• Title/Summary/Keyword: coverage expansion

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Impacts of Health Insurance Coverage Expansion on Health Care Utilization and Health Status (건강보험 보장성 확대가 의료이용 및 건강수준에 미치는 영향)

  • Bae, Ji-Young
    • 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.

An Implementation Analysis of the National Health Insurance Coverage Expansion Policy in Korea: Application of the Winter Implementation Model (건강보험 보장성 확대정책의 집행분석: Winter의 정책집행모형의 적용)

  • You, Sooyeon;Kang, Minah;Kwon, Soonman
    • Health Policy and Management
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    • v.24 no.3
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    • pp.205-218
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    • 2014
  • Background: Most studies on the national health insurance benefit expansion policy have focused on policy tools or decision-making process. Hence there was not enough understanding on how policies are actually implemented within the specific policy context in Korea which has a national mandatory health insurance system with a dominant proportion of private providers. The main objectives of this study is to understand the implementation process of the benefit coverage expansion policy. Unlike other implementation studies, we tried to examine both the process of implementation and decision making and how they interact with each other. Methods: Interviews were conducted with the ex-members of the Health Insurance Policy Review Committee. Medical doctors who implement the policy at the 'street-level' were also interviewed. To figure out major variables and the degree of their influences, the data were analyzed with Winter's Policy Implementation Model which integrates the decision making and implementation phases. Results: As predicted by the Winter model, problems in the decision making phase, such as conflicts among the members of committee, lack of applicable causal theories application of highly symbolic activities, and limited attention of citizen to the issue are key variables that cause the 'implementation failure.' In the implementation phase, hospitals' own financial interests and practitioners' dependence on the hospitals' guidance were barriers to meeting the policy goals of providing a better coverage for patients. Patients, the target group, tend to prefer physicians who prescribe more treatment and medicine. To note, 'fixers' who can link and fill the gap between the decision-makers and implementers were not present. Conclusion: For achieving the policy goal of providing a better and more coverage to patients, the critical roles of medical providers as street-level implementers should be noted. Also decision making process of benefit package expansion policy should incorporate its influence on the implementation phase.

Effect of Coverage Expansion Policy for an Ultrasonography in the Upper Abdomen on Its Utilization: A Difference-in-Difference Mixed-Effects Model Analysis (상복부초음파검사 급여확대에 따른 의료이용의 변화: 이중차이 혼합효과모형 추정방법을 이용하여)

  • Son, Yena;Lee, Yongjae;Nam, Chung-Mo;Kim, Gyu Ri;Chung, Woojin
    • Health Policy and Management
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    • v.30 no.3
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    • pp.326-334
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    • 2020
  • Background: Korea has gradually expanded the coverage of medical care services in its national health insurance system. On April 1, 2018, it implemented a policy that expanded the coverage for an ultrasonography in the upper abdomen. In this study, we aimed to investigate the effect of the policy on the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals. Methods: Using the dataset of the Health Insurance Review and Assessment Service, we explored changes in the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals from July 1, 2017 to November 30, 2018 through the difference-in-difference (DID) mixed-effects-model method. Facility factor, equipment factor and personnel factors, type of hospital, the total amount of medical care expenses, and geographic region were considered as control variables. Results: On average, the utilization of the ultrasonography in the upper abdomen increased by 228% after the coverage expansion policy. However, the results of DID mixed-effects-model method analysis showed that the utilization increased by 73%. As for the number of beds, the utilization was higher with a group of 844-930, 931-1,217, and 1,218 or greater compared with a group of 843 or fewer, while the utilization of the number of ultrasonic devices was lower with a group of 45-49 compared with a group of 44 or fewer. The utilization decreased with the number of interns and the number of nurse assistants. Besides, relative to Seoul, the utilization was lower in the other metro-cities and provinces. Conclusion: The coverage expansion policy in the national health insurance system increased service utilization among people. Future research needs to investigate the degree to which such coverage expansion policy reduces the unmet medical care needs among the deprived in Korea.

