• 보건행정학회지
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• 제31권3호
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• pp.335-343
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• 2021

Background: The purpose of this study was to extract the major areas of interest in health insurance research in Korea, and infer policy agendas related to health insurance by analyzing research keywords. Methods: For this study, 2,590 articles were selected from among 7,459 academic papers related to health insurance published between January 1987 and December 2018, which were looked up using the Research Information Sharing Service (RISS). Keyword extraction and keyword network analysis were performed using the KrKwic, KrTitle, and UCINET software. Results: First, the number of studies in the area of health insurance continued to increase in all government terms, and it was not until after the 2000s that the subjects of health insurance researches were diversified. Second, degree centrality showed that 'medical expenditure' and 'medical utilization' were consistently high-ranking keywords regardless of the government in power. Aging and long-term care insurance-related keywords were ranked higher in the Lee Myung-bak government, Park Geun-hye government, and Moon Jae-in government. Third, betweenness centrality showed the same high ranking in key topics such as medical expenditure and medical utilization, while the ranking of key keywords differed depending on the interests and characteristics of each government policy. Conclusion: We confirm that health insurance as a research topic has been the main theme in Korean health care research fields. Research keywords extracted from articles also corresponded to the main health policies promoted during each government period. Efforts to systematically investigate policy megatrends are needed to plan adaptive future policies.

• 한국병원경영학회지
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• 제25권4호
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• pp.76-93
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• 2020

Purpose: In this study, the general characteristics of subjects who spent more than a certain amount of cost for general medical examination at the general hospital health promotion center, and the characteristics of disease, family history, and lifestyle (smoking, alcohol, physical activity, oral care) significantly differed in cost expenditure. We intend to provide basic data for establishing an appropriate marketing strategy for comprehensive examination. Method: It was conducted for users who received comprehensive checkups at a health promotion center at a general hospital in Seoul. The research data collection period is for 979 people who performed comprehensive examinations from January 2019 to December 2020. In order to carry out a comprehensive examination, a questionnaire before the examination was distributed to the subjects who visited the hospital to prepare, and the investigation was conducted in a way that the subjects of the investigation directly filled in. Results: There was a significant influence on the difference in expenditure for comprehensive examination according to the gender, age, and type of health insurance of the subject. In addition, there were significant differences in expenditure according to the presence or absence of disease and the type of family history. Weight loss, smoking history, smoking period, smoking frequency, drinking history, and drinking frequency all had significant effects on cost expenditure. Also, strength training and oral treatment management showed a significant effect on the cost of comprehensive examination. The number of flossing and interdental brushing was also found to have a significant effect. According to the results of multiple regression analysis, disease history (t=2.683, p<.01) and mean smoking frequency (t=4.315, p<.001) appeared to have the most significant effect on expenditure statistically. In other words, when the subject has a history of disease and when the average number of smoking is large, it means that the comprehensive examination cost is remarkably large. Conclusion: By using these contents, hospitals can further refine the marketing of the examination center. In addition, a more convenient and specialized process should be used by patients by linking the general medical department and the examination center well. In terms of management of operating medical institutions, this can be expected to create patients and increase profits.

• 한국사회복지학
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• 제48권
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• pp.150-178
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• 2002

The elderly have higher potential for contracting chronic diseases and suffering from development of a complication. Also, the extended old age period leads the elderly to demand more medical services. All those facts indicate that the elderly need more medical services than any other age groups. Consequently, medical care for the elderly with chronic diseases causes high costs burden. However, there is few studies researching the financial burden of chronic illness of the elderly. This study aimed to 1) understand how much the elderly with chronic diseases pay for medical expenses; 2) find out some specific factors related to health care financial burden; 3) suggest the alternative policies to decrease excessive financial burden of caring for the elderly with chronic illness. National Health and Nutrition Survey, which was surveyed by the Korea Institute for Health and Social Affairs in 1998, was used in this study. 4,707 persons with chronic diseases out of 5385 persons over age 60 were selectively sampled. Using SPSSWIN, correlation analysis, T-test, ANOVA and Regression were used as statistical methods in this study. Stepwise multiple regression was employed to analyze the data with a ratio of health care expenditure to income(financial burden) as a dependent variable. Out of Korean old people, 87% had the chronic diseases and their health care financial burden rate showed the average of 17.9%, which meaned they expended almost 20% income to buy medical services. The variables having a great influence on financial burden were monthly income, activity, limitation and single household of an old person. The excessive financial burden was experienced by people who had more than 4 activity limitations(37.1%) and were in the lowest Income level(32.6%), and single household of an old person(31.4%). The new policies should be considered to 1) reduce the financial burden in these groups and to develop the sliced medical cost system considering the characteristics of chronic illness and income level; and 2) develop the medical management system to care for the elderly with chronic illness.

