$) are common poison. Common place to poison exposure were residential area ($39.9\%$), industry ($9\%$). mass residential area ($7\%$). and farm ($6\%$). The education level were primary school ($33.2\%$), high school ($23.7\%$), and middle schol ($21.3\%$) in order. We have to provide the poison guideline for lay public to understand easily, and for medical experts. The medical facilities need to be invested and have more interest for toxicology. All medical staff who work in the designated emergency medical center want PCC to establish. They want to have poison information from hospital ($91.3\%$), regional poison information center ($45.0\%$), regional poison control center ($52.5\%$), nationwide poison information center ($48.8\%$), nationwide poison control center ($46.25\%$), as a role of poison control center. They also want that pcc have poison epidemiologic study and statstics, training program for the experts, registration of rare case of posion on website, reflection of policies to activities for antidote production etc., speedy consultation system for poison analysis, public education, establishment of both regional and national pee, etc. Conclusion: Poison center must be established to provide poison information for all the public and medical experitise, focusing rural area and private clinic, to detoxify, to reduce the cost, time, morbity, and mortality through the whole country.

• International Journal of Advanced Culture Technology
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• v.9 no.1
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• pp.16-21
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• 2021

As the average age of national veterans has increased from 69 years old(2011) to 71 years old(since 2015) over the past five years, the overall medical service cost of veterans has increased by about 20%. The main cause of this phenomenon is 'ultra-aging', which accounts for 67% of veterans, while the proportion of health insurance patients aged 70 or older is 9%. Therefore, it is judged that the analysis of the trend of use of medical services at veterans hospitals in each region that is in charge of severe medical services of national veterans can serve as an opportunity to seek countermeasures for the severe medical system of national veterans. First of all, based on the details of major medical expenses (hospitalization, outpatient, pharmaceutical expenses) by region for the last 10 years(2010-2019), data significance was performed through a chi-square test, and the Central Veterans Hospital and Non-Central Veterans Hospital using EXCEL. 'Expected frequency' was calculated by year. By applying the CHITEST(observation frequency, expected frequency) function again, the p-value(p<0.05) was calculated, and the profit bias of each region's veterans hospital could be determined. The specific research method is for the last 10 years(2010-2019) for state-sponsored patients_outpatient treatment income, state-sponsored patients_hospitalization income, exempt patients_outpatients at the Central Veterans Hospital, Busan Veterans Hospital, Gwangju Veterans Hospital, Daegu Veterans Hospital, and Daejeon Veterans Hospital. A one-way analysis of variance was conducted to verify the significance of the difference between group averages on the status of 5 medical revenues of veterans hospitals in each of the 5 regions, including medical treatment income, reduced patients_hospitalization income, and reduced patients_medicine expenses. It was found to be significant(p<0.05) at all levels, including region and type. Finally, the bias in the profit structure of regional veterans hospitals was the highest in 2017(p=0.0004) and the lowest in 2013(p=0.0349). In addition, in the profit structure of the Veterans Hospital, the year in which the'regional' variable worked the most was 2019, and the year with the least affected was 2010. The order of the former is Jungang(=31,674,713), Busan(=12,314,614), Gwangju(=11,957,038), Daegu(=10,168,015), and Daejeon(=6,991,034), and the order of the latter is Jungang(=57,868,791), and Busan(=19,183,194). Gwangju(=17,904,712), Daegu(=15,656,034), and Daejeon(=14,377,395). In conclusion, the profit bias of veterans hospitals repeatedly raced the lowest(p=0.01986) and highest(p=0.03499) for the past five years(2010-2014) year by year, with the 'regional' variable being the most in the veterans hospital's profit structure It was identified as a major influence factor. On the other hand, for the last 5 years (2015-2019), the influence factors of the'regional' variable every year were in 2015(p=0.02015), 2016(p=0.01741), 2017(p=0.00045), and 2018(p=0.00394). in 2019(p=0.00227), a significant difference was confirmed at a very low level.

