• Health Policy and Management
• /
• v.27 no.4
• /
• pp.273-275
• /
• 2017

It has been forty years since the implementation of National Health Insurance (NHI) in South Korea. Following the 1977 legislature mandating medical insurance for employees and dependents in firms with more than 500 employees, South Korea expanded its health insurance to urban residents in 1989. Resultantly, total expenses of the National Health Insurance Service (NHIS) have greatly increased from 4.5 billion won in 1977 to 50.89 trillion won in 2016. With multiple insurers merging into the NHI system in 2000, a single-payer healthcare system emerged, along with separation policy of prescribing and dispensing. Following such reform, an emerging financial crisis required injections from the National Health Promotion Fund. Forty years following the introduction of the NHI system, both praise and criticism have been drawn. In just 12 years, the NHI achieved the fastest health population coverage in the world. Current medical expenditure is not high relative to the rest of the Organization for Economic Cooperation and Development. The quality of acute care in Korea is one of the best in the world. There is no sign of delayed diagnosis and/or treatment for most diseases. However, the NHI has been under-insured, requiring high-levels of out-of-pocket money from patients and often causing catastrophic medical expenses. Furthermore, the current environmental circumstances of the NHI are threatening its sustainability. Low birth rate decline, as well as slow economic growth, will make sustainment of the current healthcare system difficult in the near future. An aging population will increase the amount of medical expenditure required, especially with the baby-boomer generation of those born between 1955 and 1965. Meanwhile, there is always the problem of unification for the Korean Peninsula, and what role the health insurance system will have to play when it occurs. In the presidential election, health insurance is a main issue; however, there is greater focus on expansion and expenditure than revenue. Many aspects of Korea's NHI system (1977) were modeled after the German (1883) and Japanese (1922) systems. Such systems were created during an era where infections disease control was most urgent and thus, in the current non-communicable disease (NCD) era, must be redesigned. The Korean system, which is already forty years old, must be redesigned completely. Although health insurance benefit expansion is necessary, financial measures, as well as moral hazard control measures, must also be considered. Ultimately, there are three aspects that we must consider when attempting redesign of the system. First, the health security system must be reformed. NHI and Medical Aid must be amalgamated into one system for increased effectiveness and efficiency of the system. Within the single insurer system of the NHI must be an internal market for maximum efficiency. The NHIS must be separated into regions so that regional organizers have greater responsibility over their actions. Although insurance must continue to be imposed nationally, risk-adjustment must be distributed regionally and assessed by different regional systems. Second, as a solution for the decreasing flow of insurance revenue, low premium level must be increased to an appropriate level. Likewise, the national reserve fund (No. 36, National Health Insurance Act) must be enlarged for re-unification preparation. Third, there must be revolutionary reform of benefit package. The current system built a focus on communicable diseases which is inappropriate in this NCD era. Medical benefits must not be one-time events but provide chronic disease management. Chronic care models, accountable care organization, patient-centered medical homes, and other systems that introduce various benefit packages for beneficiaries must be implemented. The reimbursement system of medical costs should be introduced to various systems for different types of care, as is the case with part C (Medicare Advantage Program) of America's Medicare system that substitutes part A and part B. Pay for performance must be expanded so that there is not only improvement in quality of care but also medical costs. Moreover, beneficiaries of the NHI system must be aware of the amount of their expenditure through a deductible payment system so that spending can be profiled and monitored. The Moon Jae-in Government has announced its plans to expand the NHI system; however, it is important that a discussion forum is created so that more accurate analysis of the NHI, its environments, and current status of health care system, can take place for reforming NHI.

