• 보건행정학회지
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• 제25권3호
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• pp.185-196
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• 2015

Background: Issues concerning with the classification accuracy of Korean Outpatient Groups (KOPGs) have been raised by providers and researchers. The KOPG is an outpatient classification system used to measure casemix of outpatient visits and to adjust provider risk in charges by the Health Insurance Review & Assessment Service in managing insurance payments. The objective of this study were to refine KOPGs to improve the classification accuracy and to evaluate the refinement. Methods: We refined the rules used to classify visits with multiple procedures, newly defined chemotherapy drug groups, and modified the medical visit indicators through reviews of other classification systems, data analyses, and consultations with experts. We assessed the improvement by measuring % of variation in case charges reduced by KOPGs and the refined system, Enhanced KOPGs (EKOPGs). We used claims data submitted by providers to the HIRA during the year 2012 in both refinement and evaluation. Results: EKOPGs explicitly allowed additional payments for multiple procedures with exceptions of packaging of routine ancillary services and consolidation of related significant procedures, and discounts ranging from 30% to 70% were defined in additional payments. Thirteen chemotherapy drug KOPGs were added and medical visit indicators were streamlined to include codes for consultation fees for outpatient visits. The % of variance reduction achieved by EKOPGs was 48% for all patients whereas the figure was 40% for KOPGs, and the improvement was larger in data from tertiary and general hospitals than in data from clinics. Conclusion: A significant improvement in the performance of the KOPG was achieved by refining payments for visits with multiple procedures, defining groups for visits with chemotherapy, and revising medical visit indicators.

• 보건행정학회지
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• 제33권3호
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• pp.243-252
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• 2023

This paper aims to introduce Korea's total current health expenditure (CHE) and National Health Accounts of the year 2021 and their 2022 preliminary figures constructed on the basis of the System of Health Accounts 2011. As CHE includes expenditures for prevention, tracking, and treatment of coronavirus disease 2019 (COVID-19) and compensation for losses to medical institutions from 2020, the details are also introduced. Korea's total CHE in 2021 is 193.3 trillion won, which is 9.3% of gross domestic product (GDP). The preliminary figure in 2022, 209.0 trillion won, exceeded the 200 trillion won line for the first time, and its "ratio to GDP" of 9.7% is expected to exceed the average of Organisation for Economic Co-Operation and Development member countries for the first time. Korea's health expenditures, which were well controlled until the end of the 20th century, have increased at an alarming rate since the beginning of the 21st century, threatening the sustainability of national health insurance. The increase in health expenditure after 2020 is partly due to a temporary increase in response to COVID-19. However, when considering the structure of Korea's health insurance price hike, where the ratchet effect of increased medical expenses works particularly strongly, it is unlikely that the accelerating growth trend that has lasted for more than 20 years will stop easily. More aggressive policies to control medical expenses are required in the national health insurance which not only constitutes the main financing sources of the Korean health system but also has the most powerful policy means in effect for changes in the health care provision.

• 문화기술의 융합
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• 제9권6호
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• pp.729-736
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• 2023

전통적으로 성별분업에 의한 남성 생계부양자모델을 추구해온 보수주의 복지국가 독일은 오랜 기간 현금급여 중심의 경제적 지원을 통해 저출생 문제를 해결하고자 하였으나 성공하지 못했다. 2007년 독일 정부는 "시간정책, 이전소득 및 인프라의 혼합"이라는 슬로건 아래 일·가정 양립을 위한 가족정책 패러다임의 전환을 시작하였다. 독일에서 저출생 문제가 국가문제로 부상하자 정부뿐 아니라 민간 기업도 가족친화적 인사정책과 근로조건을 제공함으로써 출산율 향상에 기여해야 한다는 사회적 분위기가 조성되었다. 민간 기업은 인력 확보와 이직 예방을 목적으로 법적 의무를 넘어 자발적으로 가정친화적 근로환경을 개선해나가고 있다. 독일의 출산율은 2023년 현재 유럽 평균 수준으로 상승하고 있어 정부의 일·가정 양립정책과 민간 기업의 참여가 출산율 향상에 기여한 것으로 평가될 수 있다. 한국의 일·가정 양립 정책 개선 방안으로 아버지의 육아 동참 필요성에 대한 인식 전환, 남성 육아휴직의 의무화, 출산 후 여성의 고용 보장, 돌봄시설 확충 그리고 기업의 가족친화정책 활성화를 제안하였다.

