• Health Policy and Management
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• v.26 no.4
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• pp.305-314
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• 2016

Background: The purpose of this study is to examine the characteristics of and factors associated with long-term care (LTC) utilization under public long-term care insurance (LTCI) among end-of-life older adults in Korea. Methods: Using a 5% sample of older people aged 65 or older and their health and LTC insurance data, two-part model analyses were conducted. We compared LTC uses and their determinants during the last year of life among decedents in the year 2010 with those of survivors. We also compared the medical uses of the same sample with their LTC uses. Results: The end-of-life elderly were more likely to use LTC, and their expenditure on LTC was higher than their counterparts. Whether or not older people used LTC during their last year of life was significantly affected by age, sex, health insurance, household income, and living alone; however, LTC costs of the decedents were only affected by functional status, which may have been due to the reimbursement scheme of the current LTCI, which is mainly based on functional dependency level. For the survivors, having chronic diseases significantly increased the likelihood of LTC use, which was not the case for the decedents. End-of-life elderly with relatively low social economic status were more likely to use the LTC other than medical services, while the health conditions affected their medical uses most significantly. Conclusion: The study findings provide key information for predicting demand related to the increasing LTC needs of Korean older people at the end of life.

• Quality Improvement in Health Care
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• v.12 no.2
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• pp.93-112
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• 2006

This study reviewed published studies on interventions used by hospitals, health insurance programs, or governments to improve use of medicines in foreign countries. Interventions to improve use of medicines are classified into two categories: 1) information strategies-dissemination of educational materials, group education, one-to-one educational outreach, drug utilization review, and feedback; 2) managerial strategies- formularies, prior authorization, and financial incentives. Dissemination of educational materials, which is a common intervention, was unsuccessful in changing physicians' prescribing behaviors. Problem-based small group education was more likely to change behaviors than didactic large group education. One-to-one educational outreach(academic detailing) was among the most effective strategies used to change prescribing behaviors. Prospective drug utilization review (DUR) program was more successful in improving use of medicines than retrospective DUR program. Feedback intervention has been reported to be ineffective to change behaviors. Formularies are frequently used to control medication use by most health insurance programs. Financial incentives provide physicians economic incentives according to appropriateness of prescribing. However, few published studies have assessed the efficacy of formularies or financial incentives. Prior authorization requires physicians to get authorization from health insurers before prescribing a certain group of drugs which is usually of high costs or risk. There is no magic bullet for quality use of medicines. Multifaceted interventions that help to predispose, enable, and reinforce desired behaviors are more likely to be successful.

• The Korean Journal of Health Service Management
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• v.6 no.4
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• pp.143-152
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• 2012

This study analyzes Korea health panel data (2008) (beta version 1.2) of Korea Institute for Health and Social Affairs, and National Health Insurance Corporation to figure out determinants of healthcare expenditure. In result of Multiple Logistic Analysis, in-patents felt burden on the medical expenditure were 70.0%. As to the patients' payment of medical expenditure, patients over 65 years old had 4.765 times higher than those under 14 years, disabled patients 2.778 than non-disabled patients, chronic patients 1.632 times than non-chronic patients, patients belonging to 12 million won ~ 46 million won and under 12 million won in family income had 1.680 times and 2.168 times respectively than patients with over 46 million won, patients in professional recuperation facility 1.546 times than patients in hospital, patients in private medical institutions 1.700 times than patients in national and public medical institutions, patients using upper grade rooms 1.701 times than patients in non-upper grade rooms. As a health care safety net mechanism to protect people from medical expenditure burden, there is the patients' payment ceiling in the National Health Insurance System. Thus, in order to facilitate the patient's payment ceiling, it is required that the level of ceiling is to be specified according to the income level, and self-payment items is to be included.

