• Health Policy and Management
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• v.19 no.3
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• pp.142-165
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• 2009

Although providing universal coverage for health care through the National Health Insurance(NHI) is a remarkable achievement, the issue of limited benefit coverage of the NHI has been at the core of national debate over how to improve its coverage. This study aims to evaluate benefit extension strategies and implemented policies with regard to the NHI since 1989 using 'policy window theory' proposed by John W. Kingdon. Understanding problem stream, policy stream, political stream, and coupling streams regarding the NHI, in particular benefit extension, would contribute to broaden policy debates and to develop more effective strategies for the future. Historically, political stream had opened policy window in the past two decades and policy streams can be characterized by three waves. Three streams have been coupled since 2003 and the government had a strong will to fulfill better performance of NHI coverage. Study findings indicate that identification of problem structure regarding NHI benefit was not connected with policy stream tightly. In addition, there has been limited discussion on policy goal and principles for extension coverage of the NHI. Policy strategies to improve coverage of the NHI should be linked to characteristics of problem and sought solutions under the principle which is expected to be sustainable through consensus in the society.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.18
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• pp.8321-8325
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• 2016

Background: The incidence of hydatidiform mole (HM) differs among regions but has declined significantly over time. In Thailand, the initiation of universal health coverage in 2002 has resulted in a change of medical services countrywide. However, impacts of these policies on gestational trophoblastic disease (GTD) cases in Thailand have not been reported. This study aimed to find the incidence of hydatidiform mole (HM) in King Chulalongkorn Memorial Hospital (KCMH) from 1994-2013, comparing before and after the implementation of the universal coverage health policy. Materials and Methods: All cases of GTD in KCMH from 1994-2013 were reviewed from medical records. The incidence of HM, patient characteristics, treatment and remission rates were compared over two study decades between 1994-2003 and 2004-2013. Results: Hydatidiform mole cases decreased from 204 cases in the first decade to 111 cases in the seond decade. Overall incidence of HM was 1.70 per 1,000 deliveries. The incidence of HM in the first and second decades were 1.70 and 1.71 per 1,000 deliveries, respectively (p=0.65, 95%CI 1.54-1.88). Referred cases of nonmolar gestational trophoblastic neoplasia (GTN) increased from 12 (4.4%) to 23 (14.4%, p<0.01). Vaginal bleeding was the most common presenting symptom which decreased from 89.4% to 79.6% (p=0.02). Asymptomatic HM patients increased from 4.8% to 10.2% (p=0.07). Rate of postmolar GTN was 26%. Conclusions: The number of HM cases in this study decreased over 2 decades but incidence was unchanged. Referral rates of malignant cases were more common after universal health coverage policy initiation. Classic clinical presentation was decreased significantly in the last decade.

• Journal of Korean society of Dental Hygiene
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• v.16 no.2
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• pp.185-193
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• 2016

Objectives: The purpose of the study was to examine the recognition and satisfaction of dental care customers after 1 year national health insurance coverage of dental scaling. Methods: A self-reported questionnaire was completed by 477 dental care customers in Gyeongbuk, Busan, Yangsan, and Gyeonggido from July 18 to September 30, 2014 after receiving informed consents. The questionnaire consisted of general characteristics of the subjects(5 items), subjective awareness of oral health(4 items), recognition of scaling(5 items), and recognition and satisfaction of scaling health insurance(5 items). Data were analyzed using SPSS version 20.0 program. Results: Those who recognized the national health insurance coverage of dental scaling accounted for 80.1 percent and 47.2 percent of them got the health insurance coverage via media advertisements. Those who received the scaling service by health insurance coverage accounted for 73.8% and 66.2% of them were very satisfied with the service. Among the customers, 91.8% were satisfied with scaling health allotment. There was a statistical significance between scaling health insurance and subjective oral condition recognition(p<0.01). Through the health insurance coverage scaling service, the oral health in Korea will improve much. Conclusions: The expansion of health insurance coverage of scaling service will provide the universal oral health care for all people. Owing to low cost service, people will actively try to come in contact with public health service in the future.

