• The Journal of the Korean dental association
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• v.48 no.1
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• pp.6-11
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• 2010

Amid the rapid transitions in both local and international markets, the Korean dental industry is facing more challenges than at any time in its history. This paper tried to address some of the key issues faced by the industry as well as the policy issues and I direction of implementation that the Korean Dental Association (KDA) is expected to tackle. First, the direction of reforming the country's health insurance system was examined with emphasis on the expected changes in and improvement of the fee-for-service reimbursement system (FFSRS) and medical reimbursement system (MRS). With FFSRS, the most urgent issue would be ameliorating the current lop-sided, unreasonable reimbursement system that prevents suppliers from voicing their opinions. To help achieve that goal, the limited authority and responsibility of the president of National Health Insurance Corporation (NHIC) as one of the contract-making parties must be clarified. In addition, the functions of NHIC's Health Insurance Finance Committee must be restricted; at the same time, the panel organization of the Health Insurance Policy Review Committee needs to be reformed to embrace greater democracy. As with MRS, the government is considering a block budget bill to help promote efficiency in employing and managing the health insurance fund. Policymakers must understand that the implementation of such proposal could exacerbate an already dire situation. Improving MRS requires meeting the following preconditions: (a) the structurally vicious cycle of small charge-small salary needs to be resolved, and a certain percentage of fee raise must be guaranteed on a yearly basis to help adjust the fee system to a more realistic level; (b) the supply-and-demand balance in producing health care professionals must be improved including the prevention of oversupply of doctors, nurses, etc., and; (c) institutional strategies must be provided to enhance the quality of medical care and ensure academic advancement in health care disciplines.

• Journal of dental hygiene science
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• v.18 no.3
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• pp.182-187
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• 2018

As the elderly population increases, they are increasingly affected by oral health problems. Therefore, efforts are being made to improve the oral health of older people, alleviate mental discomfort, and reduce unmet dental needs. This study was conducted to confirm the relationship between the National Health Insurance Elderly Denture Coverage and the unmet dental need for the edentulous elderly, as part of the protection policy. We analyzed the 2011 and 2013 Community Health Survey data of the edentulous elderly, aged 75 years or older, before 2012. In order to more precisely confirm the effects of the denture donation policy on unmet dental care, basic life recipients who were subject to the free elderly prosthetic project were excluded from the analysis. The final analysis included 20,400 subjects. According to our investigation of the factors that affect the unmet dental needs of the elderly, the National Health Insurance Elderly Denture Coverage did not affect unmet dental needs. The statistically significant variables that affected the unmet dental needs of the elderly were education and income levels, which are representative socioeconomic status variables. The lower the level of education, the unhealthier the dental care experience, and income levels showed a similar tendency. The elderly who have a low socioeconomic status are more likely to experience unmet dental needs because they lack the knowledge and socioeconomic ability to pay for dental care. Therefore, the policy for health protection of the entire elderly population should be continuously expanded. In addition, the socioeconomically vulnerable groups may have health problems due to the restriction of medical use, which may lead to quality of life deterioration.

• Health Policy and Management
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• v.31 no.4
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• pp.451-461
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• 2021

Background: Readmissions related to lack of quality care harm both patients and health insurance finances. If the factors affecting readmission are identified, the readmission can be managed by controlling those factors. This paper aims to identify factors that affect readmissions of convalescent rehabilitation patients. Methods: Health Insurance Review and Assessment Service claims data were used to identify readmissions of convalescent patients who were admitted in hospitals and long-term care hospitals nationwide in 2018. Based on prior research, the socio-demographics, clinical, medical institution, and staffing levels characteristics were included in the research model as independent variables. Readmissions for convalescent rehabilitation treatment within 30 days after discharge were analyzed using logistic regression and generalization estimation equation. Results: The average readmission rate of the study subjects was 24.4%, and the risk of readmission decreases as age, length of stay, and the number of patients per physical therapist increase. In the patient group, the risk of readmission is lower in the spinal cord injury group and the musculoskeletal system group than in the brain injury group. The risk of readmission increases as the severity of patients and the number of patients per rehabilitation medicine specialist increases. Besides, the readmission risk is higher in men than women and long-term care hospitals than hospitals. Conclusion: "Reducing the readmission rate" is consistent with the ultimate goal of the convalescent rehabilitation system. Thus, it is necessary to prepare a mechanism for policy management of readmission.

• 대한예방의학회:학술대회논문집
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• 2005.10a
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• pp.501-501
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• 2005

• 대한예방의학회:학술대회논문집
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• 2005.10a
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• pp.502-502
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• 2005

• The Korean Society of Law and Medicine
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• v.20 no.3
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• pp.211-233
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• 2019

The 「Health Care Workforce Support Act」 was came into effect on 29 October 2019. Health care workforce is the most important national health resource, and the quantity and quality of them is also related to the level of national health care. This study examined the background and major contents of this Act and suggested future improvement by analyzing main issues. Th e Act was enacted to support the health care workforce for their recruitment and better working environment. By stipulating the establishment of the master plan, management of the supply and demand, improvement of working environment for health care workforce, the act contributed to raise the quality of health service and health promotion. Given that the act was developed in consideration to support of health care workers, it has many meanings. However, it is necessary to reexamine the above-mentioned five issues in order to develop the effective law while utilizing the significance of the law for health care workforce support and has to revise as soon as possible.