• 한국콘텐츠학회논문지
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• 제14권1호
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• pp.200-208
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• 2014

본 연구는 민간의료보험이 국민보건의료에 미친 영향과 관련된 오랜 논쟁에 관한 기존연구들을 분석하고, 논의가 부족했던 의료서비스 이용만족에 대한 영향을 확인하여 민간의료보험의 발전적 역할설정에 기여하는 데 목적이 있다. 선행연구 고찰을 통해 민간의료보험이 국민보건의료에 미친 영향을 확인한 결과 민간의 료보험 활성화가 저소득층과 건강상태가 좋지 않은 국민을 배제시키는 국민양극화를 초래할 가능성이 있고, 민간의료보험에 가입한 가입자의 의료이용량이 많아서 건강보험 추가재정지출을 유발할 가능성이 있었다. 그러나 민간의료보험이 의료서비스 질 개선과 의료소비자 만족에 기여하는지는 더 많은 연구가 필요한 상황이었다. 문헌고찰에서 연구가 미진한 것으로 확인된 민간의료보험이 소비자의 의료서비스 만족에 미치는 영향을 국민건강영양조사 자료를 통하여 확인한 결과 민간의료보험가입여부에 따라서 외래의료이용과 입원의료이용에 대한 의료서비스 만족도의 차이가 없었으며, 통계적으로 유의미한 영향관계도 없었다. 즉, 민간의료보험가입이 의료서비스 만족에 영향을 미치지 않는 것이다. 이러한 분석결과에 따라 향후 우리나라의 민간의료보험은 비급여 보충형으로 운영하는 것이 바람직할 것이다.

• 한국의료질향상학회지
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• 제22권1호
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• pp.29-37
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• 2016

Readmission which reflects capacity to manage patients and general level of medical services has been known for one of the causes of medical expenditure due to inefficient service. Compared to disease-specific readmission, hospital wide readmission (HWR) is relatively easy to understand, and has merit to get over limitation of collateral medical services assessment; therefore, a growing interest in development and usage of readmission indicator as quality of care indicator focusing on all-disease is detected. In this study, we investigate current state of risk standardized readmission rate indicator used in the United States, the United Kingdom, and Canada, and examine the considerations when using readmission rate as quality indicator in Korea. Differences in risk-adjustment methods were showed among countries. The United States do not control race not to hide socio-demographic factors on readmission. Canada shows differentiation compared to other countries about reflecting community factors. All three-countries utilize readmission rate as monitoring quality of care rather than incentives or penalty due to the fact that readmission rate could not represent the whole quality of hospital and has a limitation at controlling socio-economic factors. Therefore, for usage readmission rate as quality indicator in Korea, preparing readmission classification standard for Korean medical environment and additional methods for acquiring information by using discharge summary is need. Moreover, continued discussion with clinical specialists is needed for obtain clinical reliability and validity.

• 한국병원경영학회지
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• 제29권2호
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• pp.37-47
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• 2024

Purpose: This study aimed to determine the effect of adjusted out-of-pocket maximum rules in the 'differential co-payment ceiling', which means having a higher burden of co-payment, that expanded to the entire ceiling level in long-stay admission patients in long-term care hospitals(LTCH). Methodology: We used health insurance claim data between January 1, 2022, and December 31, 2022 received from the National Health Insurance Service. The study populations were inpatients in long-term care hospitals more than 1 days during the study period. We performed the difference in characteristics of the LTCH patient of the differential and general ceiling by the chi-square test. We estimated the change of the population, cost, and co-payments per person under the assumption of restructuring. Finding: Based on adjusted out-of-pocket maximum rules in 2023, it was expected that the number of benefits decreases at the high-income level while increasing at the low-income level. The burden of health expenditure after reimbursement of co-payment ceiling, is expected to increase by 65.1% in the highest medical necessity, whereas the low medical necessity would decreases compared to 2022. Practical Implications: The results demonstrate that the current out-of-pocket maximum rules do not reflect the needs of medical necessity. This study suggested the need to reflect the medical necessity in LTCH on the out-of-pocket maximum rules in the future.

• 동남아시아연구
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• 제28권1호
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• pp.173-218
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• 2018