• Journal of Preventive Medicine and Public Health
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• v.51 no.1
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• pp.59-61
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• 2018

• Health Policy and Management
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• v.27 no.3
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• pp.256-266
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• 2017

Background: Primary health care (PHC) plays a major role to ensure the basic right and equal distribution of the essential health care services. This study presents comparative analyses of PHC in Korea and Uzbekistan, discusses the existing scenario and the challenges, and provides recommendations. Methods: This study reviewed secondary data from Korea's National Statistical Information Service and the State Committee of the Republic of Uzbekistan on Statistic, regulatory legislation, research reports, and policy papers by research and international institutions. We focus on comparing input and outcome health data, PHC structure, and health expenditure. Results: Overall health status of the population in Korea is better than in Uzbekistan; both countries achieved more than 95% immunization coverage. The reforms implemented in both countries provide initial health care service delivery. However, there are several challenges such as the distribution of the staff between urban and rural areas and interest of the graduates on specialization rather than working in PHC system. Conclusion: PHC plays an important role in the provision of medical services to the population, addressing both health and social problems; it is the best tool for achieving universal coverage for basic health needs of the population. The community health practitioners in Korea and nurses in Uzbekistan plays main role in universal coverage through providing essential health care services. Continuous reform of the PHC system should be directed to strengthen the capacity of the PHC staff in health promotion knowledge and activities as well as to encourage population to improve their own health.

• Journal of Microbiology and Biotechnology
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• v.24 no.6
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• pp.812-822
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• 2014

Metagenomic analysis of the human intestinal microbiota has extended our understanding of the role of these bacteria in improving human intestinal health; however, a number of reports have shown that current total fecal DNA extraction methods and 16S rRNA universal primer sets could affect the species coverage and resolution of these analyses. Here, we improved the extraction method for total DNA from human fecal samples by optimization of the lysis buffer, boiling time (10 min), and bead-beating time (0 min). In addition, we developed a new long-range 16S rRNA universal PCR primer set targeting the V6 to V9 regions with a 580 bp DNA product length. This new 16S rRNA primer set was evaluated by comparison with two previously developed 16S rRNA universal primer sets and showed high species coverage and resolution. The optimized total fecal DNA extraction method and newly designed long-range 16S rRNA universal primer set will be useful for the highly accurate metagenomic analysis of adult and infant intestinal microbiota with minimization of any bias.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.18
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• pp.8541-8551
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• 2016

Background: The coverage of breast and cervical cancer screening has only slightly increased in the past decade in Thailand, and these cancers remain leading causes of death among women. This study identified socioeconomic and contextual factors contributing to the variation in screening uptake and coverage. Materials and Methods: Secondary data from two nationally representative household surveys, the Health and Welfare Survey (HWS) 2007 and the Reproductive Health Survey (RHS) 2009 conducted by the National Statistical Office were used. The study samples comprised 26,951 women aged 30-59 in the 2009 RHS, and 14,619 women aged 35 years and older in the 2007 HWS were analyzed. Households of women were grouped into wealth quintiles, by asset index derived from Principal components analysis. Descriptive and logistic regression analyses were performed. Results: Screening rates for cervical and breast cancers increased between 2007 and 2009. Education and health insurance coverage including wealth were factors contributing to screening uptake. Lower or non-educated and poor women had lower uptake of screenings, as were young, unmarried, and non-Buddhist women. Coverage of the Civil Servant Medical Benefit Scheme increased the propensity of having both screenings, while the universal coverage scheme increased the probability of cervical screening among the poor. Lack of awareness and knowledge contributed to non-use of both screenings. Women were put off from screening, especially Muslim women on cervical screening, because of embarrassment, fear of pain and other reasons. Conclusions: Although cervical screening is covered by the benefit package of three main public health insurance schemes, free of charge to all eligible women, the low coverage of cervical screening should be addressed by increasing awareness and strengthening the supply side. As mammography was not cost effective and not covered by any scheme, awareness and practice of breast self examination and effective clinical breast examination are recommended. Removal of cultural barriers is essential.