Disparities in High-cost Outpatient Imaging Test Utilization between Private Health Insurance Subscribers and Non-subscribers: Changes Following the National Health Insurance Benefit Expansion Policy (민간의료보험 가입자와 미가입자 간 외래 고가영상검사 이용의 격차: 건강보험 보장성 강화 정책에 따른 변화)

  • Yukyung Shin;Young Kyung Do
    • Health Policy and Management
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    • v.33 no.3
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    • pp.325-337
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    • 2023
  • Background: While there are many studies estimating the effects of private health insurance on various types of health care utilization, few have examined how such effects change in conjunction with important policy reforms in national health insurance (NHI). This study examined how the effect of private health insurance (supplemental and fixed cash benefit) on high-cost outpatient imaging test utilization changed following the expansion of magnetic resonance imaging (MRI) coverage in 2018, which is a key example of the NHI benefit expansion policy in recent years. Methods: Data from the 2017 and 2019 Korea Health Panel Survey, which contained information about healthcare utilization before and after the expansion of MRI coverage in 2018, were used. The incremental effect of private health insurance on high-cost outpatient imaging test utilization for each period were quantified and compared, with special attention given to the type of private health insurance. Results: While people with supplemental private health insurance were more likely to use high-cost outpatient imaging tests than those without, both before and after the expansion of MRI coverage, the incremental effect increased from 1.6% points in 2017 to 2.5% points in 2019. Conclusion: Benefit expansion in NHI does not necessarily reduce disparities in the use of health care between private health insurance subscribers and non-subscribers. The results of our study also suggest that the path through which private health insurance affects healthcare utilization may not be limited to the price mechanism alone but can be more complex.

Distributed File Placement and Coverage Expansion Techniques for Network Throughput Enhancement in Small-cell Network (소형셀 네트워크 전송용량 향상을 위한 분산 파일저장 및 커버리지 확장 기법)

  • Hong, Jun-Pyo
    • Journal of the Korea Institute of Information and Communication Engineering
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    • v.22 no.1
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    • pp.183-189
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    • 2018
  • This paper proposes distributed file placement and coverage expansion techniques for mitigating the traffic bottleneck in backhaul for small-cell networks. In order to minimize the backhaul load with limited memory space, the proposed scheme controls the coverage and file placement of base station according to file popularity distribution and memory space of base stations. In other words, since the cache hit ratio is low when there is small memory capacity or widespread file popularity distribution, the base stations expand its coverage and cache different set of files for the user located in overlapped area to exploit multiple cached file sets of base stations. Our simulation results show that the proposed scheme outperforms the conventional cache strategy in terms of network throughput when there is small memory capacity or widespread file popularity distribution.

A New Health Care Policy in Korea Part 2: Expansion of Coverage by National Health Insurance on the Abdominal Ultrasound and MRI (새로운 건강보험 보장성 강화 대책 2부: 복부 초음파 및 MRI 급여 확대)

  • Min Jae Jang;Seong Jin Park
    • Journal of the Korean Society of Radiology
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    • v.81 no.5
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    • pp.1069-1082
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    • 2020
  • Coverage by National Health Insurance (NHI) was expanded in the abdominal imaging area as follows: upper abdominal ultrasound on April 1, 2018, lower abdominal ultrasound on February 1, 2019, and abdominal MRI on November 1, 2019. Many patients can benefit from the expansion of NHI coverage. Newly included diseases for NHI coverage includes liver cirrhosis, gallbladder polyps, hepatic adenoma/dysplastic nodules, pancreatic cysts, autoimmune pancreatitis and bile duct stone disease. However, the expansion of coverage made each examination more complex, including indications, follow-up strategy, the number of examination per patients, the standard images to be acquired, and the standard forms of the radiological report. Therefore, more careful consideration is mandatory when an abdominal imaging examination is prescribed and conducted.

Development of a national medium vacuum standard by static expansion method (정적법을 이용한 중진공 국가표준기 개발)

  • Hong S. S.;Lim I. T.;Shin Y. H.;Chung K. H.
    • Journal of the Korean Vacuum Society
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    • v.14 no.2
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    • pp.59-68
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    • 2005
  • We developed a national medium vacuum standard by static expansion method. A 133 Pa capacitance diaphragm gauge was calibrated and analysed according to the document of 'Guide to the Expression of Uncertainty in Measurement' of ISO. The results showed that the expanded uncertainty of $2.628\times10^{-3}$ Pa at $95\%$ confidence level and coverage factor of k=2.

