• Journal of Preventive Medicine and Public Health
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• 제43권6호
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• pp.496-504
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• 2010

Objectives: The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. Methods: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. Results: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. Conclusions: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.

• 간호행정학회지
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• 제15권1호
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• pp.136-146
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• 2009

Purpose: The purpose of this study was to investigate the effects of copayments for doctor visits and prescription drugs on health services utilization in the Type I Medicaid beneficiaries in Korea. Method: This study examined data from the 2007 survey on Health Services Use and Health Status of Medicaid Beneficiaries performed by the Ministry for Health Welfare and Family Affairs. To analyze these sample survey data, the SURVEYFREQ, SURVEYMEANS, and SURVEYREG procedures which incorporate the sample design into the analyses were used. Results: Findings of this study indicate that copayments for doctor visits and prescription drugs of Medicaid Type I beneficiaries have cut overall medical costs. However, although results should be interpreted very carefully because of the relatively low $R^2$, copayments have cut more health services utilization of people who need more health services because of their complex diseases and disability. In addition, besides copayment, several factors are affecting differences in health services utilization before and after copayments implementation. Conclusion: These results highlight the need to examine the effects of copayments more thoroughly according to the kinds of disease, the severity of disease, and the level of copayment.

• 지역사회간호학회지
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• 제21권4호
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• pp.375-385
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• 2010

Purpose: This study examined the effects of case management (CM) for Medicaid on healthcare utilization considering the Medicaid system. Methods: Data were extracted from survey data on "Healthcare utilization and health status of Medicaid beneficiaries" conducted in 2007 and 2008 by the Ministry for Health, Welfare and Family Affairs. This study was designed to compare the effects on healthcare utilization between the CM group and the non-CM group. The subjects were 535 Type I Medicaid beneficiaries who utilized healthcare more than 365 days during 2006. Results: The outpatient days and medication days of the CM group decreased significantly more than those of the non-CM group with the copayment system. There were no significant differences of healthcare utilization between the CM group and the non-CM group with the designated doctor system. Conclusion: CM worked effectively on Medicaid beneficiaries' outpatient healthcare utilization with the copayment system. However, its effects on hospitalization, which is a major cause increasing the total expense, were not observed. Therefore, future studies are needed to develop strategies to reduce hospitalization and Medicaid beneficiaries outpatient healthcare utilization with the designated doctor system.

• 한국병원경영학회지
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• 제19권2호
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• pp.1-11
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• 2014

The purpose of this study is to investigate awareness on medical insurance on the caregivers cost for hospital administrative staff and to provide the basic data for realization of legislation. The subjects were caregivers living in Busan, the survey was conducted from February 18 to March 9, 2013, 283 except for 17 copies of non-response and error response among a total of 300 questionnaires were analyzed. As a result, To improve the quality of care services, there were 51.8% of refresher training needs in refresher training items, 72.7% in favor of premiums increases in health insurance details, as for health insurance coverage subjects, patients' income were 32.0%, copayment for caregivers cost was 20.0%, which was 42.3%. Refresher training item, premiums increases, health insurance applied subjects, variables for copayment for care fee were related to medical insurance on the caregivers cost. On legislation on the medical insurance, systematic and standardized criteria should be provided to provide standardized curriculum for caregivers, to relieve patients and guardians of economic burden for caregivers cost and offer the stability of the cost.

• 보건행정학회지
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• 제7권1호
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• pp.73-99
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• 1997

