• Health Policy and Management
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• v.16 no.1
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• pp.17-40
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• 2006

With the prospect of rapidly growing health insurance expenditures, particularly spending for ambulatory care, the introduction of a case-based payment method is discussed as an alternative to the current fee-for-service based method. A system to measure case mixes of providers is a core component of such payment systems. The objective of this study were to develop a classification system for ambulatory care, Korean Ambulatory Patient Group (KAPG) based on the U.S. APG version 2.0 and to evaluate the classification accuracy of the system. A database of 64,258,386 records was constructed from insurance claims submitted to the Health Insurance Review Agency (HIRA) during three months from August 2002. A total of 41,347,307 records with a single visit was used for the development and 7% random sample of the database was used for the evaluation. Additional groups were defined to include both physician and hospital fees in the classification, age splits were added to classify the entire population as well as the population older than 65, and the definition of medical groups used by the HIRA was adopted. The variance reduction in charges achieved by KAPGs was computed to evaluate the accuracy of classification. A total of 474 KAPGs was defined compare to 290 groups in the U.S. APG. The variance reduction for charges of all visits ranged from 20% to 37% depending on the type of provider, and ranged from 22% to 42% for non-outliers, that were better than those achieved by the system currently used by the .HIRA for its internal review purpose. Although further study is required to improve the classification for complicated care in larger hospitals, the results indicated that KAPGs could be used for better management of costs for ambulatory care.

• Journal of Preventive Medicine and Public Health
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• v.55 no.4
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• pp.389-397
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• 2022

Objectives: This study examined the effect of out-of-pocket (OOP) payment reduction on the potential utilization of low-value magnetic resonance imaging (MRI) across income groups. Methods: We conducted an experimental vignette survey using a proportional quota-based sample of individuals in Korea (n=1229). In two hypothetical vignettes, participants were asked whether they would be willing to use MRI if they had uncomplicated headache and non-specific low back pain, each before and after OOP payment reduction. To account for the possible role of physician inducement, half of the participants were initially presented with vignettes that included a physician recommendation for low-value care. The predicted probability, slope index of inequality (SII), and relative index of inequality (RII) were calculated using logistic regression. Results: Before OOP payment reduction, the lowest income quintile was least likely to use low-value MRI regardless of physician inducement (36.7-49.6% for low back pain; 30.5-39.3% for headache). After OOP payment reduction, almost all individuals in each income quintile were willing to use low-value MRI (89.8-98.0% for low back pain; 78.1-90.3% for headache). Absolute and relative inequalities concerning potential low-value MRI utilization decreased after OOP payments were reduced, even without physician inducement (SII: from 8.15 to 5.37%, RII: from 1.20 to 1.06 for low back pain; SII: from 6.99 to 0.83%, RII: from 1.20 to 1.01 for headache). Conclusions: OOP payment reduction for MRI has the potential to increase low-value care utilization among all income groups while decreasing inequality in low-value care utilization.

• Journal of Korean society of Dental Hygiene
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• v.22 no.6
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• pp.477-483
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• 2022

Objectives: The purpose of this study was to provide basic data that would inform the direction of oral rehabilitation and how to expand of the role of dental hygienists in Japan. Methods: A systematic literature review was conducted on the role of dental hygienists in the field of oral rehabilitation in Japan. Results: Japan has been making academic and practical developments in the field of oral rehabilitation for over 30 years, and has been gradually implementing a fee support policy since the 1990s. In addition, Japan has been operating a dental hygienist system specializing in oral rehabilitation since 2006. The related work was being carried out with the dental hygienist's expertise in the field of rehabilitation medical treatment secured. Dental hygienists work full-time at long-term care facilities for the elderly in addition to conducting oral care activities under the local comprehensive care system, in the areas of convalescence and acute rehabilitation, as well as in the field of visiting rehabilitation. It can be seen that, in the field of nursing care, they are specialized in oral care tasks for the elderly. Conclusions: In the future, a policy and related fee system should be gradually prepared to expand the role of dental hygienists in the field of oral rehabilitation that can contribute to improving oral health linked to systemic diseases.

• Journal of Digital Convergence
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• v.18 no.6
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• pp.531-540
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• 2020

The purpose of this study was to present ways and tasks for the successful settlement of community care that the korea government recently aimed to convert the care system of the vulnerable from the center of institutional care to the community-based care system. As a research method, we tried to find out the community care policies for foreign developmental disabilities and explore major issues and problems in the process. As a result of the study, de-institutionalization and maintenance and enactment of laws related to community-based care systems, the division of subjects and tasks in policy implementation, and above all, it is necessary to specify necessary financial estimation, procurement plan, and budget securing method. In addition, sincere deliberation on the form of living space for people with developmental disabilities after de-institution and clarification of the subjectivity of using the services provided Establish reliable statistics on the characteristics and degree of disability of people with developmental disabilities, worry about human rights violation factors that can occur in community residential facilities that will be provided after de-facility, and create consensus in the community was also analyzed as an important factor. I think it is a key factor to secure the success of the community care policy by carrying out the above multiple tasks simultaneously.