본 연구는 지속가능개발목표(Sustainable Development Goals) 하에 보편적 건강보장(Universal Health Coverage) 달성을 목표로 전 국민의 건강보험 가입을 추진하고 있는 베트남의 보건의료 부문에 주목하여 보건의료 체계와 건강보험법의 개혁 과정에서 나타난 특징을 역사 문화적 맥락을 통해 파악해보고 개발의 관점에서 그 함의를 살펴보고자 한다. UHC의 세 가지 차원, 즉 인구 집단에 대한 보장성 확대, 다양한 의료서비스 제공, 그리고 재정적 보호를 기준으로 베트남 보건의료 부문의 현황을 요약하면 다음과 같이 정리할 수 있다. 첫째, 2015년 발효된 개정 건강보험법에서 가구 단위의 의무 가입과 그에 따른 건강보험료 정산 방식이 새로운 제도로 시행되고 있다는 점이다. 둘째, 1차 의료시설, 즉 사($X{\tilde{a}}$, Commune)급 단위의 보건소를 중심으로 예방 및 건강관리 서비스를 제공할 수 있는 의료 네트워크가 구축되어 있다는 점이다. 셋째, 의료보험법 및 다양한 제도 시행 이후 공공 지출이 증가하고 민간 지출이 감소하고 있지만 여전히 본인부담 의료비 지출(Out-of-Pocket Expenditure)이 많은 비중을 차지하고 있다는 점이다. 베트남의 사회건강보험 개혁은 현재 과도기이다. 따라서 베트남은 보건의료 체계와 건강보험 제도를 어떻게 구축해 나갈 것인가에 대한 문제가 더욱 중요할 수밖에 없는 시기적 상황에 당면해 있다. 제도와 체계에 대한 개발은 효율성보다는 그것을 고스란히 감당해내야 하는 주체, 즉 해당 사회의 구성원들에게 적절하고 정당한 방식으로 설계되어야 한다. 본 연구는 제도와 문화, 즉 제도를 공유하는 사회적 가치, 가족 문화 그리고 비공식적인 제도 등과의 상호작용 등으로부터 그 함의를 이끌어내고자 하였다.

• 보건행정학회지
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• 제26권4호
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• pp.305-314
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• 2016

Background: The purpose of this study is to examine the characteristics of and factors associated with long-term care (LTC) utilization under public long-term care insurance (LTCI) among end-of-life older adults in Korea. Methods: Using a 5% sample of older people aged 65 or older and their health and LTC insurance data, two-part model analyses were conducted. We compared LTC uses and their determinants during the last year of life among decedents in the year 2010 with those of survivors. We also compared the medical uses of the same sample with their LTC uses. Results: The end-of-life elderly were more likely to use LTC, and their expenditure on LTC was higher than their counterparts. Whether or not older people used LTC during their last year of life was significantly affected by age, sex, health insurance, household income, and living alone; however, LTC costs of the decedents were only affected by functional status, which may have been due to the reimbursement scheme of the current LTCI, which is mainly based on functional dependency level. For the survivors, having chronic diseases significantly increased the likelihood of LTC use, which was not the case for the decedents. End-of-life elderly with relatively low social economic status were more likely to use the LTC other than medical services, while the health conditions affected their medical uses most significantly. Conclusion: The study findings provide key information for predicting demand related to the increasing LTC needs of Korean older people at the end of life.

• 대한가정학회지
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• 제40권4호
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• pp.139-152
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• 2002

This study was performed to estimate living cost for the elderly couple living in a city in Korea. Living cost means expenditure per month for elderly couple. It was assumed that the elderly couple will need different living cost according to their circumstances. The circumstances are health status, retirement status, and the level of living they want. The subjects were the elderly couple households over the age 65 of household head. Total number of subject was 1,649 households. Used data was Annual Report surveyed by National Statistical Office on the Family Income and Expenditure. Analysis of data was done through frequency, percentage, means, median using SAS Program. The results of this study were as follows: Their standard living cost was 844,980 won by pure relative standard line and 842,300 won by quasi relative standard lines. And minimum living cost was 713,400 won by the former, by the latter was 557,600 won (3/2 of median). And abundant Living cost was 1,068,020 won by the former, by the latter 1,263,450 won. The living cost of elderly households was about 81-83%, comparing with non-elderly households. Among the item of expenditure, the proportion of housing and medical care cost was larger than any other items.

• 보건행정학회지
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• 제30권1호
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• pp.72-81
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• 2020

Background: The out-of-pocket maximum is one of the distinctive healthcare systems which sets a ceiling on co-payment in order to reduce the burden of households from the unpredictable medical expenditure. However, this leads to an increase in the demand for healthcare services especially in long-term care hospitals (LTCHs) in Korea. Methods: This study analyzed the influence factor of medical service overuse of 165,592 inpatients in LTCHs which out-of-pocket maximum is applied, by utilizing data from the National Health Insurance Service (2016). Based on Anderson Model, the medical service overuse, as a dependent variable, was defined as long-stay admission more than 180 days at the LTCHs. Independent variable was comprised of predisposing factors (gender, age), enabling factors (income level, types of out-of-pocket maximum) and need factors (illness level, patient use of tertiary hospital). Results: The most powerful factor of medical service overuse in LTCHs was availability of pre-payment for the out-of-maximum (odds ratio [OR], 191.66; p<0.001). This tendency was found in high income level status (p<0.001). Furthermore, mild inpatients (OR, 1.50; p<0.001) which had no experience with the tertiary hospitals (OR, 2.06; p<0.001) were more relevant to the medical service overuse in LTCHs, compared to the severe inpatients. Conclusion: It is suggested that a separate standard of out-of pocket maximum with regards to LTCHs is required to secure the beneficial functions of long-term hospitals and prevent unnecessary financial leakage to achieve sustainable and financially sound National Health Insurance.