• Korea Journal of Hospital Management
• /
• v.12 no.1
• /
• pp.1-30
• /
• 2007

The study carried out a survey with employees of hospitals located in Daejeon, Chungnam, and Chungbuk from Sep. 12 to Sep. 30, 2005 in order to derive primary elements that affect the improvement of hospital's competitiveness. The study investigated and analyzed the employees' recognition on the change of competitive environment caused by the change of medical environment. The study also analyzed the elements that affect the hospital's competitiveness and the competitive strategies of the hospitals. The conclusion of this study can be summarized as follows. 1. Summary 1) Most of the employees responded that there is a rival in the competitive environment and the competitive is intense. Especially when the employees are married, live in urban areas, have an education level of university graduate or are managers, they tend to think the competitive is very intense. Also, they said that the competitive is based upon the quality of medical service. They mentioned the element that has the biggest effect on the competitiveness is the element of medical consumer and they recognized that the medical services in university and general hospitals have more competitiveness than the one-department hospitals. 2) It was investigated that the medical technique service has the most effect on the hospital's competitiveness. Also, the external service of medical techniques also has a large effect on the hospital's competitiveness. 3) When they were asked for the factors that affect the patients' decision on selecting a hospital, most of them responded "capability and technique of the medical staffs." Also, they said that "sufficient explanation from doctors" and "special center and clinic" are the factors that have big effects on the patients' decision. 4) In the SWOT analysis, most of them responded that the strength is the hospital's characteristics and the weakness is insufficient and obsolete equipment. They said the opportunity is the demands for professional medical service and the risk is the intense competitive among the hospitals. 5) In the SWOT strategy, they emphasized the strategy that uses the opportunity and the strength and the strategy that uses the opportunity while overcoming the weakness. 6) As for the basic competition strategy, most of them thought of the strategy of professionalizing the medical service most importantly. Next, they focused on the strategy of distinct service and the strategy of lower prime cost. 2. Conclusion 1) Because service competition between hospitals is happening seriously, need competitiveness security through right awareness transfer and satisfaction upgrade about medical consumer. 2) For medical technique service upgrade that equip Hospital's competitiveness but affects most, must solidify the countermeasure because professionalizing the medical service and newest medical technique induction should be achieved first, and compose task force for the external service of medical techniques improvement. 3) To improve SWOT of hospital, opportunity and the strength strategy choice that rescue hospital's characteristics heightening professionalizing the medical service level is fancied. 4) As for the basic competition strategy, will have to try in phase triangular position of hospital which is trusted medical level upgrade and excellent manpower security and finance independence through upgrade. The study was only done with hospitals in Daejeon, Chungnam and Chungbuk. Also, it is a study from the side of suppliers of medical service so there are limitations. However, the significance of the study is to present the basic data for improvement of hospital's competitiveness by examining the importance of medical techniques and external service of medical techniques that are the main effects on the improvement of hospital's competitiveness.

• Journal of Korea Water Resources Association
• /
• v.56 no.11
• /
• pp.751-764
• /
• 2023

Gangwon State is centered on the Taebaek Mountains with very different climate characteristics depending on the region, and localized heavy rainfall is a frequent occurrence. Heavy rain disasters have a short duration and high spatial and temporal variability, causing many casualties and property damage. In the last 10 years (2012~2021), the number of heavy rain disasters in Gangwon State was 28, with an average cost of 45.6 billion won. To reduce heavy rain disasters, it is necessary to establish a disaster management plan at the local level. In particular, the current criteria for heavy rain warnings are uniform and do not consider local characteristics. Therefore, this study aims to propose a heavy rainfall warning criteria that considers the threshold rainfall for the advisory areas located in Gangwon State. As a result of analyzing the representative value of threshold rainfall by advisory area, the Mean value was similar to the criteria for issuing a heavy rain warning, and it was selected as the criteria for a heavy rain warning in this study. The rainfall events of Typhoon Mitag in 2019, Typhoons Maysak and Haishen in 2020, and Typhoon Khanun in 2023 were applied as rainfall events to review the criteria for heavy rainfall warnings, as a result of Hit Rate accuracy verification, this study reflects the actual warning well with 72% in Gangneung Plain and 98% in Wonju. The criteria for heavy rain warnings in this study are the same as the crisis warning stages (Attention, Caution, Alert, and Danger), which are considered to be possible for preemptive rain disaster response. The results of this study are expected to complement the uniform decision-making system for responding to heavy rain disasters in the future and can be used as a basis for heavy rain warnings that consider disaster risk by region.

• Land and Housing Review
• /
• v.8 no.1
• /
• pp.1-11
• /
• 2017

The government has been constructing and supplying public rental housing to ordinary people in order to stabilize housing since 1989. However, the public rental houses initially supplied to ordinary people are at high risk for safety accidents due to the deterioration of the facilities. Therefore, this study is aimed to propose a solution to solve the life safety hazards of the old rental housing complex as a follow-up study of Analysis of Accident Patterns and Hazard Factor for Life Safety in Rental Housing Complex. Types of life safety accidents that occur in public rental housing complexes are sliding, falling, crash, falling objects, breakage, fire accidents, traffic accidents and criminal accidents. The types of safety accidents that occur in rental housing complexes analyzed in this study are sliding, crashes, falling objects, and fire accidents. Although the incidence of safety accidents such as falling, breakage, traffic accidents and crime accidents in public rental housing complexes is low, these types are likely to cause safety accidents. The method of this study utilized interviews and seminar results, and it suggested ways to solve the life safety hazards in rental housing complexes. Interviews were conducted with residents and managers of rental housing complexes. Seminars were conducted twice with experts in construction, maintenance, asset management, housing welfare and safety. Through interviews and seminars, this study categorizes the life safety hazards that occur in rental housing complexes by types of accidents and suggests ways to resolve them as follows. (1) sliding ; use of flooring materials with high friction coefficient, installation of safety devices such as safety handles, implementation of maintenance, safety inspections and safety education, etc. (2) falling ; supplementation of safety facilities, Improvement of the design method of the falling parts, Safety education, etc. (3) crash ; increase the effective width of the elevator door, increase the effective width of the lamp, improve the lamp type (U type ${\rightarrow}$ I type), etc. (4) falling objects and breakage ; design of furniture considering the usability of residents, replacement of old facilities, enhancement of safety consciousness of residents, safety education, etc. (5) fire accidents ; installation of fire safety equipment, improvement by emergency evacuation, safety inspection and safety education, etc. (6) traffic accidents ; securing parking spaces, installing safety facilities, conducting safety education, etc. (7) criminal accidents; improvement of CCTV pixels, installation of street lights, removal of blind spots in the complex, securing of security, etc. The roles of suppliers, administrators and users of public rental housing proposed in this study are summarized as follows. Suppliers of rental housing should take into consideration the risk factors that may arise not only in the design and construction but also in the maintenance phase and should consider the possibility of easily repairing old facilities considering the life cycle of rental housing. Next, Administrators of rental housing should consider the safety of the users of the rental housing, conduct safety checks from time to time, and immediately remove any hazardous elements within the apartment complex. Finally, the users of the rental housing needs to form a sense of ownership of all the facilities in the rental housing complex, and efforts should be made not to cause safety accidents caused by the user's carelessness. The results of this study can provide the necessary information to enable residents of rental housing complexes to live a safe and comfortable residential life. It is also expected that this information will be used to reduce the incidence of safety accidents in rental housing complexes.