• Health Policy and Management
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• v.13 no.1
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• pp.98-115
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• 2003

Concerns about growing health insurance expenditures became a national Issue in 2001 when the National Health Insurance went into a deficit. Increases in spending for ambulatory care shared the largest portion of the problem. Methods and systems to control the spending should be developed and a system to measure case mix of providers is one of core components of the control system. The objectives of this article is to examine the feasibility of applying Korean Diagnosis Related Groups (KDRGs) to classify health insurance claims for ambulatory care and to identify problem areas of the classification. A database of 11,586,270 claims for ambulatory care delivered during January 2002 was obtained for the study, and the final number of claims analyzed was 8,319,494 after KDRG numbers were assigned to the data and records with an error KDRG were excluded from the study. The unit of analysis was a claim and resource use was measured by the sum of charges incurred during a month at a department of a hospital of at a clinic. Within group variance was assessed by th coefficient of variation (CV), and the classification accuracy was evaluated by the variance reduction achieved by the KDRG classification. The analyses were performed on both all and non-outlier data, and on a subset of the database to examine the validity of study results. Data were assigned to 787 KDRGs among 1,244 KDRGs defined in the classification system. For non-outlier data, 77.4％ of KDRGs had a CV of charges from tertiary care hospitals less than 100％ and 95.43％ of KDRGs for data from clinics. The variance reduction achieved by the KDRG classification was 40.80％ for non-outlier claims from tertiary care hospitals, 51.98％ for general hospitals, 40.89% for hospitals, and 54.99% for clinics. Similar results were obtained from the analyses performed on a subset of the study database. The study results indicated that KDRGs developed for a classification of inpatient care could be used for ambulatory care, although there were areas where the classification should be refined. Its power to predict tile resource utilization showed a potential for its application to measure case mix of providers for monitoring and managing delivery of ambulatory care. The issue concerning the quality of diagnostic information contained in insurance claims remains to be improved, and significance of future studies for other classification systems based on visits or episodes is guaranteed.

• Journal of the Korean Society of Child Welfare
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• no.36
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• pp.7-27
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• 2011

This study empirically examines the effects of after-school self-care on children's development. More specifically, we examine whether the level of after-school self-care experiences that a child had during the 4 to 6 grade period affects the levels of school achievement, internalizing problem behaviors, externalizing problem behaviors, and delinquent behaviors during the child's middle school years. The study utilized the data from the Korea Welfare Panel Study's 1st and 4th year child supplementary surveys. The results show that the level of after-school self-care experiences negatively affects children's school achievement and internalizing problem behaviors. The study finds that, as the level of after-school self-care experiences increase, school achievement decreases and internalizing problem behaviors increase. The effects of after-school self-care on school achievement and internalizing behaviors were statistically significant even after controlling for the other variables that are known to be important factors on child development including child, parent, and family characteristics. The findings suggest that there is an independent effect of the level of after-school self-care on school achievement and internalizing problem behaviors. We also provide policy implications of the study. The policy considerations for latchkey children should include not only increasing the quantity of after-school programs, but also paying attention to the need of child development support programs beyond basic protection and care.

• Korean Journal of Social Welfare Studies
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• v.41 no.2
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• pp.35-65
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• 2010

The purpose of this study is to identify the relationship between health insurance and health by evaluating the impacts of health insurance coverage expansion on health care utilization and health status. To analyze the causal relationship between health insurance and health, this study employed a "difference-in-difference method" that could compare changes in health care utilization and health status across groups in health insurance coverage expansion in 2005. The researcher predicted that the expansion of health insurance coverage would be an exogenous source of variation in the prices of health service use. First, the difference-in-differences estimator between 'illness group' and 'non-illness group' revealed that the increase in coverage of inpatient care services would result from the increases in the stay of length of 'non-illness group' rather than that of 'illness group'. However, the difference-in-differences estimator between 'serious illness group' and 'chronic illness group' identified that the policy change that focuses on expansion of the coverage for 'serious illness' effects on the increases in health care utilization and promotion of health status. In summary, the changes of health insurance coverage focusing on serious illness and inpatient care have positive effects on health care utilization and health status of serious illness group. But, 'non-illness groups' with acute illness receive more benefits from the policy change than 'illness group' with chronic illness.

• Journal of the Korean Home Economics Association
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• v.45 no.6
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• pp.21-33
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• 2007

In present study, using longitudinal data of 161 families from Durham Child and Development Study, we examine the characteristics of infant child care chosen by families of different income levels and ethnicity in the U.S. Time-related changes in child care selection for the first year of the child's life were also investigated. Infants from high-income families were more likely to be cared for by someone other than the mother, compared to infant from lower-income families. African-American families were more likely to use non-maternal care for their infant compared to European-American families. Although the effects of income on type of care were not significant, descriptively, more low-income families used relative care while high-income families used more formal arrangements such as daycare center. Infants from low-income families began care earlier and low-income families paid less for care than other families. The findings call for attention to the importance of child care policy for low-income families as well as further research examining the function of cultural differences in selection of infant child care.