• Health Policy and Management
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• v.31 no.4
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• pp.387-398
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• 2021

Moon Jae-in Care can be seen as a 2.0 version of Roh Moo-Hyun Care. Just as Roh Care failed to achieve its coverage rate goal and 30% share of public beds, Moon Care also failed to achieve its expected goal. The reason is that it followed Roh Care's failed strategy. Failure to control non-covered services has led to a long way to achieve a 70% coverage rate and induced the expansion of voluntary indemnity insurance, resulting in increased public burden. The universal coverage of non-covered services caused an immediate backlash from doctors. And Moon government also failed to control the private insurance market. The expansion of publicly owned beds has not become realized and has not obtained public support. Above all, it failed to overcome the resistance of doctors and failed to obtain consent from budget power groups in the cabinet for public investment. It was also insufficient to win the support of civic groups. Communication with interested groups failed and the role of private health care providers was neglected. The next government should also continue to strengthen health care coverage, but it should prioritize preventing medical poor and create a consensus with both medical providers and consumers for the control of non-covered services. Ahead of the super-aged society, the establishment of linkage between medical services and long-term care and visiting health care or welfare services is an important task. All public and private provisions and resources should be utilized in the view of a comprehensive public health perspective, and public investment should be input in sectors where public medical institutions can perform more effective functions. The next government, which will be launched in 2022, should design a new paradigm for health care in the face of a period of transformation, such as the coming super-aged society in 2026 and the Fourth Industrial Revolution, and recognize that the capabilities of the health care system represent the nation's overall capacity.

• Health Policy and Management
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• v.32 no.2
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• pp.137-153
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• 2022

In the process of promoting policies to strengthen health insurance coverage, the relationship between public health insurance and private health insurance, along with the management of non-benefit, is also emphasized as a policy issue. First, the concept and scope of non-benefit were comparatively analyzed by country. Second, the interaction between the public and private health insurance was classified as 'large or small,' and the government's regulation and management policy on private health insurance was classified as 'strong or weak.' Korea has relatively smaller benefits covered by public health insurance, higher copayment expenses, and more areas and scope of non-benefits. In countries where the interaction between public and private health insurance is small, private health insurance-related policies are weak. And in countries with large interactions had public-private partnerships and the government's management policies were also strong. On the other hand, Korea has a large interaction, but the actual structure of cooperation between public and private insurance and management policies were weak. Because the non-benefit sector in Korea is relatively wide, it is difficult to manage compared to other countries where the concept of non-benefit is limited. In addition, the health authorities rarely perform the role of supervision over private health insurance, and they have so few linkages and cooperation for public-private insurance. Therefore, practical policy enforcement is necessary to achieve the easing of the burden of national medical expenses through linkage and cooperation of public-private health insurance with reference to relevant other countries' cases.

• Health Policy and Management
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• v.18 no.4
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• pp.23-48
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• 2008

Although the universal health insurance, National Health Insurance (NHI), have improved access to health care and financial burden of health care costs for Koreans, limited coverage of the NHI leads to high out-of-pocket payment for health care. This study examines financial burden of household health expenditures by income level. Data from the Urban Household Expenditure Survey from 1985 through 2005 is analyzed and household expenditure is used as a proxy measure for income. Health expenditures include spending for inpatient care, ambulatory care and pharmaceuticals. If a household spends health expenditure above 40% of household consumption except for foods, that is defined as catastrophic health expenditure. Access to health care for the lowest income group had been improved for two decades relative to other income groups as well as in absolute term. However, both financial burden of health expenditures and the proportion of households that experienced catastrophic health expenditure had been increased in the lowest income group. Study findings have several policy implications. First, in terms of financial burden of health expenditures. the differences among income groups decreased until 2000 but it was worsen in 2005. This suggests that recent policies for extending NHI coverage are not enough to improve the disparity by income level. Second, a differential catastrophic coverage by income level would be an effective strategy that relieves financial burden for low income group. Third, since the catastrophic coverage is applied to only covered services by the NHI, additional strategy for uncovered services should be considered.