• Asian Pacific Journal of Cancer Prevention
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• 제16권18호
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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.

• 한국사회정책
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• 제19권3호
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• pp.247-281
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• 2012

본 연구는 현 국민연금 장애연금이 직면하고 있는 문제점을 포괄범위의 보편성, 급여수준의 적정성, 제도의 형평성 세 관점에서 고찰하고 그 개선방안을 모색하려 하였다. 연구결과, 낮은 보편성 문제는 제도의 넓은 적용사각지대 그리고 좁은 장애범주의 설정과 엄격한 장애판정기준에 기인하는 것으로 판단된다. 따라서 국민연금의 장애범주를 사회심리적 질환으로 확대하고 장애판정체계를 소득활동능력기준의 체계로 전환하는 것이 개선안으로 제안되었다. 또한, 장애연금의 급여수준은 장기적으로 볼 때 노령연금에 비해 크게 후퇴할 것으로 전망되었다. 낮은 급여수준은 낮은 기준가입기간과 낮은 장애등급별 지급률에 기인하는 것으로 판단되어, 이를 극복하기 위한 대안으로 기준가입기간의 상향조정과 장애등급별 지급률의 상향조정이 검토되었다. 그 결과, 등급별 지급률 상향조정이 가입자간 형평성 문제를 악화시키지 않으면서 급여수준 정적성 문제를 해결할 수 있는 방안으로 나타났다. 한편, 장애연금의 형평성 문제와 관련해서는 본 연구는 가입상태에 따라 다르게 설정된 수급 요건이 그 주요 원인이라고 보고, 이를 최근의 납부 요건이나 생애 일정비율 납부요건 또는 그 혼합형의 수급요건으로 단일화하는 방안을 검토하였다.

• 대한예방한의학회지
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• 제21권3호
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• pp.29-42
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• 2017

Background : Efforts towards increasing insurance coverage for traditional Korean medicine (TKM) are being continued. However, various difficulties are faced in generating evidence for TKM due to limited financial support and the low quality of research methodology. Objectives : The objectives of this study were to review the Swiss evaluation program for complementary and alternative medicine (CAM) and assess the expansion in public health insurance coverage of complementary medicine as approved by referendum in Switzerland. Methods : The regulations of CAM in the European Union were assessed. Research articles, reports, government publications and websites which deal with the 'Programm Evaluation $Komplement{\ddot{a}}rmedizin$ (PEK)' and the referendum in Switzerland were searched for and analyzed. Results : The PEK was conducted from 1998 to 2005. The PEK evaluated the efficacy, utilization and cost-effectiveness of anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese medicine. However, clear conclusions could not be drawn from the evaluation according to the PEK Report. Later, a referendum was implemented in which 5 therapies would be added to the Switzerland Constitution with the support of the public. The coverage of CAM was approved by Swiss a plebiscite with an approval rate of 67.0%. Conclusions : The reason for the successful referendum is suggested to be public support and the solidarity with CAM experts and politicians. It may be surmised that recognition of the political efforts and scientific aspects required to expand insurance coverage of TKM, and towards obtaining public support, is necessary.

• 한국치위생학회지
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• 제15권1호
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• pp.31-38
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• 2015

Objectives: The purpose of this study is to investigate the factors of oral health beliefs on scaling performance by national health insurance coverage in consumers. Methods: The subjects were 353 people living in Seoul, Incheon, and Gyeonggi-do from September 25 to October 20, 2013. They filled out the self-reported questionnaire after receiving informed consents. The questionnaire included 6 questions of general characteristics, 6 questions of oral health behavior, 6 questions of health insurance coverage, and 1 question of subjective oral health recognition. The oral health belief consisted of 6 questions of seriousness, 6 questions of susceptibility, 8 questions of barriers, 5 questions of benefit, and 3 questions of self-efficacy measure by Likert 5 scale. Cronbach's alpha in the study was 0.759. Data were analyzed using SPSS version 20.0 for frequency analysis, t-test, ANOVA, post-hoc Scheffe test, Pearson's correlation coefficient, and binary logistic regression. Results: The influencing factors of oral health belief model were Seriousness(${\beta}=0.091$), Self efficacy(${\beta}=-0.471$) and age(${\beta}=0.855$)(p<0.05). Those who had highly perceived seriousness and younger age tended to have probability of scaling performance. Higher self-efficacy tended to take more chance to have scaling performance probability. Conclusions: In order to cover the scaling by national health insurance, it is very important to notice the benefit of health insurance coverage of scaling to the consumers. National health insurance coverage enables the scaling practice to be easily accessible to the people. Easy access to scaling by low cost strategy can improve the oral health behavior.

• 의학교육논단
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• 제24권1호
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• pp.10-17
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• 2022

South Korea is not a wasteland of publicly funded health care-instead, it has a good medical social security system known as the national health insurance (NHI). The NHI of Korea has three unique features; (1) low premiums, low insurance fees, and low coverage; (2) obligatory designation of medical institutions; (3) and allowance of non-benefit services. These features have made hospitals and doctors interested in profit-seeking. However, the commercialization of medical institutions has taken place in both private- and public-established sectors. A basic problem of commercialization is the co-existence of the obligatory designation of medical institutions and non-benefit services. The problem became worse in the Kim Dae-Jung government because it officially permitted non-benefit services. Since 2000, the Korean government has consistently pursued benefit extension policies, but the coverage rates of the NHI have stagnated. In addition, premiums and current medical expenses have markedly increased because policy-makers have emphasized accessibility to the NHI, while ignoring important principles of medical social security such as a needs-based approach and patient-referral system. In order to resolve the commercialization problem, the obligatory designation of medical institutions to the NHI should be changed to a contract system, and non-benefit services should be prohibited at NHI institutions. We must re-establish the patient-referral system via a needs-based approach. We also need to build a primary healthcare system and public health policies. We should make a long-term plan for healthcare reform.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.215-220
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• 2022