• Clean Technology
• /
• v.26 no.2
• /
• pp.151-157
• /
• 2020

Rapid urbanization has elevated the risk of urban flooding due to the increase in the impervious surface, causing environmental disasters and environmental pollution problems, such as lowering the groundwater level and increasing water pollution. In Korea, low impact development (LID) techniques have been introduced to minimize these environmental impacts and maintain the water cycle soundness. However, most small-scale development projects are in blind spots because there is no legal basis for rainfall runoff management. Small-scale development projects that increase the surface runoff of rainwater are required to mandate the application of LID facilities in accordance with the polluters' responsibility principle. Therefore, it is necessary to implement a preliminary consultation system for water cycle recovery. This study focuses on the cost-benefit analysis on the application of LID techniques for small-scale development projects. The scale of nationwide small-scale development projects used for cost-benefit analysis were defined as buildings with a land area of more than 1,000 ㎡ or a total floor area of 1,500 ㎡. As a result of analyzing the cost-benefits from the installation of LID facilities, they were found to be much lower than the economic standard value of 1. This might be due to the high cost of facilities compared to the scale of the project. However, considering the overall environmental value of improving the water environment and air quality by the installation of LID facilities and the publicity of reducing the operating cost of sewage treatment facilities, the introduction of a prior consultation for small-scale development projects is inevitable. In the future, institutional and financial support from local governments is required to improve the cost-benefits with the introduction of a prior consultation for small-scale development projects.

• Journal of agricultural medicine and community health
• /
• v.22 no.1
• /
• pp.1-18
• /
• 1997

This study was carried out to reveal the status of health examination among farmers and to attract more attention to the health care system for farmers. Ten pre-trained medical students interviewed the rural residents 18 years of age and older in eight villages which were randomly selected from a county near Taegu city in Korea, in August 1996. Finally 751 persons were interviewed of whom the percentages of male and female were 41.8%, 58.2% respectively. Among the subjects, 361(48.3%) were fully engaged in farming, 184(24.4%) were partly engaged, and the remaining 206(27.3%) were not engaged in farming at all. The overall prevalence of farmer's disease was 23.0% and there was no significant difference between the group of fully engaged in farming(23.3%) and the group of not-fully engaged(22.9%). But the prevalence of farmer's disease in female subjects(27.8%) was significantly higher than that in male(16.2%)(p<0.01). Among the 288 farmer engaged in spraying pesticide, 113(39.2%) had experienced one or more pesticide related symptoms during last one year, but only 18(15.9%) of them had visited medical facilities due to their symptoms. The experience of receiving education about pesticide was significantly correlated with the degree of wearing protectors during pesticide spraying(p<0.001). Among the 736 persons excluding non-respondents, 281(38.2%) received health examination during last one year ; 176(62.6%) of them received free health examination, and 105(37.4%) received charged one. Among the 533 persons 40 years age and older, only 124(23.3%) had received the 'health examination for the elderly' during last one year, which is provided for the 40 years age and older by Korea medical insurance corporation and medical insurance societies. Most of all beneficiaries of self-employed medical insurance thought the imposed contributions as very expensive(77.4%) or moderately expensive(13.2%). The great majority of farmers are exposed to various health risk factors including pesticide, high temperature, overwork etc. comparable to industrial workers. But farmers are excluded from the regular yearly worker's health examination because of not belonging to a company despite they pay relatively more medical insurance contributions compared with the industrial workers and the urban self-employed medical insureds. It is necessary to develop special health management program for farmers such as the special health examination for the industrial workers exposed harmful agents.