This study was carried out by using questionnaires with 126 insurance societies from Sept. 30, 1995 to Oct. 18, 1995. The primary data collected bythe survey have been significantly supplemented by secondary data obtained from sources such as health insurance statistical year books and internal data in the Ministry of Health and Wolfare. Major findings were summarized as follows: Two financial coordinating programs have significantly improved financial status of regional health insurance societies: the catastrophic program for high cost medical care that was initiated in 1991 and the program for hospitalization cost of the aged in 1995. Another finding is that there existed ambiguity and inconsistency of equity index that had been used by stabilization programs and its side effects could not be ignored. Regression analyses were made to identify factors that affect financial transfers. Inde pendent variables in the regression include utilization frequency, dependancy ration, insurance contribution per insured and medical expense per insured. All these variables were statistically significant in the equations of applying distribution rate (distribution/contribution) and transfer rate (transfer/contribution) as dependent variables. Policy suggestions for the catastrophic program for high cost medical care are modifying the definition of catastrophic case and setting the maximum amount of subsidies for each society based on distribution rates. To solve the problems of the financial coordinating program for the aged, we could consider reimbursing more than 50% of the copayment incurred by the aged 65 or more and determining the maximum amount of outpatient copayment at 10,000 Won per day or per visit for the elderly. More fundamental improvement could be made by amending the Welfare Benefit Act to establish and expand medical and welfare facilities for the elderly.

• 치위생과학회지
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• 제15권1호
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• pp.46-53
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• 2015

본 연구는 향후 건강보험 급여화 방안 마련을 위한 기초자료로 활용하고자 시행되었으며, 구강보건인력의 전문가불소도포 건강보험 급여화에 대한 인식 및 요구를 조사 분석하여 다음과 같은 결론을 얻었다. 전문가불소도포 건강보험 급여화를 찬성(적극찬성 포함)하는 치과의사, 치과위생사는 각각 92.5%, 90.8%로 나타났고, 반대(강력히 반대 포함)하는 경우는 7.5%, 9.2%로 나타났다. 구강보건인력의 전문가불소도포 건강보험 급여화에 대한 찬성 이유는 치아우식증 예방이라는 응답이 치과의사는 72.5%, 치과위생사는 72.8%로 가장 많았다. 전문가불소도포 건강보험 급여화에 대한 반대 이유는 치과의사는 수입감소(38.5%)가, 치과위생사는 치과위생사 부족으로 업무과중화(46.2%)라는 응답이 가장 많았다. 전문가불소도포 건강보험 급여화시 적절한 연령은 초 중 고등학생(8~19세)이라는 응답이 치과의사에서 43.2%, 치과위생사에서 45.7%로 가장 많았다. 전문가불소도포 건강보험 급여화시 적절하다고 생각하는 본인부담금(평균값)은 APF겔, NaF, $SnF_2$용액 도포의 경우 치과의사가 25,782원, 치과위생사는 14,282원이었고 불소바니쉬도포는 치과의사가 31,705원, 치과위생사는 17,979원이었으며, 불소이온도입법은 치과의사는 40,156원, 치과위생사는 21,210원인 것으로 나타났다. 전문가불소도포 건강보험 급여화시 급여인정 횟수에 대해 치과의사에서는 무제한 급여(37.5%)가, 치과위생사에서는 2회(31.3%)라는 응답이 가장 많았다. 전문가불소도포는 우식예방효과가 매우 크고 이로 인한 건강보험 재정 절감효과가 있을 뿐만 아니라 장기적으로 전 국민의 구강건강증진 및 삶의 질 향상에 크게 기여할 것이라 생각되므로 건강보험 요양급여에 예방치과진료 항목으로 전문가불소도포가 포함되어야 하며, 전문가불소도포 건강보험 급여화시 대상 및 본인부담금은 구강보건인력의 의견을 적극적으로 반영하여 설정되어야 할 것이다.