Background In Japan, there is a large regional disparity in plastic surgery availability. In order for plastic surgery to be widely available for all citizens, it is essential for at least one plastic surgery facility to be located in each secondary medical zone. Methods Using the Japan Society of Plastic and Reconstructive Surgery homepage and some databases, we extracted data on secondary medical zones that do not have a plastic surgery facility. The national and regional coverage rates were calculated. The coverage rate for each group divided by the degree of population concentration was also calculated. Results We found that 147 of 344 secondary medical zones did not have a plastic surgery facility, and the area coverage rate was found to be 57.27% nationwide. The coverage rate in terms of population was 87.07% (correlation coefficient of area and population coverage = 0.983). The area coverage rates in Hokkaido-Tohoku, Kanto, Chubu, Kansai, Chugoku-Shikoku, and Kyushu-Okinawa districts were 47.46, 72.15, 76.47, 62.79, 52.08, and 32.81%, respectively. The corresponding population coverage rates were 79.92, 91.62, 94.27, 90.59, 80.68, and 69.54%, respectively. The area coverage rates in metropolitan areas, provincial cities, and rural areas were 98.08, 75.90, and 15.87%, respectively. In contrast, the area coverage rate of dermatology was 62.79% and that of orthopaedics was 97.09%. Conclusion Unfortunately, it is estimated that more than 40% of secondary medical zones are underserved by plastic surgery, and 13% of the population is not able to fully benefit from this specialty in Japan.

• 대한예방한의학회지
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• 제19권3호
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• pp.57-66
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• 2015

Objective : Private health insurance coverage in Korean medicine has been reduced since October 2009 for preventing unnecessary utilization. The aim of this study is to identify how private health insurance coverage reduction affects on the Korean medicine utilization. Method : We analyzed the Korea Health Panel data from 2008 to 2012. Panel negative binominal regression model was used to analyze the relationship between private health insurance coverage reduction and utilization of outpatient service. Panel tobit regression analysis was used to identify the relationship between private health insurance coverage reduction and health expenditure of outpatient service. Results : Private health insurance coverage reduction significantly dropped both utilization and health expenditure of outpatient service by 9%, 9.22% respectively. In addition, therapeutic utilization significantly decreased up to 10%. Conclusion : Private health insurance coverage reduction seems to have an effect to reduce both utilization and the health expenditure of Korean medicine outpatient service. This effect was more noticeable in the therapeutic utilization. Thus, more elaborate policy will be needed to prevent unnecessary utilization of Korean medicine.

• 한국임상약학회지
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• 제30권3호
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• pp.177-184
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• 2020

Background & objective: The Korean government has expanded its benefit coverage to enhance patients' access to orphan drugs and cancer medicines. However, the number of new drugs whose indications were not applied to reimbursement in health insurance was increased. This study aimed to understand the perspectives of experts and various stakeholders on the introduction of a new funding program for cancer treatment and orphan drugs. Methods: We conducted email surveys comprising 19 questions, from September 9 to 26, 2016. We distributed questionnaires to members of the Pharmaceutical Benefit Appraisal Committee and Cancer Assessment Committee. We also conducted a qualitative study through group interviews with stakeholders, including pharmaceutical companies and some patient groups for diseases. Results: A total of 35 survey respondents recommended the introduction of a funding program for orphan drugs, whereas 66% recommended the launch of funding for anticancer drugs. In addition, most pharmaceutical companies and patient groups recommended the introduction of new funding programs targeting patients with cancer and rare diseases. However, some participants asserted that it would be more appropriate to modify the existing reimbursement scheme than launch new funding. Conclusion: This study concluded that introducing new funding needs a social consensus to relieve financial hardships at the patient level.

• 보건행정학회지
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• 제20권3호
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• pp.104-122
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• 2010

Long-term care insurance has been introduced in Korea a year ago, and we are in a stage requiring to set principles regarding the generosity of coverage and how to gradually extend the coverage. This study empirically analyzes how the long-term care insurance in Korea is operated. Special attention is given to who is the main beneficiary of the long-term care insurance introduction, and what is the factors influencing the elderly's decision to apply for or use long-term care services. Use of a detailed information of individuals' public health insurance and long-term care insurance from administration data made it possible to control for health status, socioeconomic status including family type, housing tenure, income level. Logit models were employed to analyze the effects of various socioeconomic factors on the likelihood of applying and using long-term care services. Also, this study employed a survey questioning whether to ever willing to take other option as a alternative to residential care or home-care and the level of cash benefit for which they are willing to replace the formal care with informal care. The result indicated that although the poorest elderly population groups are in the greatest need for the long-term care service, they are in difficulty using the service due to economic burden. This implies the copayment amount needs to be adjusted in order for the poor elderly group to be able to get the benefit of the long-term care service.

• 보건행정학회지
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• 제17권1호
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• pp.75-93
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• 2007

This research purposed to analyse the diversity of the long-term care system based on the dependency/independency of the aged. For this purpose, we divided the long-term care systems to three components; form of benefit, generosity of benefit and delivery system. Form of benefit is whether the benefit is cash or in-kind, and the generosity of benefit is related to the level and coverage of benefit. The last concerned to focus on provider and user selection. According to this, we tried to make an ideal type of long-term care in the perspective of citizenship and consumerism. As a result, we established four types of long-term care system; active citizen type, passive citizen type, latent citizen type, and family dependent type. And we investigated Austria, Sweden, Germany and Korea for each type empirically.