• The Korean Journal of Health Service Management
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• v.8 no.2
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• pp.11-22
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• 2014

This study purposed to analyze the regional variation of the local-out rates of inpatient services. Multiple data sources collected from National Health Insurance Corporation and statistics Korea were merged to produce the analysis data set. The unit of analysis in this study was city, Gun, Gu, and all of them were included in analysis. The dependent variable measured the local-out rate of inpatient cost in study regions. Local environments were measured by variables in three dimensions: provider factors, socio-demographic factors, and health status. Along with the traditional ordinary least square (OLS) based regression model, geographically weighted regression (GWR) model were applied to test their effects. SPSS v21 and ArcMap v10.2 were applied for the statistical analysis. Results from OLS regression showed that most variables had significant relationships with the local-out rate of inpatient services. However, some variables had shown diverse directions in regression coefficients depending on regions in GWR. This implied that the study variables might not have consistent effects and they may varied depending the locations.

• Korea Journal of Hospital Management
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• v.27 no.3
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• pp.26-38
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• 2022

Purposes: We analyzed the profitability determinants of regional public hospitals during the entire period between 2010 and 2020 and the period before and after COVID-19. We intended to provide fundamental data for developing publicness evaluation index and task of establishing and expanding regional public hospitals. Methodology: The financial and non-financial information of the regional public hospitals were used as the main analysis data; The financial data was established by the Center for Public Healthcare Policy of National Medical Center, and the non-financial data by the Health Insurance Review and Assessment Service. T-test and regression analysis were used. Findings: The results can be summarized in two. First, the main determinants of profitability of the regional public hospitals were appeared to be the total asset turnover rate and the labor cost rate. Second, during the COVID-19 pandemic in the regional public hospitals, the number of sickbeds, the number of isolation rooms, the total asset turnover rate and the labor cost rate appeared to be the factor worsening the profitability. Practical Implication: The results of this study suggests that the management of the regional public hospitals is not aiming for the profit making, but it performs the functions as the community healthcare safety net such as controlling infectious diseases.

• The Korean Journal of Pain
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• v.36 no.4
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• pp.458-464
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• 2023

Background: Fibromyalgia (FM) is a complex disorder characterized by widespread chronic pain and tenderness in the muscles, ligaments, and soft tissues. It is a chronic pain condition often accompanied by other symptoms and comorbidities. To effectively manage FM, it is crucial to obtain fundamental epidemiological data pertaining to the target population. Therefore, this study was conducted to elucidate the epidemiological characteristics of FM in the Korean population. Methods: Population-based medical data of 51,276,314 subscribers to the National Health Insurance Service of Korea from 2014 to 2018 were used in this study. Results: The overall incidence of FM ranged from 441 (2014) to 541 (2018) cases per 100,000 person-years, with a higher prevalence observed among female patients compared to male patients. The incidence gradually increased until middle age, followed by a decrease. The highest incidence rates were observed in the fifth decade of life for females and the sixth decade of life for males. When categorizing the affected parts of the body, the shoulder region was observed to be the most frequently affected. A comparison of the drug prescriptions based on medical specialty showed that antidepressants were the most commonly prescribed medications. The management of FM leads to consistent increases in medical expenses, regional disparities, and variations in prescription patterns across different medical specialties. Conclusions: The findings of this study will not only contribute to the understanding of FM characteristics but also provide a vital foundation for efficient management of FM in Korea.