• 보건행정학회지
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• 제30권2호
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• pp.185-191
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• 2020

Background: From January 2018, a policy was applied to differentially apply the co-payment for medical expenses of 15,000 won or more from 30% to 10%-30% for each medical fee. This policy lowers the burden on the medical use of the elderly, and it is necessary to analyze the effect of the policy by confirming changes in medical use and supply behavior after 2 years. Methods: The National Health Insurance Service's national medical use database was used. As for the analysis method, first, the medical use and medical supply behavior change over the age of 65 years were confirmed, and second, in order to check the net effect of the policy, the 66-year-old as the experimental group and the 63-year-old as the control group were selected as the control group. The propensity score matching was performed using the variables of age, living alone, income quartile, residence, disability, chronic disease, and co-morbid disease scores, and then it was analyzed using the difference in difference analysis method. Results: The share of the number of treatments under 15,000 won decreased from 37.0% in 2017 to 20.2% in 2018, while the share of the number of treatments under 15,001-20,000 won increased from 8.0% to 22.7%. It was confirmed that the reason for the increase in the cost of treatment per treatment was the result of the increase in the amount of physical therapy and examination. As a result of the policy effect, the burden of co-payment per person was reduced, and as a result, the number of hospital visits per person and the total medical cost per person increased. Conclusion: The self-pay rate differential policy reduced the burden of medical expenses for the elderly and confirmed the increase in medical use. However, the interpretation of the increase in medical use was not able to distinguish whether the unsatisfactory medical care was satisfied or the inducement demand. Efficient allocation of resources is a more important point in the future when the super-aged society is in front. It is necessary to prepare a plan to induce rational medical use within a range that does not impair the medical accessibility of the elderly.

• 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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• 제10권1호
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• pp.57-94
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• 2000

Korea's social health insurance system was introduced in 1977, which has made a universal coverage possibly by July 1989. Korean government had pursued a single objective for the last decade to put the whole population under the coverage of medical security, and the objective was achieved within 12 years. The rapid accomplishment is primarily due to such factors as limited benefits, high copayment rate, low contributions as well as rapid economic growth. There are several sources of pressure for the implementation of social health insurance such as health professional group, labor unions, politicians, international organizations etc.. However it is important to look at the feasibility of social health insurance. Among other things, it is necessary to identify the administrative infrastructure of insurance system and to assess income for source of fund. As many developed countries, Korea began to apply health insurance to the employees of the large firms, and the expansion based on employment status. Thus the several funds system was inevitable according to the gradual expansion strategy. However many persons had criticized several funds system in respect with equity and efficiency aspects. In the short history of the Korean health insurance, whether one fund or sever or funds had been the most controversial issue. In Febrary 1999, the National Assembly passed the act of one fund system. From July 2000 separate funds will be unifed under new health insurance scheme. In this study we will analyze the policy making process on implementation, expansion and integration of health insurance system of Korea. And also analyse problems related to policy making.

• 한국병원경영학회지
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• 제15권3호
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• pp.1-16
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• 2010

As a cross-sectional study, this study was aimed to investigate and compare the job efficiency and satisfaction of nurses according to the hospital grade. Survey was conducted by mail on June 2009, and the respondents were 1,016 nurses working in 15 hospitals which are 9 high-grade general hospitals and 6 general hospitals. The percent of nurses acknowledging their hospital grades is 34.5%, and that is 20.5% at high-grade general hospitals. As the result of review of studies, it is concluded that under the circumstance that differential rates are contracted to calculate fees for hospital services and copayment of patients are according to nursing grades and hospital grades, the degree of nurses' awareness of insurance fees impact on their performance like recording of care and prescription. In order to improve nurses' performance, they need to be educated about the national insurance fee system. In hospitals with higher nursing grade and more beds, the levels of nursing quality and faithfulnes and their job satisfaction were higher. Nurses' awareness of their hospital nursing grade was related to the quality of nursing but not the faithfulness. Nurses working in higher nursing-grade hospital are more self-respect and satisfied at their jobs, and their job efficiencies are not significantly different. The current nursing fees based on the proper number of nurses per beds of nursing units should be changed to be based on the amount of job per nurse by their nursing protocol, and the nurse staffing standard should be differentiated between nursing grades. As the aspect of nursing, 24-hours patient care, it is difficult to improve nurses' job satisfaction, and in the other hand, that tends to depend on their income level. In the current circumstance, comprehensive research is required to investigate the propriety of 25% of the inpatient fees as the nursing management charge.