• Journal of Korean society of Dental Hygiene
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• v.23 no.4
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• pp.311-321
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• 2023

Objectives: The purpose of this study was conducted an in-depth analysis of the subjective oral status and oral care needs according and problems of the elderly. Methods: A phenomenological research method was from April 13 to 30, 2023, 15 elderly people aged 65 or older in Gwangju and Jeolla regions were surveyed. Results: He was experiencing oral changes such as difficulty chewing, dry mouth and indigestion, sensitive teeth, smell of fear and feeling sensitive when eating sweet or cold food. They were burdened by the financial difficulties of dental treatment costs, the inconvenience caused by frequent visits, and the pain experienced during treatment. Realized the need for necessity of oral care education, and their confidence was restored through dental treatment. It was necessary the image recovery of dentistry, and they wanted to maintain oral health through the expansion of treatment health insurance. Conclusions: Consequently, it is necessary to develop a practical oral health management program for the elderly based on social communication regarding of the elderly and to expand health insurance coverage.

• Health Policy and Management
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• v.10 no.3
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• pp.169-187
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• 2000

Cigarette smoking has been identified as the most important source of preventable morbidity and premature mortality (WHO, 1995), The prevalence of smoking among men is very high in Korea. This study estimated productivity losses due to smoking in Korea, 1997. The derivation of cost estimates for mortality, disability, hospitalization and use of physician services related to cigarette smoking is bas 어 on the calculation of attributable fractions suggested by MacMahon and Cole and Smoking-Attributable Mortality, Morbidity, and Economic Cost(SAMMEC) software. To estimate the number of deaths from neoplastic, cardiovascular, respiratory diseases associated with cigarette smoking, estimates for adults(aged 20 years and over) were based on 1997 mortality data, 1995 data on smoking prevalence from Korea Institute for Health and Social Affairs. Smoking-attributable indirect morbidity cost data were obtained from the National Federation of Medical Insurance. As the result of cost estimation, these productivity losses were 336-430 billion won. During 1997, 8,620-10,804 deaths were attributed to smoking. Cigarette smoking resulted in 133,991-169,422 Years of Potential Life Lost (YPLL) to life expectancy. For smoking -attributable indirect mortality costs, the present value of future earnings(PVFE) for the age at death are 299-384 billion won. Smoking-attributable indirect morbidity costs, the costs of lost productivity for persons who are disabled by smoking-related chronic diseases are 37-46 billion won. In this study the productivity losses due to smoking were restricted to the health effects of smoking. It is possible that these costs were underestimated with the limitation of the data. Smoking is the leading preventable cause of illness and death. The results of this study can be used as elementary data for antismoking policy.

• Journal of Nutrition and Health
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• v.38 no.9
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• pp.786-792
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• 2005

With dramatic transitions from a traditionally food-insecure to a food-sufficient society, over weight and/or obesity are an increasing health concern in Korea. In 2000, $35.9\%$ of Korean adults were over weight (BMI>25) with increasing trends. It is well known that obesity is highly correlated with chronic diseases, such as diabetes, hypertension, cardiovascular disease, cancer and high cholesterol. In 2003, the social cost of obesity is estimated at $529.5\~799.3$ billion won (direct cost) and at $1,200\~1,817$ billion won (including indirect cost). The share of the direct cost is estimated at $2.6\~3.9\%$ of total medical bill 20,742 billion won. These costs are underestimated and would surely be higher if the expenditures outside of the official medical insurance system of Korea were included. Based on the rapid increase of obesity rate among the Korean youth, it is crucial to develop and implement appropriate policies to curb the obesity epidemic.

• Korean Journal of Acupuncture
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• v.30 no.1
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• pp.21-26
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• 2013