• 보건교육건강증진학회지
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• 제31권3호
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• pp.83-95
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• 2014

Objectives: This study was to examine the experts perception on the operation of the national health promotion fund and related policies, and to obtain the perspective on the improving governance of the fund. Methods: Experts opinion survey was recruited 120 experts who were public health officials, and members of board in academic societies related to health promotion and health policy, and 60 experts participated in the survey. Results: Most health care experts agreed that the current allocation of health promotion fund was not optimal with its lack of allocation on promoting healthy lifestyle and R&D for health promotion, while the majority of the fund was being spent on supporting national health insurance. Thus, establishing governance system and control tower for the fund was viewed as critical. Also the status of deliberation committee should be raised to higher position where it can hold practical authority to plan and evaluate fund spending. Conclusions: The priority of health promotion fund spending should be more on improving health such as modifying life-style and spreading healthy habits, rather than on disease management or subsidizing health insurance. It is recommended that change from to environment in health promotion policy regime is required to establish effective governance system for the fund operation.

• KSII Transactions on Internet and Information Systems (TIIS)
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• 제12권4호
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• pp.1832-1853
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• 2018

The personal health record (PHR) system is a promising application that provides precise information and customized services for health care. To flexibly protect sensitive data, attribute-based encryption has been widely applied for PHR access control. However, escrow, exposure and abuse of private keys still hinder its practical application in the PHR system. In this paper, we propose a coordinated ciphertext policy attribute-based access control with user accountability (CCP-ABAC-UA) for the PHR system. Its coordinated mechanism not only effectively prevents the escrow and exposure of private keys but also accurately detects whether key abuse is taking place and identifies the traitor. We claim that CCP-ABAC-UA is a user-side lightweight scheme. Especially for PHR receivers, no bilinear pairing computation is needed to access health records, so the practical mobile PHR system can be realized. By introducing a novel provably secure construction, we prove that it is secure against selectively chosen plaintext attacks. The analysis indicates that CCP-ABAC-UA achieves better performance in terms of security and user-side computational efficiency for a PHR system.

• 보건행정학회지
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• 제25권1호
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• pp.31-39
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• 2015

Background: The purpose of this study is comparison of the results between regression and multi-level analysis to find out factors influencing outcome indicators (in-hospital death, length of stay, and medical charges) of stroke patients. Methods: By using patient sample data of Health Insurance Review & Assessment Service, patients admitted with stroke were selected as survey target and 15,864 patients and 762 hospitals were surveyed. Results: For the results of existing regression analysis and multi-level analysis, models were assessed through model suitability index value and as a result, the value of results of multi-level analysis decreased compared to the results of regression, showing it is a better model. Conclusion: Factors influencing in-hospital death of stroke patients were analyzed and as a result, intra-class correlation (ICC) was 13.6%. In factors influencing length of stay, ICC was 11.4%, and medical charges, ICC was 17.7%. It was found that factors influencing the outcome indicators of stroke patients may vary in every hospital. This study could carry out more accurate analysis than existing research findings through analysis of reflecting structure at patient level and hospital level factors and analysis on random effect.