Changes in dental care utilization and expenditure by the expansion policy of the health insurance coverage : Korea Health Panel Survey 2012-2016 (건강보험 보장성 확대정책에 따른 치과 이용 및 의료비 지출 변화 : 한국의료패널(2012-2016)을 이용하여)

  • Seo, Hye-Won;Kim, Young-Sil
    • Journal of Korean society of Dental Hygiene
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    • v.20 no.5
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    • pp.611-621
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    • 2020
  • Objectives: This study aimed to verify the impact of dental health care insurance coverage policy by analyzing the changes in dental care utilization and expenditures over 5 years from 2012 to 2016, when the dental health insurance coverage expansion policy was implemented. From the national cohort data collected by the Korea Health Panel Survey, a retrospective study was conducted for all household members using dental services. Methods: This study statistically verified the difference in the dependent variables by frequency analysis, chi-square test, t-test, and one-way analysis of variance (SPSS version 22, IBM Co. USA, p<0.05). Results: The annual utilization rate steadily increased from 23.4% to 26.1% between 2012 and 2016. Although there were differences in utilization rates by gender, age, and income level, patients kept using the dental services in 2016 regardless of the type of health insurance. The average annual copayment for patient expenditures (out-of-pocket amount) increased from ₩463,844 to ₩537,401 in 2012 and 2016, respectively. Of the dental care expenditures over 5 years, the ratio of uninsured expenses by the elderly decreased from 38.5% to 25.9%, and the national health insurance service coverage increased from 40.3% to 49.1%. Conclusions: Although this policy did not reduce overall patient expenditures, it has been found that there was a positive effect on the elderly and low-income groups; it increased the utilization and access to dental services.

Relationships among a Habitat-Riparian Indexing System (HIS), Water Quality, and Land Coverage: a Case Study in the Main Channel of the Yangsan Stream (South Korea)

  • Jeong, Kwang-Seuk;Kim, Dong-Kyun;Hong, Dong-Kyun;Choi, Jong-Yun;Yoon, Ju-Duk;Joo, Gea-Jae
    • Korean Journal of Ecology and Environment
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    • v.42 no.4
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    • pp.502-509
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    • 2009
  • In this study a total of 27 stream sites, at 1 km intervals, were monitored for simple physicochemical water characteristics, land coverage patterns, and stream environment characteristics using the Habitat-riparian Indexing System (HIS), in the Yangsan Stream. The HIS has been tested in previous research, resulting in some identification of advantages in the application to the stream ecosystems data. Even though reliable stream environment characterization was possible using HIS, there was no information about the application of this tool to present continuity of environmental changes in stream systems. Also the necessity was raised to compare the results of HIS application with land coverage information in order to provide useful information in management strategy development. The monitoring results of this study showed that changes of environmental degradation were well represented by HIS. Especially, stream environment degradation due to construction was relatively well reflected in the HIS monitoring results, and the main causality of Yangsan Stream degradation was expansion of the urbanized area. In addition, there were significant relationships between the HIS scores and land coverage information. Therefore, it is necessary to prepare appropriate options in controlling or managing the expansion of the industrialized areas in this stream basin in order to improve the stream environment. For this purpose, ensemble utilization of HIS results, water quality, and geographical information, resulting in integration with remote sensing processes can be possible.

Implementation of VLC Relay Module to Improve Communication Disconnection Phenomenon and Coverage Expansion in Non-Line-of-Sight Area (비가시선 영역의 통신 단절 현상 개선과 커버리지 확장을 위한 VLC 릴레이 모듈 구현)

  • Lee, Sang-gwon;Lee, Dae-hee;Oh, Chang-heon
    • Journal of the Korea Institute of Information and Communication Engineering
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    • v.22 no.1
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    • pp.140-146
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    • 2018
  • Recently, VLC(Visible Light Communication) fusing with LED(Light Emitting Diode) used in indoor lighting and wireless communication technology has attracted attention. However, the VLC can communicate only within the coverage to measure the optical signal and the communication disconnection phenomenon is occur in the NLoS(Non-Line-of-Sight) area. In this paper, we propose VLC relay module to extend the coverage of VLC and improve the communication disconnection phenomenon in NLoS area. The proposed VLC relay module transmits the packet received from the transmitter to the VLC relay module and receiver. The experiment was carried out by installing one VLC transmitter and three VLC relay modules, communication coverage expansion and the improvement of communication disconnection phenomenon in the NLoS were confirmed by the increase of the VLC relay module. Also, we confirmed that the optical signal measurement performance is improved 2.4 times by using the dual sampling method.