Objectives : The purpose is to introduce the recent large-scale clinical researches for safety, efficacy and effectiveness of acupuncture in Germany. Results : In 2000, the German Federal Committee of Physicians and Health insurer proposed that large research initiatives on acupuncture, Acupuncture Model Projects(Modellvorhaben Akupunktur), could be conducted by health insurance companies for several pain that acupuncture is syndromes to justify the insurance-based reimbursement. Accordingly, 4 clinical researches were carried out; the Acupuncture Safety and Health economics studies(ASH), the Acupuncture Randomised Trial(ART), the Acupuncture in Routine Care studies(ARC), and the German Acupuncture trial(GERAC). Meanwhile, ASH is a prospective observational study for safety and costs. ART and GERAC are composed of RCTs for efficacy. ARC includes 6 pragmatic RCTs with additional non-randomized cohort study for effectiveness. We investigated the papers related to them and discussed about the outcomes. The researches showed that acupuncture is effective in practice for several chronic conditions such as migraine, tension-type headache, chronic low back pain, osteoarthritis of knee, dysmenorrhea, and allergic rhinitis. Based in part on them, the German health authorities decided that acupuncture would be included into routine reimbursement by social health insurance funds for chronic low back pain and chronic osteoarthritis of the knee in 2006. Conclusions : The German clinical researches may suggest the clues for establishing the evidence of acupuncture treatment.

• Korean Journal of Social Welfare
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• v.56 no.3
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• pp.113-133
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• 2004

Although National Health Insurance(NHI) in the South Korea has guaranteed access to health insurance coverage to virtually all the people, a significant portion of out-of-pocket spending can create substantial financial burdens for some beneficiaries, particularly those with low incomes. Previous studies have estimated the magnitude of out-of-pocket spending by types of chronic illness or in- and out-patients. Prior estimates, however, have not given a complete picture of the impact of health care costs on lower-income populations. The result from this study shows that 20 percent of beneficiaries in the lowest-income quintile spent more than twelve percent of their household equivalent income out-of-pocket health services, whether they were enrolled in a Health care services or not. In comparison, the beneficiaries in the highest-income quintile level spent only 2 percent of their income out-of-pocket on health care. Also, the regression analysis suggests that age, household income, number of chronic illness, type of hospital in addition to the number of usage may affect the size of out-of-pocket spending.

• 한국사회정책
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• v.25 no.1
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• pp.99-123
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• 2018

Purpose: This study empirically investigates the utilization and expenditure of health care and long-term care at the last year of life for long-term care beneficiaries in Korea. Methods: This study used National Health Insurance and Long-term Care Insurance claims data of 271,474 LTCI beneficiaries, who died from July 2008 to December 2012. Their cause of death, place of death, health care costs, and the provision of aggressive care were analyzed. Results: Cardio-vascular disease(29.8%) and cancer(15.3%) were reported as their major cause of death, and hospital(64.4%), home(22.0%), social care facility(9.2%) were analyzed as the place of death. 99.3% of subjects used both health care and long-term care during the last 1 year of life. The average survival period were 516.2 days after they were LTCI beneficiaries. The health care expenditure gradually increased near the death, and the last month were three times more rather than the first month. Furthermore, 31.8% experienced some aggressive cares(CPR, blood transfusion, hemo-dialysis, etc.) at the last month of life. Conclusion: The results of this study suggest that it is important to develop the end of life care policies(for example, hospice, advanced care directives) for the LTCI beneficiaries. They might contribute to the improvement of quality of life and the reduction of health care expenditure of the elderly at the end-of-life.

• Journal of Families and Better Life
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• v.27 no.2
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• pp.191-201
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• 2009

The Korean Government has recently prepared the comprehensive five-year basic plan (2006-2010) to deal with low fertility and population ageing. The basic plan aims at recovering the fertility rate to the appropriate level and improving the social and economic systems in preparation for the aged society. The main objective of this study was to examine the effects of fertility policies on childbirth by birth order. The data came from 1,729 adults who gave birth to babies in 2007 and 991 adults as the control group. The serial logistic regression analyses revealed that establishing the health and nutrition system for maternity and children, and expanding of tax and social insurance benefit were effective policy measures to increase childbirths of first children, while the policy measures establishing the health and nutrition system for maternity and children, supporting for daycare and pre-school education, and work-life balance were effective to childbirths of second or third children in 2007. However, the policies of supporting for costs of test-tube baby and expanding childcare infra didn't have any significant influences on childbirths in 2007. The implications of study results were discussed.