• 여성건강간호학회지
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• 제14권4호
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• pp.248-256
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• 2008

Purpose: The findings of various studies and policy reports on marriage change, international marriage migrant women and its issues are presented in this study. Method: Research objectives were accomplished by conducting a literature review. The main areas of the literature review included married migrant women, its challenges, and current policies for international marriage migrant women. Result: Women migrating through international marriage are known to face various difficulties due to their migration. Some important obstacles women migrants face in the Republic of Korea are cultural differences in daily lifestyle, language, food, health care services, cultural assumptions, gender structure, family relationships, expected roles within family, interpersonal relationships and more. The plights of married migrant women include commercialization of international marriage, false information regarding the spouse, family abuse, insecure nationality, economic difficulty and unemployment, racial prejudice, and cultural maladjustment. Current support policies for migrant women living in Korea are suggested. Conclusion: This study concluded with policy implications and recommendations for future study. In addition, the author suggests the necessity of programs and policies for the improvement of married migrant women's well-being based on women's health and family nursing dimensions.

• 보건행정학회지
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• 제14권1호
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• pp.44-64
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• 2004

As of 1 July 2000 a big reform was introduced into the Korean health care system: the separation between prescribing and dispensing of drugs (SPD reform). There was, however, a big financial stake associated with pharmaceuticals, particularly before the reform, because physicians as well as pharmacists were allowed to purchase drugs at much lower costs than the insurance reimbursement. In this respect, this study focuses on the change in income and profit of both doctor's clinics and pharmacies after the reform. Data from National Health and Nutritional Survey by the ministry of health and welfare were used to estimate the income or expenditure that are financed by out-of-pocket payment of the patients, while national health insurance data etc. were used for the estimation of the income or expenditure that is financed by insurers. Average annual income per doctor's clinic increased from 299 million won to 338 million won for the three years between 1998 and 2001, whereas average annual income per pharmacy increased enormously from 60 million won to 305 million won for the same period. Average annual 'profit' increase per each doctor's clinic caused by the reform itself was estimated to range from 50 to 83 million won, while that per each pharmacy, from 23 to 87 million won. In sum, while both doctor's clinics and pharmacies are beneficiaries of the SPD reform, its positive impact is particularly prominent on the latter.

• 보건행정학회지
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• 제14권2호
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• pp.99-116
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• 2004

This study estimates the determinants of national health expenditures of OECD countries using panel regression method. The data used are OECD Health Data(2003) covering 33 countries and from 1970 to 2001. This study shows several important different results compared to the previous studies. Further this study estimates the determinants of Korean case using data from 1m to 2000, and compare with the results of OECD panel. The main findings are as follows. The income elasticity of health expenditures is estimated below 1.0, but is shown above 1.0 when the different health systems of each country are controlled. The women's labor participation influences strongly positive effect on the health expenditures. The diffusion of new technologies is positively related with the increasing expense. The increasing government expenditures have a tendency not to contain health expenses, but to increase expenses. The expansion of public health insurance holders is containing the expenses, and the increasing number of doctors is pushing expenditures. This implies the health expenditures are influenced more by the induced demand of providers rather than the moral hazard of patients. However, the above result is opposite in Korean case. The existence of primary care doctors affects slightly up warding rather than containing expenditures. Finally the determinants are seriously depending upon which factors are included in the model and which statistical model is chosen. Therefore it must be cautious to interpret the results of statistical model.

• 대한가정학회지
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• 제42권2호
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• pp.195-212
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• 2004

This research is based on the survey of welfare beneficiaries, aiming to set up the gender-equal welfare policies. Through the survey, this research examines status of women in the family and society and also examines, the degree of perception of women's welfare policies, needs, and satisfaction. According to the survey results, the current welfare policies that are limited to needy women should expand its range, enforcing the infra structure. That employment policy for women turned out to be very important in welfare policies. Demand for more enlarged welfare policies is quite high, especially in housing, employment and elderly care. On the contrary, the degree of satisfaction degree appears quite low because of unrealistic welfare program and benefits. In order to improve the welfare policies, more active and realistic employment policies should be emphasized with the proper support for family life. To raise the status of women, proper policies for women's economic independence should be set up. In addition, consciousness of gender equality should be encouraged in the whole society. Also, women's participation in politics and decision-making process is necessary.