• Health Policy and Management
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• v.28 no.3
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• pp.195-196
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• 2018

The Korean Academy of Health Policy and Management (KAHPM) has shown remarkable achievements in the field of health policy and management in Korea for the last 30 years. The KAHPM consists of experts in various fields of health policy and management, and has been the leading academic discussion forum for health policy agendas of interest to the public. Health Policy and Management (HPM), the official journal of the KAHPM, published the first issue of volume 1 in October, 1991 and is publishing the second issue of volume 28 as of 2018. Currently, it is one of Korea' main journals in the field of health policy and management. HPM has published a special issue in commemoration of the 30th anniversary of the KAHPM. The HPM invited authors, including former presidents of the KAHPM and current board members, to write about main issues in health policy and management. Although the HPM tried to set up an invited author on all subjects in the health policy and management field, 19 papers are published, that completed the peer review process by August, 2018. The authors of the special issue of the 30th anniversary of the KAHPM include six former presidents, a senior professor, and 12 board members. The subjects of this issue are reform of the healthcare delivery system, health insurance and medical policy, reform of health system governance, the role of National Health Insurance Service (NHIS), the Korea Institute for Health and Social Affairs (KIHASA) and the National Evidence-based healthcare Collaborating Agency (NECA), ethical aspects of health policy change, regional disparities of healthcare, healthcare accreditation, new healthcare technology evaluation system, globalization of the healthcare industry, the epidemiological investigator system, the quarantine system, safety and disaster, and official development assistance. There are some remaining topics to deal with for the KAHPM: aged society, anti-smoking, non-infectious disease, suicide, healthcare resources, emergency medical care, out-of-pocket money, medical fee payment system, medical aid system, long-term care insurance, industrial accident compensation insurance, community-centered health welfare system, and central government and local government of health. The HPM will continue to publish review articles on the main topics in health policy and management. This is because the KAHPM, which has been the leading academic society of Korea's health policy and management for the last 30 years, feels responsible for continuing its mission for the next 30 years.

• Korea Journal of Hospital Management
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• v.19 no.4
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• pp.21-33
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• 2014

This study was conducted to propose an insight into the appropriateness of hospital length of stay(LOS) by developing a severity-adjusted LOS model for patients with pneumonia, organism unspecified. The pneumonia risk-adjustment model developed in this paper is based upon the 2006-2010 the Korean National Hospital Discharge in-depth Injury Survey. Decision tree analysis revealed that age, admission type, insurance type, and the presence of additional disorders(pleural effusion, respiratory failure, sepsis, congestive heart failure etc.) were major factors affecting the severity-adjusted model using the Clinical Classifications Software(CCS). Also there was a difference in LOS among the regional hospitals, especially the hospital LOS has not been efficiently managed in Gyeongsangbuk-do, Jeollanam-do, Jeollabuk-do, Daejeon, and Busan. To appropriately manage hospital LOS, reliable statistical information about severity-adjusted LOS should be generated on a national level to make sure that hospitals voluntarily reduce excessive LOS and manage main causes of delayed discharge.

• Journal of Digital Convergence
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• v.20 no.4
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• pp.469-482
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• 2022

The purpose of this study is to analyze regional variation factors of hypertension treatment rate in COVID-19 based on the analysis results based on ecological methodology. To this end, data suitable for ecological analysis were collected from the Korea Centers for Disease Control and Prevention's regional health statistics, local government COVID-19 confirmed cases, National Health Insurance Corporation, Health Insurance Review and Assessment Service's welfare statistics, and Korea Transport Institute's traffic access index. Descriptive statistics and correlation analysis were conducted using SPSS Statistics 23 for regional variation and related factors in hypertension treatment rate, and geographical weighted regression analysis was conducted using Arc GIS for regional variation factors. As a result of the study, the overall explanatory power of the calculated geo-weighted regression model was 27.6%, distributed from 23.1% to 33.4% by region. As factors affecting the treatment rate of hypertension, the higher the rate of basic living security medical benefits, diabetes treatment rate, and health institutions per 100,000 population, the higher the rate of hypertension treatment, the lower the number of COVID-19 confirmed patients, the lower the rate of physical activity, and the alcohol consumption. Percentage of alcohol consumption decreased due to COVID-19 pandemic. It was analyzed that the lower the ratio, the higher the treatment rate for hypertension. Based on these results, the analysis of regional variables in the treatment rate of hypertension in COVID-19 can be expected to be effective in managing the treatment rate of hypertension, and furthermore, it is expected to be used to establish community-centered health promotion policies.