• Journal of Hospice and Palliative Care
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• v.16 no.2
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• pp.65-73
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• 2013

The objective of this paper is to suggest future goals and strategies for social work in hospice and palliative care in Korea by understanding its historical background. Both literature review and participant observation were performed to examine historical data relating to social work in hospice and palliative care in Korea. Also reviewed were the current trends with a focus on the roles of social workers in the said arena, qualifications, education, research and medical insurance policy. First of all, the roles of social workers do not appear to be clearly defined in the field of hospice and palliative care, which seems to lead to the lack of recognition as professional workers. The qualification standard for social workers in hospice and palliative care remains inadequate. Second, there seems to be insufficient professional social worker training resources, in terms of both the number of educators and training programs. Third, social workers in Korea produce significantly less publications than those in other professions. There is also a dearth of qualified evidence-based research that is needed to prove benefits of intervention and ultimately for policy implications. Last, the current medical insurance policy needs to be revised to secure fees for social work services and dedicated full-time social workers in hospice and palliative care. Korea needs to approach social work in hospice and palliative care with specific goals to develop future strategies. Related infrastructure and an executive structure should be established via networking and partnership with academic societies, associations and schools.

• Health Policy and Management
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• v.15 no.4
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• pp.65-80
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• 2005

This study examines the effects of supplemental insurance on health care utilization and expenditures among cancer patients, who were hospitalized in a general hospital in Korea 2003. We find that those who purchase the supplemental insurance in addition to the social health insurance use more health care services and pay more than those who do not, suggesting insurance effects. This paper, however, cannot distinguish the moral effects of the health insurance from the selection effects due to adverse selection.

• Health Policy and Management
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• v.21 no.1
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• pp.1-22
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• 2011

This study investigated unmet health care needs and associated factors among patients with hypertension and those with diabetes. Patients were identified by medical professionals. Patients who did not take pharmaceuticals to treat their disease(s) were defined as those with unmet health care needs. Using data from 2005 National Health and Nutrition Examination Survey, 3,635 hypertension patients and 1,431 diabetes patients were analyzed. A multivariate logistic regression analysis was employed to examine factors associated with unmet needs. Overall, 16.6% of hypertension patients, 20.3% of those with diabetes presented unmet needs. Common factors associated unmet needs for both hypertension and diabetes were sex, insurance type, self-reported health status and length of disease. Study findings suggest that hypertension and diabetes should be treated in early stage and further study is needed to examine the reasons for unmet needs to improve patient's status effectively.

• Health Policy and Management
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• v.21 no.2
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• pp.213-248
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• 2011

Past studies on organizational accountability have had similar limitations. First, empirical evidence of organizational accountability is rare as the majority of research takes a conceptual approach of the topic. Only a few of these studies are applicable to health care organizations (HCOs). To fill these gaps, we attempted to develop a model for analysis of organizational accountability for HCOs. Accountability for HCOs was conceptualized by two axes: answerability(X, horizontal) and value-creation(Y, vertical). Our concept building could relieve competing accountability mechanism which past studies stressed. Four elements of accountability(legal, economical, social, and clinical) were applied to specify each of the two features of organizational accountability. And then four types of accountability behavior were coordinated by this x-y axis : high A/high VC, high A/low VC, low A/high VC, low A/low VC. Finally, a multidimensional model of HCOs' accountability, enabling an empirically testable multi-level analysis, was proposed.

• Health Policy and Management
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• v.2 no.2
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• pp.152-178
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• 1992

This study focuses on making recommendations for the improvement of poor emergency medical services or EMS in Korea. Problems of the current EMS system is widely reviewed. As an alternative of the current system, a franchises system is introduced to EMS. A feasibility study of the new system is carried out as follows. 1) The current EMS system shows such problem as; - Inadequacy of emergency medical fee schedule, - Shortage of emergency medical resources, - Concentration of emergency medical facilities in metropolitan area, - Unestablishment of training program for emergency personnel, - Inappropriateness of patients' behvaviro pattern in emergency care system. 2) Recommendations for the improvement of EMS are as follows: - Well organized communication and transportation system needs to be established by utilizing all the availabl EMS is to be devised for the provision of appropriate emergency care. - A franchises system can be widly adopted so that private organizations are willing to establish a free standing emergency center. - Emergency care fee schedule of the franchises system needs to be appropriate for the system to provide high standard medical services.

• Journal of Family Resource Management and Policy Review
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• v.17 no.4
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• pp.101-125
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• 2013

Recently family policy and social policy have focused on the balance between the work and family of working parents. The purpose of this study is to analyze the status of the work-life balance of married working women. For this purpose the eight married working women who care for 1 or more pre-school child(ren) were interviewed. The questionnaire used was consisted of 4 themes : 1) child care, 2) working situation, 3) the work-life balance and 4) the need to improve related policies. Through the interviews and data analysis we found the following : 1) Accessibility to educarecenter was considered the most important factor for working moms when they choose an educarecenter. In order to improve accessibility of educarecenters we have to install more educarecenters with various level. 2) All respondents look maternity leave and they evaluated that other services were very weak in terms of quality, usefulness and accessibility. 3) Many childcare services aid in creating work and family balance, however they are not effective. Therefore future policies should focus on providing more options for working women for appropriate services according to childcare needs, working conditions and preferences.